scholarly journals Traumatic Cervical Cord Injury at C3–4 without Radiographic Abnormalities: Correlation of Magnetic Resonance Findings with Clinical Features and Outcome

2002 ◽  
Vol 10 (2) ◽  
pp. 129-135 ◽  
Author(s):  
M Takahashi ◽  
Y Harada ◽  
H Inoue ◽  
K Shimada
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Magnetic Resonance ◽  
Clinical Features ◽  
Cervical Spinal Cord ◽  
Magnetic Resonance Images ◽  
Clinical Severity ◽  
Neurological Involvement ◽  
Sensory Level ◽  
Cord Injury

Purpose. Clinical features and outcomes of 43 patients at the Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama, were studied prospectively. These patients were not found to have radiographic abnormalities but magnetic resonance images showed acute cervical spinal cord trauma at the C3–4 disc level. Methods. Magnetic resonance images were analysed at presentation (immediately after the injury) and subsequent follow-up visits (at subacute and chronic stages, respectively) in an attempt to correlate imaging findings to clinical features and outcomes, respectively. Results. The injury mechanism was usually a yper-extension of the cervical spine. The level of neurological involvement was assessed in 9 patients with complete tetraplegia: the motor level was C5 in 6 patients and C4 in 3, whereas the sensory level was C5 in 7 patients, C4 in one, and C3 in one. Respiratory dysfunction in patients with severe paralysis, or numb and clumsy hands in patients with incomplete paralysis were the characteristic clinical features of cervical spinal cord injury at these lesions. Three patterns of signal change on magnetic resonance images were observed in patients with spinal cord injury at C3–4. A low-intensity area on T2-weighted images in the acute stage indicated a poor prognosis, while a high-intensity area at 2 to 3 weeks after injury indicated some degree of permanent paralysis. Conclusion. The serial signal changes of magnetic resonance images and the clinical severity or outcome seemed to be well correlated.

Delayed Magnetic Resonance Imaging in Patients With Cervical Spinal Cord Injury Without Radiographic Abnormality

Spine ◽  
2016 ◽  
Vol 41 (16) ◽  
pp. E981-E986 ◽  
Author(s):  
Jun Ouchida ◽  
Yasutsugu Yukawa ◽  
Keigo Ito ◽  
Yoshito Katayama ◽  
Tomohiro Matsumoto ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Magnetic Resonance ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Resonance Imaging ◽  
Radiographic Abnormality ◽  
Cord Injury

Microcystic spinal cord degeneration causing posttraumatic myelopathy

1988 ◽  
Vol 68 (3) ◽  
pp. 466-471 ◽  
Author(s):  
Robert L. Macdonald ◽  
J. Max Findlay ◽  
Charles H. Tator
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Magnetic Resonance ◽  
Magnetic Resonance Image ◽  
Cervical Spinal Cord ◽  
Content Type ◽  
Progressive Myelopathy ◽  
Cord Injury ◽  
Posttraumatic Syringomyelia ◽  
Bull's Eye

✓ Two cases of progressive myelopathy occurring years after incomplete cervical spinal cord injury are presented. In both patients, the clinical features, as well as the “bull's-eye” appearance of the delayed computerized tomography (CT) myelography study and the circumscribed low density of the magnetic resonance image, were consistent with posttraumatic syringomyelia, but surgical exploration including intraoperative spinal sonography failed to reveal a syrinx. Although arachnoiditis was present in both patients, the striking abnormality found at surgery was the softened appearance and the microcystic degeneration of the cord. The microcystic spinal cord degeneration found in these cases represents a previously undescribed cause of late deterioration after spinal cord injury that may mimic the clinical, CT-myelographic, and magnetic resonance features of posttraumatic syringomyelia.

scholarly journals Multivariate Analysis of Acute Magnetic Resonance Imaging Predicts Neurological Improvements in Patients With Cervical Spinal Cord Injury After Early Surgical Decompression

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Tomoo Inoue ◽  
Toshiki Endo ◽  
Shinsuke Suzuki ◽  
Hiroshi Uenohara ◽  
Teiji Tominaga
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Spinal Injury ◽  
Cervical Spinal Cord ◽  
Principal Component ◽  
Surgical Decompression ◽  
Cervical Spinal Cord Injury ◽  
Cord Injury

Abstract INTRODUCTION Patients with cervical spinal cord injury (SCI) show different clinical outcomes. There is a significant association between the acute magnetic resonance (MR) imaging of cervical SCI and neurological recovery of cervical SCI. We speculated that principal component analysis (PCA), a dimension reduction procedure, would detect clinically predictive patterns in complex MR imaging and predict neurological improvements assessed by the American Spinal Injury Association Impairment Scale (AIS) and Japanese Orthopaedic Association (JOA) score. METHODS We performed a retrospective analysis of 50 patients with cervical SCI who underwent early surgical decompression less than 48 h after the trauma. We analyzed 7 types of MR imaging assessments: axial grade assessed by the Brain and Spinal Injury Center score (BASIC), longitudinal intramedurallry lesion length, spinal cord signal intensity on T1 and T2 weighted image, maximum canal compromise, maximum spinal cord compression, Subaxial Cervical Spine Injury Classification System. PCA was applied on these multivariate data to identify factors that contribute to recovery after cervical SCI following surgery. AIS conversion was evaluated at 6 mo. RESULTS Nonlinear principal component (PC) evaluation detected 2 features of MR imaging. PCA revealed PC 1 (40.6%) explaining the intramedullary signal abnormalities that were negatively associated with postoperative AIS conversion. PC2 (18.5%) suggested extrinsic morphological variables, but did not predict outcomes. The BASIC score revealed the significant overall predictive value for AIS conversion at six months (AUC 0.86). This result suggested that the intramedullary signal abnormalities reflect delayed neurological improvements even after early surgical decompressions in patients with cervical SCI. CONCLUSION PCA could be a useful data-mining tool to show the complex relationships between acute MR imaging findings in cervical SCI. This study emphasized the importance of multivariable intramedullary MR imaging as clinical outcome predictors.

Prediction of Neurological Recovery Using Apparent Diffusion Coefficient in Cases of Incomplete Spinal Cord Injury

Neurosurgery ◽  
2011 ◽  
Vol 68 (2) ◽  
pp. 329-336 ◽  
Author(s):  
Toshiki Endo ◽  
Shinsuke Suzuki ◽  
Akihiro Utsunomiya ◽  
Hiroshi Uenohara ◽  
Teiji Tominaga
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Diffusion Coefficient ◽  
Magnetic Resonance ◽  
Cervical Spinal Cord ◽  
Postoperative Recovery ◽  
Cavity Formation ◽  
Cord Injury ◽  
Apparent Diffusion ◽  
Adc Values

Abstract BACKGROUND: Magnetic resonance imaging is useful in evaluating acute spinal cord injury. Apparent diffusion coefficient (ADC) values obtained by diffusion-weighted imaging can differentiate cytotoxic edema from vasogenic edema through microscopic motion of water protons. OBJECTIVE: To determine whether ADC values in the cervical spinal cord match neurological grades and thus predict functional recovery in patients suffering from cervical spinal cord injury. METHODS: Diffusion-weighted images were obtained using 15 axial slices covering the cervical spinal cord from 16 consecutive patients. ADC values were determined for both gray and white matter. All patients were treated surgically. Patient neurological status was evaluated preoperatively and postoperatively with the Frankel classification and neurosurgical cervical spine scale. One patient had complete spinal cord injury and showed no recovery. Using 15 patients with incomplete injury, we analyzed correlations between preoperative ADC values and neurological grading, degree of postoperative recovery, or cavity formation in follow-up magnetic resonance images. For comparison, ADC values of 11 healthy volunteers were also calculated. RESULTS: There was significant correlation between ADC values and degree of postoperative recovery (P = .02). ADC values of patients showing cavity formation were significantly lower than those of patients without cavity formation (0.70 vs 0.96 × 10−3 mm2/s; P = .01). The cutoff ADC value of 0.80 × 10−3 mm2/s resulted in 75% sensitivity and 81.8% specificity for predicting cavity formation. CONCLUSION: Low ADC values in acute spinal cord injury may indicate postoperative cavity formation in the injured spinal cord and predict poor functional recovery.

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