NONCONTIGUOUS SPINAL-INJURY - CLINICAL AND IMAGING FEATURES, AND POSTULATED MECHANISM

In an attempt to identify possible mechanisms for remote or non-contig uous spinal injury, clinical records and magnetic resonance (MR) image s were analysed in 71 consecutive patients admitted for management of acute cervicothoracic spinal trauma. Seven patients (10%) were identif ied with clinical or MR evidence of non-contiguous spinal injury, and either more than one neurological level, or a cord lesion remote from the imaging abnormality. Five of these had radiographic and MRI findin gs suggesting that the second lesion was due to cord stretching, follo wing local tethering at the first level, including three patients with a small extramedullary haematoma at the site of the distant cord lesi on. The other two patients had underlying multilevel degenerative spin al canal stenosis, explaining the second cord lesion. Non-contiguous s pinal injury is an infrequent manifestation of acute spinal trauma, an d, in contrast to most forms of cord injury associated with spinal tra uma, which are due to cord compression, this entity may represent the sequel of cord stretching.