IMAGING OF THE LATE SEQUELAE OF SPINAL-CO RD INJURIES

Most patients who have suffered spinal cord injuries now expect a norm al life span, so the late complications of these injuries are becoming increasingly frequent. Regular surveillance of the state of the urina ry tract and the treatment of impending, even if clinically silent, co mplications is a well-established aspect of follow-up. With an increas ing ability to diagnose and treat the neurological complications, surv eillance of the state of the spinal cord has now assumed great importa nce. Magnetic resonance imaging (MRI), or computerized tomography (CT) with myelography if MRI is contra-indicated is the method of choice a nd can demonstrate the pathology with great clarity. In most patients, midline sagittal T1 W images are sufficient for screening purposes an d for monitoring the success of treatment. Operative, imaging and post -mortem studies have shown that the two main changes that occur are: ( a) atrophic and (b) cystic - the microcystic and myxoid gel changes of myelomalacia, focal cysts and the larger, more expansive, syringomyel ia. As yet, there is no standardization of terminology to describe the various pathological and radiological states. This is critical as onl y one condition, syringomyelia, is currently amenable to definitive su rgery and without conformity, comparisons of incidence in different po pulations and assessment of the results of surgery are impossible. The published small studies of predominantly symptomatic patients at vary ing stages of chronicity give differing incidences of changes. Prelimi nary results of a surveillance MRI study of the spinal cord changes in 153 patients who had had a spinal cord injury over 20 years previousl y are presented. Atrophy was present in 62%, myelomalacia in 54%, syri ngomyelia in 22%, focal cysts in 9% and disruption in 7%.