The optimal radiologic method for assessing spinal canal compromise and cord compression in patients with cervical spinal cord injury - Part I: An evidence-based analysis of the published literature

Study Design. An evidence-based analysis of published radiologic criteria f or assessing spinal canal compromise and cord compression in patients with acute cervical spinal cord injury. Objectives. This study was conducted to determine whether literature-based guidelines could be established for accurate and objective assessment of sp inal canal compromise and spinal cord compression after cervical spinal cor d injury. Summary of Background Data. Before conducting multicenter trials to determi ne the efficacy of surgical decompression in cervical spinal cord injury, r eliable and objective radiographic criteria to define and quantify spinal c ord compression must be established. Methods. A computer-based search of the published English, German, and Fren ch language literature from 1966 through 1997 was performed using MEDLINE ( U. S. National Library of Medicine database) to identify studies in which c ervical spinal canal and cord size were radiographically assessed in a quan titative manner. Thirty-seven references were included for critical analysi s. Results. Most studies dealt with degenerative disease, spondylosis and sten osis; only 13 included patients with acute cervical spinal cord injury. Sta ndard lateral radiographs were the most frequent imaging method used (23 st udies). T1- and T2-weighted magnetic resonance imaging were used to assess spinal cord compression in only 7 and 4 studies, respectively. Spinal cord size or compression were not precisely measured in any of the cervical trau ma studies. Interobserver or intraobserver reliability of the radiologic me asurements was assessed in only 7 (19%) of the 37 studies. Conclusions. To date, there are few quantitative, reliable radiologic outco me measures for assessing spinal canal compromise or cord compression in pa tients with acute cervical spinal cord injury.