Emergency magnetic resonance imaging of cervical spinal cord injuries: Clinical correlation and prognosis

OBJECTIVE: The goal of this study was to determine the prognostic and clini cal value of magnetic resonance imaging (MRI) performed within hours after cervical spinal cord injuries in human patients. METHODS: Fifty-five patients with acute cervical vertebral column and spina l cord injuries underwent MRI as part of their initial treatment at the Uni versity of Michigan Medical Center. All images were obtained within 21 hour s after injury (mean, 7.8 h) and were interpreted by an attending neuroradi ologist who was blinded to the clinical status of the patients. Neurologica l function at presentation and in long-term follow-up examinations was comp ared with MRI characteristics assessed immediately after the injury. RESULTS: The presence and rostrocaudal length of intra-axial hematoma, the rostrocaudal length of spinal cord edema, the presence of spinal cord compr ession, and spinal cord compression by extra-axial hematoma were each signi ficantly associated with poor neurological function at presentation and in long-term follow-up examinations. Although the best single predictor of lon g-term improvement in neurological function was the neurological function a t presentation, four MRI characteristics, i.e., the presence of intra-axial hematoma, the extent of spinal cord hematoma, the extent of spinal cord ed ema, and spinal cord compression by extra-axial hematoma, provided signific ant additional prognostic information. MRI data demonstrated spinal cord co mpression for 27 of 55 patients (49%), leading to emergency surgery. Among patients who underwent imaging after restoration of normal vertebral alignm ent using closed cervical traction, 13 of 26 (50%) underwent emergency surg ery for treatment of persistent, MRI-demonstrated, spinal cord compression. CONCLUSION: Emergency MRI after spinal cord injury provides accurate progno stic information regarding neurological function and aids in the diagnosis and treatment of persistent spinal cord compression after vertebral realign ment.