Acute cervical cord injury without fracture or dislocation of the spinal column

Object. It is known that the spinal cord can sustain traumatic injury witho ut associated injury of the spinal column in some conditions, such as a fle xible spinal column or preexisting narrowed spinal canal. The purpose of th is study was to characterize the clinical features and to understand the me chanisms in cases of acute cervical cord injury in which fracture or disloc ation of the cervical spine has not occurred. Methods. Eighty-nine patients who sustained an acute cervical cord injury w ere treated in our hospitals between 1990 and 1998. In 42 patients (47%) no bone injuries of the cervical spine were demonstrated, and this group was retrospectively analyzed. There were 35 men and seven women, aged 19 to 81 years (mean 58.9 years). The initial neurological examination indicated com plete injury in five patients, whereas incomplete injury was demonstrated i n 37. In the majority of the patients (90%) the authors found degenerative change s of the cervical spine such as spondylosis (22 cases) or ossification of t he posterior longitudinal ligament (16 cases). The mean sagittal diameter o f the cervical spinal canal, as measured on computerized tomography scans, was significantly narrower than that obtained in the control patients. Magn etic resonance (MR) imaging revealed spinal cord compression in 93% and par avertebral soft-tissue injuries in 58% of the patients. Conclusions. Degenerative changes of the cervical spine and developmental n arrowing of the spinal canal are important preexisting factors. In the acut e stage MR imaging is useful to understand the level and mechanisms of spin al cord injury. The fact that a significant number of the patients were fou nd to have spinal cord compression despite the absence of bone injuries of the spinal column indicates that future investigations into surgical treatm ent of this type of injury are necessary.