Factors affecting long-term outcome in acute cervical cord injury

Abstract

Several clinico-imageological factors affect the neurological outcome following cervical cord injury. Studying these factors is essential for predicting the outcome. Thirty-three patients with acute cervical cord injury who were treated at our institute from 2000–2003, were assessed by the American Spinal Injury Association (ASIA) scoring and magnetic resonance imaging (MRI) of cervical spine. MR patterns of cord injury and length of damage were evaluated by senior neuroradiologist. They were followed up with ASIA score at the end of one year. Four factors were analyzed for their possible influence on outcome namely age, initial neurological status, timing of surgery, MR findings. Patients were divided into groups based on the factor studied, and the improvement was compared amongst the groups. Chi Square analysis was done to study the statistical association. All patients with ASIA Grade ‘D’ improved whereas none improved in ASIA grade ‘A’. Patients with cord edema showed good recovery (52%) compared to patients with cord contusion (0%). Among the patients with cord edema, improvement was better in three or less than three segments (84.6%) compared to more than three segments (16.66%). There was no significant difference in improvements between age groups< 40 years (45%) and > 40 years (46.1%) (p>0.05). The difference in improvements between early surgery (60%) and delayed surgery (33.33%) was also not significant (p>0.05). The single most important factor, which determines the outcome, is the initial neurological status following injury. The age of the patient and the timing of surgery do not seem to influence the outcome. MRI pattern of cord edema with less than three segments has best prognosis for recovery.

Keywords

ASIA scoring - magnetic resonance imaging features - neurological outcome

• References

• 1 Bedbrook GM. The development and care of spinal cord paralysis (1918 to 1986). Paraplegia 1987; 25: 172-184
• 2 Gerhart KA. Spinal cord injury outcomes in a population based sample. J Trauma 1991; 31: 1529-1535
• 3 Lazar LB, Yarkony GM, Ortolano D, Heinemann AW, Perlow E, Lovell L. et al Prediction of functional outcome by motor capability after spinal cord injury. Arch Phys Med Rehabil 1989; 70: 819-822
• 4 ASIA/IMSOP. Standards for Neurological and Functional Classification of Spinal Cord Injury — Revised 1992. American Spinal injury association; Chicago: 1992
• 5 Silberstein M, Brian M, Tress Hennessy O. Prediction of neurologic outcome in acute spinal cord injury: The role of CT and MR. AJNR Am J Neuroradiol 1992; 13: 1597-1608
• 6 Burney RE, Maio RF, Maynard F, Karunas R. Incidence, characteristics, and outcome of spinal cord injury at trauma centers in North America. Arch Surg 1993; 128: 596-599
• 7 Lucas JT, Ducker TB. Motor classification of spinal cord injuries with mobility, morbidity and recovery rates. Am Surg 1979; 03: 151-158
• 8 Burns SP, Golding DG, Rolle Jr WA, Graziani V, Ditunno Jr JF. Recovery of ambulation in motor-incomplete tetraplegia. Arch Phys Med Rehabil 1997; 78: 1169-1172
• 9 Fine PR, Kuhleimer KV. Spinal cord injury: An epidemiological perspective. Paraplegia 1980; 17: 237-250
• 10 Alander DH, Parker J, Stauffer ES. Intermediate-term outcome of cervical spinal cord-injured patients older than 50 years of age. Spine 1997; 22: 1189-1192
• 11 Kulkarni MV, McArdle CB, Kopanicky D. et al Acute spinal cord injury: MR imaging at 1.5T. Radiology 1988; 164: 837-843
• 12 Ramon S, Dominguez R, Ramirez L. Clinical and magnetic resonance imaging correlation in acute spinal cord injury. Spinal Cord 1997; 35: 664-673
• 13 Selden NR, Douglas J, Patel N. Emergency magnetic resonance imaging of cervical spinal cord injuries: Clinical correlation and prognosis. Neurosurgery 1999; 44: 785-792
• 14 Bondurant FJ, Cotler HB, Kulkarni MV, McArdle CB, Harris JH. Acute spinal cord injury: A study using physical examination and magnetic resonance imaging. Spine 1990; 15: 161-168
• 15 Flanders CM, Spettell. Lisa M. Forecasting motor recovery after cervical spinal cord injury: Value of MR imaging. Radiology 1996; 201: 649-655
• 16 Fehlings MG, Tatter CH. An evidence based review of decompressive surgery in acute spinal cord injury: Rationale, indications and timing based on experimental and clinical studies. J Neurosurg 1999; 91: 1-11
• 17 Akmal M, Trivedi R, Sutcliffe J. Functional outcome in trauma patients with spinal injury. Spine 2003; 28: 180-185
• 18 Hall KW, Cohen ME, Wright J, Call M, Werner P. Characteristics of functional independent measure in traumatic spinal cord injury. Arch Phys Med Rehab 1999; 80: 1507-1513