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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2022; 41(03): e232-e238
DOI: 10.1055/s-0042-1748869
Original Article

Traumatic Cervical Spinal Cord Injury: Correlation of Imaging Findings with Neurological Outcome

Lesão traumática da medula espinal cervical: Correlação de achados de imagem com laudo neurológico
Shahrokh Yousefzadeh-Chabok
1   Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
2   Neuroscience Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
,
Khatereh Asadi
1   Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
3   Department of Medical Nanotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
,
Javid Jahanbakhsh
4   Department of Radiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
,
Enayatollah Homaie Rad
5   Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
,
Zoheir Reihanian
1   Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
2   Neuroscience Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
,
Morteza Modaenama
1   Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Abstracts

Background Traumatic spinal cord injury (TSCI) is extremely costly to the global health system. Due to the significant frequency rate of traumatic cervical spinal cord injuries (TCSCI), the possible association between imaging findings and clinical outcome is not yet clear. In this study, we quantified maximum spinal cord compression and maximum cord swelling following TCSCI and determined the relevance of imaging findings to clinical outcome in patients.

Materials and Methods This retrospective cohort comprises 20 patients with TCSCIs (C3-C7), classified as complete, incomplete, and no SCI, who were treated at the Poursina Hospital, Iran, from 2018 to 2020, and underwent spinal surgery. Patients with penetrating injuries and multiple trauma were excluded. Imaging findings revealing spinal cord compression, swelling, and canal stenosis, based on the American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades of patients from hospital admission (up to 48 hours after injury) and improvement of postoperative neurological symptoms (6–12 months) were evaluated.

Results Cord compression (p = 0.05) and cord swelling (p = 0.02) were significantly related to predictive neurological outcomes in all cases. Evaluation with AIS at hospital admission and at 6 to 12 months postoperatively showed significant correlation with fracture type (p = 0.05) and the longitudinal length of the intramedullary lesion (IML); p = 0.01, respectively.

Conclusion According to the results obtained in this study, it may be concluded that there is a significant association between cervical spinal cord compression and swelling, and clinical outcomes in patients with complete, incomplete, and no SCI.

Resumo

IntroduçãoA lesão traumática da medula espinal (LTME) é extremamente onerosa para o sistema de saúde global. Devido à significativa taxa de frequência de lesões traumáticas da medula espinal cervical (TCSCI), a possível associação entre achados de imagem e evolução clínica ainda não está clara. Neste estudo, quantificamos a compressão medular máxima e o edema medular máximo após TCSCI e determinamos a relevância dos achados de imagem para o resultado clínico dos pacientes.

Materiais e métodos Esta coorte retrospectiva compreende 20 pacientes com TCSCIs (C3-C7), classificados como completos, incompletos e sem LME, que foram tratados no Hospital Poursina, Irã, de 2018 a 2020, e submetidos a cirurgia da coluna vertebral. Pacientes com lesões penetrantes e politraumatismos foram excluídos. Achados de imagem revelando compressão da medula espinhal, edema e estenose do canal, com base nos graus da American Spinal Injury Association (ASIA) Impairment Scale (AIS) de pacientes desde a admissão hospitalar (até 48 horas após a lesão) e melhora dos sintomas neurológicos pós-operatórios (6-12 meses) foram avaliados.

Resultados A compressão do cordão (p ≡ 0,05( e o edema do cordão (p ≡ 0,02) foram significativamente relacionados aos desfechos neurológicos preditivos em todos os casos. A avaliação com AIS na admissão hospitalar com 6 a 12 meses de pós-operatório mostrou correlação significativa com o tipo de fratura (p ≡ 0,05) e o comprimento longitudinal da lesão intramedular (IML); p ≡ 0,01, respectivamente.

Conclusão De acordo com os resultados obtidos neste estudo, pode-se concluir que existe uma associação significativa entre compressão e edema da medula espinal cervical e desfechos clínicos em pacientes com lesão medular completa, incompleta e sem lesão medular.

Keywords

traumatic cervical spinal cord injury - imaging findings - neurological outcome

Palavras-chave

lesão traumática da medula espinal cervical - achados de imagem - laudo neurológico


Publication History

Received: 06 February 2021

Accepted: 20 December 2021

Article published online:
05 September 2022

© 2022. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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