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Predicting Neurologic Recovery in Cervical Spinal Cord Injury With Postoperative MR Imaging

Boldin, Christian, MD*; Raith, Johann, MD; Fankhauser, Florian, MD*; Haunschmid, Christian, MD*; Schwantzer, Gerold, MSc; Schweighofer, Franz, MD*

doi: 10.1097/01.brs.0000201274.59427.a4

Study Design. Prospective, nonrandomized, observational cohort study.

Objectives. To determine whether the presence of spinal cord hemorrhage and length of hematoma on magnetic resonance imaging (MRI) is predictive of recovery in cervical spinal cord injury (SCI).

Summary of Background Data. A clear picture of the location, extent, and severity of traumatic cervical cord injury can be obtained with MRI. Several prognostic studies looked for an association between the degree of SCI, as depicted by MRI, and neurologic outcome. Up to now, an association between the length of hemorrhage and the extent of SCI and motor recovery could not be demonstrated.

Methods. Twenty-nine patients with acute traumatic cervical spinal cord injury underwent surgery within 2 to 9 hours. MRI was performed within 2 weeks of injury. Neurologic impairment was classified using the ASIA classification. The effects of hemorrhage and length of hematoma on changes in the neurologic impairment were assessed at time of MRI and at median follow-up in 35 months (range, 24–65 months).

Results. Patients with hemorrhage were much more likely to have a complete injury at time of follow-up (odds ratio = 2.33, 95% confidence interval, 1.42–3.82). Patients admitted with complete SCI, ASIA A, showed a median length of hematoma of 10.5 mm and a median length of edema of 66.5 mm and no change at follow-up. Patients with incomplete SCI showed a median length of hematoma of 4 mm and small edema. Presence of hemorrhage less than 4 mm was associated with good prognosis.

Conclusion. This study indicates that presence of hemorrhage of less than 4 mm was not associated with complete SCI and showed good prognosis.

The MRI pattern observed in the acute injured spinal cord has a prognostic significance in the final outcome of the motor system. Intramedullary hemorrhage was not always associated with complete lesion. Small focal hematoma of less than 4 mm is associated with incomplete lesion showing good prognosis.

From the *Department of Traumatology, †Department of Radiology, and ‡Institute for Medical Informatics, Statistics and Documentation, Medical University Graz, Graz, Austria.

Acknowledgment date: July 28, 2004. First revision date: December 14, 2004. Second revision date: March 10, 2005. Acceptance date: March 10, 2005.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Christian Boldin, MD, Medical University Graz, Department of Traumatology, Auenbruggerplatz 7a, A-8036 Graz, Austria. E-mail:

© 2006 Lippincott Williams & Wilkins, Inc.