Chen Jin1, Lijuan Zhao1, Jinhui Wu2, Lianshun Jia2, Liming Cheng3,4, Ning Xie5. 1. Division of Spine Surgery, Department of Orthopedics, Tongji Hospital, Tongji University School of Medicine, No. 389 Xincun Road, Putuo District, Shanghai, China. 2. Department of Orthopedics, Shanghai Changzheng Hospital, Shanghai, China. 3. Division of Spine Surgery, Department of Orthopedics, Tongji Hospital, Tongji University School of Medicine, No. 389 Xincun Road, Putuo District, Shanghai, China. limingcheng@tongji.edu.cn. 4. Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration (Tongji University), Ministry of Education, Shanghai, China. limingcheng@tongji.edu.cn. 5. Division of Spine Surgery, Department of Orthopedics, Tongji Hospital, Tongji University School of Medicine, No. 389 Xincun Road, Putuo District, Shanghai, China. nxieprof18@tongji.edu.cn.
Abstract
PURPOSE: To quantify the degree of available space for the cord and cord swelling in patients following traumatic cervical spinal cord injury (TCSCI), and to assess the relationship among the available space for the cord, cord swelling, and the severity of neurological impairment. METHODS: This study included 91 patients. The following indexes were measured by two blinded observers: maximum cord available area (CAAmax) and maximum cord swelling area (CSAmax). The American Spinal Injury Association (ASIA) impairment scale (AIS) grades were used to evaluate the extent of neurological injury. Relationship among CAAmax, CSAmax, and initial AIS grades was assessed via univariate and multivariate analyses. RESULTS: Patients who were AIS grade A (complete injury) demonstrated significantly greater median CAAmax and CSAmax than AIS grade C or D (incomplete injury) (P < 0.01). Multivariate analysis identified only CAAmax (OR 20.88 [95% CI 1.50-291.21]; P = 0.024) and CSAmax (OR 17.84 [95% CI 1.15-276.56]; P = 0.039) were identified as independently influencing the likelihood of complete injury at the initial assessment. The classification accuracy was best for CAAmax and CSAmax; areas under the curve were 0.8998 (95% CI 0.7881-1.0000) and 0.9167 (95% CI 0.8293-1.0000), respectively. CONCLUSION: The present study provides a novel radiologic method for identifying the severity of TCSCI with T2-weighted MRI findings. Greater available space for the cord (CAAmax > 38%) and cord swelling (CSAmax > 29%) can be used to identify patients at risk for TCSCI and both imaging characteristics are associated with an increased likelihood of severe neurological deficits. LEVEL OF EVIDENCE: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
PURPOSE: To quantify the degree of available space for the cord and cord swelling in patients following traumatic cervical spinal cord injury (TCSCI), and to assess the relationship among the available space for the cord, cord swelling, and the severity of neurological impairment. METHODS: This study included 91 patients. The following indexes were measured by two blinded observers: maximum cord available area (CAAmax) and maximum cord swelling area (CSAmax). The American Spinal Injury Association (ASIA) impairment scale (AIS) grades were used to evaluate the extent of neurological injury. Relationship among CAAmax, CSAmax, and initial AIS grades was assessed via univariate and multivariate analyses. RESULTS: Patients who were AIS grade A (complete injury) demonstrated significantly greater median CAAmax and CSAmax than AIS grade C or D (incomplete injury) (P < 0.01). Multivariate analysis identified only CAAmax (OR 20.88 [95% CI 1.50-291.21]; P = 0.024) and CSAmax (OR 17.84 [95% CI 1.15-276.56]; P = 0.039) were identified as independently influencing the likelihood of complete injury at the initial assessment. The classification accuracy was best for CAAmax and CSAmax; areas under the curve were 0.8998 (95% CI 0.7881-1.0000) and 0.9167 (95% CI 0.8293-1.0000), respectively. CONCLUSION: The present study provides a novel radiologic method for identifying the severity of TCSCI with T2-weighted MRI findings. Greater available space for the cord (CAAmax > 38%) and cord swelling (CSAmax > 29%) can be used to identify patients at risk for TCSCI and both imaging characteristics are associated with an increased likelihood of severe neurological deficits. LEVEL OF EVIDENCE: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
Authors: M A Marciello; A E Flanders; G J Herbison; D M Schaefer; D P Friedman; J I Lane Journal: Arch Phys Med Rehabil Date: 1993-09 Impact factor: 3.966