Feasibility and Safety of Cervical Kinematic Magnetic Resonance Imaging in Patients with Cervical Spinal Cord Injury without Fracture and Dislocation

Dynamic evaluation of the cervical spine by kinematic MRI in patients with cervical spinal cord injury without fracture and dislocation

BACKGROUND

The pattern of changes in the cervical spine and the spinal cord and their dynamic characteristics in patients with cervical spinal cord injury without fracture and dislocation remain unclear. This study aimed to evaluate the dynamic changes in the cervical spine and spinal cord from C2/3 to C7/T1 in different positions by using kinematic magnetic resonance imaging in patients with cervical spinal cord injury without fracture and dislocation. This study was approved by the ethics committee of Yuebei People's Hospital.

METHODS

Using median sagittal T2-weighted images for 16 patients with cervical spinal cord injury without fracture and dislocation who underwent cervical kinematic MRI, the anterior space available for the cord, spinal cord diameter, posterior space available for the cord from C2/3 to C7/T1, and Muhle's grade were determined. The spinal canal diameter was calculated by adding the anterior space available for the cord, spinal cord diameter, and posterior space available for the cord.

RESULTS

The anterior space available for the cord, posterior space available for the cord, and spinal canal diameters at C2/3 and C7/T1 were significantly higher than those from C3/4 to C6/7. Muhle's grades at C2/3 and C7/T1 were significantly lower than those at the other levels. Spinal canal diameter was lower in extension than in the neutral and flexion positions. In the operated segments, significantly lesser space was available for the cord (anterior space available for the cord + posterior space available for the cord), and the spinal cord diameter/spinal canal diameter ratio was higher than those in the C2/3, C7/T1, and non-operated segments.

CONCLUSION

Kinematic MRI demonstrated dynamic pathoanatomical changes, such as canal stenosis in different positions, in patients with cervical spinal cord injury without fracture and dislocation. The injured segment had a small canal diameter, high Muhle's grade, low space available for the cord, and high spinal cord diameter/spinal canal diameter ratio.

Diagnostic Value of Magnetic Resonance Imaging Scan, Multislice Spiral Computed Tomography Three-Dimensional Reconstruction Combined with Plain Film X-Ray in Spinal Injuries

Objective

The main objective is to explore the diagnostic value of magnetic resonance imaging (MRI) scan, multislice spiral computed tomography (MSCT) three-dimensional reconstruction combined with plain film X-ray in spiral injuries.

Methods

By means of retrospective study, the data of 100 patients with spiral injury treated in our hospital from January 2020 to December 2021 were retrospectively analyzed, and all patients received MRI scan, MSCT three-dimensional reconstruction, and plain film X-ray examination, and by taking the operation results as the reference, the diagnostic results of different diagnostic modalities were analyzed, and the accordance rates (diagnostic result/surgical result × 100%) of the three diagnostic modalities and their combination were calculated, respectively.

Results

Among the 100 patients, 52 cases (52%) had a fracture at the anterior column of the spine, 28 cases (28%) had a fracture at the middle column of the spine, and 20 cases (20%) had a fracture at the posterior column of spine; 24 cases (24%) had simple flexion compression fracture, 60 cases (60%) had burst fracture, 6 cases (6%) had seat belt fracture, and 10 cases (10%) had fracture dislocation. The accordance rate of combined diagnosis for fracture site was 100%, and that for fracture type was 98.0%; MRI could visualize bone marrow injuries, ligamentous injuries, soft tissue injuries, and nerve root injuries that could not be visualized on X-ray plain films, and 3D reconstruction with MSCT could clearly demonstrate the 3D relationship of spinal fracture displacement, fracture line orientation, and spinal injury.

Conclusion

Plain film X-ray is the basic method for diagnosing spinal injuries, while MRI and MSCT have their unique advantages in this regard, and patients with a negative result of X-ray plain film can be examined by MRI and MSCT to observe the spinal injury comprehensively.

The Role of Magnetic Resonance Imaging to Inform Clinical Decision-Making in Acute Spinal Cord Injury: A Systematic Review and Meta-Analysis

The clinical indications and added value of obtaining MRI in the acute phase of spinal cord injury (SCI) remain controversial. This review aims to critically evaluate evidence regarding the role of MRI to influence decision-making and outcomes in acute SCI. A systematic review and meta-analysis were performed according to PRISMA methodology to identify studies that address six key questions (KQs) regarding diagnostic accuracy, frequency of abnormal findings, frequency of altered decision-making, optimal timing, and differences in outcomes related to obtaining an MRI in acute SCI. A total of 32 studies were identified that addressed one or more KQs. MRI showed no adverse events in 156 patients (five studies) and frequently identified cord compression (70%, 12 studies), disc herniation (43%, 16 studies), ligamentous injury (39%, 13 studies), and epidural hematoma (10%, two studies), with good diagnostic accuracy (seven comparative studies) except for fracture detection. MRI findings often altered management, including timing of surgery (78%, three studies), decision to operate (36%, 15 studies), and surgical approach (29%, nine studies). MRI may also be useful to determine the need for instrumentation (100%, one study), which levels to decompress (100%, one study), and if reoperation is needed (34%, two studies). The available literature consistently concluded that MRI was useful prior to surgical treatment (13 studies) and after surgery to assess decompression (two studies), but utility before/after closed reduction of cervical dislocations was unclear (three studies). One study showed improved outcomes with an MRI-based protocol but had a high risk of bias. Heterogeneity was high for most findings (I² > 0.75). MRI is safe and frequently identifies findings alter clinical management in acute SCI, although direct evidence of its impact on outcomes is lacking. MRI should be performed before and after surgery, when feasible, to facilitate improved clinical decision-making. However, further research is needed to determine its optimal timing, effect on outcomes, cost-effectiveness, and utility before and after closed reduction.

The Assessment of Dynamic Spinal Cord Impingement by Kinematic Magnetic Resonance Imaging in Patients with Traumatic Central Cord Syndrome

Background

There are few reports describing the imaging features of traumatic central cord syndrome (TCCS) in kinematic magnetic resonance imaging (kMRI) scans. The current study aimed to assess and characterize dynamic spinal cord impingement (DSCI) using kMRI and evaluate the risk factors for poor outcomes in patients with TCCS after surgery.

Methods

This retrospective study included 63 patients with TCCS who underwent surgery in the authors' hospital. The American Spinal Injury Association impairment scale grade and Japanese Orthopedic Association (JOA) score were collected preoperatively and at the final follow-up to assess neurological function. Patients were divided into two groups based on the JOA score (> or <50%), and clinical and radiographic evaluations were compared. The metrics examined included age at the time of surgery, gender, type of trauma, the interval from injury to surgery, surgical approach, pathological signs, range of motion, DSCI and the length of intramedullary hyperintensity signal (LIHS).

Results

There were statistical differences in the LIHS, DSCI and preoperative JOA score between good (JOA >50%; n = 50) and poor (JOA <50%, n =13) recovery patient groups (P<0.05). Logistic regression, with poor outcomes as the dependent variable, suggested independent risk associations with preoperative JOA score (P<0.05), DSCI (P<0.05) and LIHS (P<0.05).

Conclusion

kMRI can be effective for decision-making in the treatment of TCCS. The lower preoperative JOA score, longer high signal cord and higher dynamic spinal cord impingement were risk factors for poor outcomes in patients with TCCS after surgery.