Validation of the National Institute of Neurological Disorders and Stroke Spinal Cord Injury MRI Common Data Elements Instrument

Adolescent Idiopathic Scoliosis Minimum Data Set: Towards Standardization of Data Elements in History and Physical Examination

INTRODUCTION

Nonoperative care represents a cornerstone of adolescent idiopathic scoliosis (AIS) management, although no consensus exists for a minimal data set. We aimed to determine a consensus in critical data points to obtain during clinical AIS visits.

METHODS

A REDCap-based survey was distributed to Pediatric Orthopedic Society of America (POSNA), Pediatric Spine Study Group (PSSG), and International Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT). Respondents ranked the importance of data points in history, physical examination, and bracing during AIS visits.  Results: One hundred eighty-one responses were received (26% response rate), of which 86% were physicians and 14% were allied health professionals. About 80% of respondents worked at pediatric hospitals or pediatric spaces within adult hospitals, and 82% were academic, with the majority (57%) seeing 150+ unique AIS patients annually. Most respondents recommended six-month follow-up for patients under observation (60%) and bracing (54%). Most respondents (75%) considered family history and pain important (69%), with the majority (69%) asking about pain at every visit. Across all time points, Adam's forward bend test, shoulder level, sagittal contour, trunk shift, and curve stiffness were all considered critically important (>60%). At the first visit, scapular prominence, leg lengths, motor and neurological examination, gait, and iliac crest height were also viewed as critical. At the preoperative visit, motor strength and scapular prominence should also be documented. About 39% of respondents use heat sensors to monitor bracing compliance, and average brace wear since the prior visit was considered the most important (85%) compliance data point.

CONCLUSIONS

This study establishes recommendations for a 19-item minimum data set for clinical AIS evaluation, including history, physical exam, and bracing, to allow for future multicenter registry-based studies.

Differences between spinal cord injury and cervical compressive myelopathy in intramedullary high-intensity lesions on T2-weighted magnetic resonance imaging: A retrospective study

Increases in aging populations have raised the number of patients with cervical spinal cord injury (SCI) without fractures due to compression of the cervical spinal cord. In such patients, it is necessary to clarify whether SCI or cervical compressive myelopathy (CCM) is the cause of disability after trauma. This study aimed to clarify the differences in magnetic resonance imaging (MRI) features between SCI and CCM. Overall, 60 SCI patients and 60 CCM patients with intramedullary high-intensity lesions on T2-weighted MRI were included in this study. The longitudinal lengths of the intramedullary T2 high-intensity lesions were measured using sagittal MRI sections. Snake-eye appearance on axial sections was assessed as a characteristic finding of CCM. The T2 values of the high-intensity lesions and normal spinal cords at the first thoracic vertebra level were measured, and the contrast ratio was calculated using these values. The longitudinal length of T2 high-intensity lesions was significantly longer in SCI patients than in CCM patients. Snake-eye appearance was found in 26 of the 60 CCM patients, but not in SCI patients. On both the sagittal and axial images, the contrast ratio was significantly higher in the SCI group than in the CCM group. Based on these results, a diagnostic scale was created. This scale made it possible to distinguish between SCI and CCM with approximately 90% accuracy.

The influence of conventional T2 MRI indices in predicting who will walk outside one year after spinal cord injury

CONTEXT/OBJECTIVE

Magnetic resonance imaging (MRI) indices of spinal cord damage are predictive of future motor function after spinal cord injury (SCI): hyperintensity length, midsagittal tissue bridges, and Brain and Spinal Injury Center (BASIC) scores. Whether these indices are predictive of outdoor walking after SCI is unknown. The primary purpose was to see if these MRI indices predict the ability to walk outdoors one-year after SCI. The secondary purpose was to determine if MRI indices provide additional predictive value if initial lower extremity motor scores are available.

DESIGN

Retrospective. Clinical T₂-weighted MRIs were used to quantify spinal cord damage. Three MRI indices were calculated: midsagittal ventral tissue bridges, hyperintensity length, BASIC scores.

SETTING

Academic hospital.

PARTICIPANTS

129 participants with cervical SCI.

INTERVENTIONS

Inpatient rehabilitation.

OUTCOMES MEASURES

One year after SCI, participants self-reported their outdoor walking ability.

RESULTS

Midsagittal ventral tissue bridges, hyperintensity length, and BASIC scores significantly correlated with outdoor walking ability (R = 0.34, P < 0.001; R = -0.25, P < 0.01; Rs = -0.35, P < 001, respectively). Using midsagittal ventral tissue bridges and hyperintensity length, the final adjusted R² for model 1 = 0.19. For model 2, the adjusted R² using motor scores alone = 0.81 and MRI variables were non-significant. All five participants with observable intramedullary hemorrhage reported they were unable to walk one block outdoors.

CONCLUSIONS

The MRI indices were significant predictors of outdoor walking ability, but when motor scores were available, this was the strongest predictor and neither midsagittal tissue bridges nor hyperintensity length contributed additional value. MRI indices may be a quick and convenient supplement to physical examination when motor testing is unavailable.