Singh Roop, Kumar Rohilla Rajesh, Setia Nishant, Magu Sarita
Department of Orthopaedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India.
Department of Radiodiagnosis, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India.
Asian J Neurosurg. 2015 Jul-Sep;10(3):181-9. doi: 10.4103/1793-5482.161166.
The aim was to correlate the clinical profile and neurological outcome with findings of imaging modalities in acute spinal cord injury (SCI) patients.
Imaging (radiographs, computed tomography [CT], and magnetic resonance imaging [MRI]) features of 25 patients of acute SCI were analyzed prospectively and correlated with clinical and neurology outcome at presentation, 3, 6 and 12 months.
Average initial sagittal index, Gardner's index, and regional kyphosis were 8.12 ± 3.90, 15.68 ± 4.09, 16.44 ± 2.53, respectively; and at 1-year were 4.8 ± 3.03, 12.24 ± 4.36, 12.44 ± 2.26, respectively. At presentation patients with complete SCI had significantly more compression percentage (CP) (P < 0.001), maximum canal compromise (P < 0.001), maximum spinal cord compression (P < 0.001), in comparison to incomplete SCI patients. Qualitative MRI findings; hemorrhage, cord swelling, stenosis showed a predilection toward complete SCI. Improvement in canal dimensions (P = 0.001), beck index (P = 0.008), spinal cord edema (P = 0.010) and stenosis (P = 0.001) was more significant in patients managed operatively; but it was not associated with improved neurological outcome. Cord edema was found more in incomplete SCI patients. Patients presenting with complete SCI improved neurologically to a lesser extent.
The present study concludes that imaging modalities in spinal cord injuries have a major role in diagnosis, directing management and predicting prognosis. Imaging findings of severe kyphotic deformities, higher canal and cord compression, lesion length, hemorrhage, and cord swelling are associated with poor initial neurological status and recovery. Quantitative and qualitative parameters measured on MRI have a significant role in predicting initial severity of neurological status and outcome. Operative intervention helps in improving few of these imaging parameters, but not ultimate neurological outcome. MRI is an excellent modality to evaluate acute SCI, and MR images obtained in the acute period significantly and usefully predict neurological outcome.
本研究旨在探讨急性脊髓损伤（SCI）患者的临床特征、神经功能预后与影像学检查结果之间的相关性。
前瞻性分析25例急性SCI患者的影像学（X线片、计算机断层扫描[CT]和磁共振成像[MRI]）特征，并将其与患者就诊时、3个月、6个月及12个月时的临床及神经功能预后进行相关性分析。
初始矢状指数、加德纳指数及局部后凸角的平均值分别为8.12±3.90、15.68±4.09、16.44±2.53；1年后分别为4.8±3.03、12.24±4.36、12.44±2.26。就诊时，完全性SCI患者的压迫百分比（CP）、椎管最大狭窄程度、脊髓最大受压程度均显著高于不完全性SCI患者（P<0.001）。MRI定性表现；出血、脊髓肿胀、椎管狭窄多见于完全性SCI。手术治疗患者的椎管尺寸（P = 0.001）、贝克指数（P = 0.008）、脊髓水肿（P = 0.010）及椎管狭窄（P = 0.001）改善更显著；但与神经功能预后改善无关。不完全性SCI患者脊髓水肿更常见。完全性SCI患者神经功能改善程度较小。
本研究得出结论，脊髓损伤的影像学检查在诊断、指导治疗及预测预后方面具有重要作用。严重后凸畸形、较高的椎管及脊髓压迫、损伤长度、出血及脊髓肿胀等影像学表现与初始神经功能状态及恢复情况较差相关。MRI测量的定量及定性参数在预测神经功能状态及预后的初始严重程度方面具有重要作用。手术干预有助于改善部分影像学参数，但不能改善最终神经功能预后。MRI是评估急性SCI的优秀检查方法，急性期获得的MR图像能显著且有效地预测神经功能预后。
