Singla Navneet, Nellikoppad Hareesh Shanthappa, Latawa Archit, Ahuja Chirag Kamal
Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
J Neurosci Rural Pract. 2022 Oct-Dec;13(4):658-662. doi: 10.25259/JNRP-2021-11-26. Epub 2022 Oct 22.
Elasticity of the skeletal system in children and degenerative changes in adults are responsible for SCIWORA. The purpose of this study was to determine those degenerative changes on CT scan that predispose adults to SCIWORA, their correlation with MRI findings, clinical presentation and recovery.
This prospective study was conducted over a period of 1.5 years and 30 patients were enrolled. Apart from the demographic profile, mode of injury, clinical symptoms, ASIA at admission, X-ray, CT and MRI findings were noted. All patients were managed conservatively and were followed up after 3 months. NCCT and MRI findings were correlated with each other, with clinical presentation and with recovery. Recovery was defined as any improvement in ASIA class.
Data was collected and organized. For normally distributed data parametric test and for others non-parametric test was used. Kendall tau rank correlation coefficient was used to measure the ordinal association between two measured quantities.
28 (93.3%) patients were males and 2 (6.7%) were females. Patients with osteoporosis and/or osteophytes ( = 16) had a higher incidence of development of cord edema or non-haemorrhagic contusion ( = 15) ( = 0.028) while patients with canal stenosis and/or ligamentous calcification ( = 14) had a higher incidence of development of haemorrhagic contusion ( = 12) ( = 0.04). Patients with canal stenosis and/or ligament calcification showed significantly less recovery ( = 3) when compared with patients of osteophytes and/or osteoporosis ( = 6) ( = 0.04). Disc abnormality was seen in 1 patient only. 9 patients showed recovery and maximum recovery was seen in ASIA D ( = 4) class while no patient recovered in ASIA A class.
Osteoporosis, osteophytes, canal stenosis and ligament calcification are the factors that predispose adults to SCIWORA. The final outcome seems to be poorer in cases of canal stenosis when compared with osteophytes and osteoporosis. NCCT findings can be used as an adjunct to MRI to predict clinical presentation, severity and recovery in adult SCIWORA.
儿童骨骼系统的弹性及成人的退行性改变是儿童无放射影像异常的脊髓损伤（SCIWORA）的成因。本研究的目的是确定CT扫描上那些使成人易患SCIWORA的退行性改变、它们与MRI表现、临床表现及恢复情况的相关性。
本前瞻性研究历时1.5年，纳入了30例患者。除了人口统计学资料、损伤方式、临床症状、入院时的美国脊髓损伤协会（ASIA）分级、X线、CT及MRI表现外，所有信息均有记录。所有患者均接受保守治疗，并在3个月后进行随访。非增强CT（NCCT）和MRI表现相互之间、与临床表现及恢复情况进行了相关性分析。恢复定义为ASIA分级的任何改善。
收集并整理数据。对于正态分布的数据使用参数检验，对于其他数据使用非参数检验。肯德尔tau秩相关系数用于测量两个测量量之间的有序关联。
28例（93.3%）患者为男性，2例（6.7%）为女性。患有骨质疏松症和/或骨赘（n = 16）的患者发生脊髓水肿或非出血性挫伤（n = 15）的发生率更高（p = 0.028），而患有椎管狭窄和/或韧带钙化（n = 14）的患者发生出血性挫伤（n = 12）的发生率更高（p = 0.04）。与患有骨赘和/或骨质疏松症的患者（n = 6）相比，患有椎管狭窄和/或韧带钙化的患者恢复明显较差（n = 3）（p = 0.04）。仅1例患者出现椎间盘异常。9例患者显示恢复，ASIA D级（n = 4）恢复程度最大，而ASIA A级无患者恢复。
骨质疏松症、骨赘、椎管狭窄和韧带钙化是使成人易患SCIWORA的因素。与骨赘和骨质疏松症相比，椎管狭窄患者的最终结局似乎更差。NCCT表现可作为MRI的辅助手段，用于预测成人SCIWORA的临床表现、严重程度及恢复情况。
