Clinical Outcome and Predictors of Traumatic Cervical Injury: A Prospective Observational Study.

Traumatic cervical spine injuries (CSIs) have an incidence of 1.7 to 8% among traumatic brain injury (TBI) patients and should be a pivotal part of its neurological examination. Prognosis of cervical spine insult in TBI depends on several epidemiological and clinical factors which need to be considered during the management of these injuries. This study aims to analyze the outcomes of patients with CSI and its associated predictors.  A prospective observational study was conducted among 63 patients of traumatic CSI admitted at a tertiary care center of Lucknow, Uttar Pradesh, India. All patients underwent a clinical assessment using the American Spinal Injury Association, Functional Independence Measure (FIM), and Barthel Index scoring and grading at admission, 1, and 4 months, respectively. All patients at the facility underwent magnetic resonance imaging (MRI). Midsagittal T1- and T2-weighted sequences were used to measure the degree of spinal cord injury (SCI) impairment. Patients were followed for outcome assessment.  There was a significant difference in the median values of Barthel Index and mean values of FIM preoperatively and at 4 months' follow-up. There was a significant improvement in the neurological outcome of the patients after admission, at 1, and 4 months' follow-up. Out of the 30 patients who had improvement in the neurological outcome, majority (26) had edema present in less than equal to 2 segments and this was statistically significant. The overall FIM score was significantly higher among those with ≤ 2 segment edema as compared with those with > 2 segments.  The study concludes that incomplete injury, edema on MRI imaging less than equal to 2 segments, and no listhesis are predictors of neurological and functional improvement in patients with traumatic cervical spinal injuries.