The optimal radiologie method for assessing spinal canal compromise and cord compression in patients with cervical spinal cord injury part II: Results of a multicenter study

Michael G. Fehlings, Sanjay C. Rao, Charles H. Tator, Ghassan Skaf, Paul Arnold, Edward Benzel, Curtis Dickman, Brian Cuddy, Barth Green, Patrick Hitchon, Bruce Northrup, Volker Sonntag, Frank Wagner, Jack Wilberger

Research output: Contribution to journalArticlepeer-review

Abstract

Study Design. A multicenter, retrospective study using computed tomographic and magnetic resonance imaging data to establish quantitative, reliable criteria of canal compromise and cord compression in patients with cervical spinal cord injury. Objectives. To develop and validate a radiologie assessment tool of spinal canal compromise and cord compression in cervical spinal cord injury for use in clinical trials. Summary of Background Data. There are few quantitative, reliable criteria for radiologie measurement of cervical spinal canal compromise or cord compression after acute spinal cord injury. Methods. The study included 71 patients (55 men, 16 women; mean age, 39.7 ± 18.7 years) with acute cervical spinal cord injury. Causes of spinal cord injury included motor vehicle accidents (n = 36), falls (n = 20), waterrelated injuries (n = 8),vSports (n = 5), assault (n = 1), and farm accidents (n = 1). Canal compromise was measured on computed tomographic scan and T1- and T2-weighted magnetic resonance imaging, and cord compression at the level of maximum injury was measured on T1- and T2-weighted magnetic resonance imaging. All films were assessed by two independent observers. Results. There was a strong correlation of canal compromise and/or cord compression measurements between axial and midsagittal computed tomography, and between axial and midsagittal T2-weighted magnetic resonance imaging. Spinal canal compromise assessed by computed tomography showed a significant although moderate correlation with spinal cord compression assessed by T1- and T2-weighted magnetic resonance imaging. Virtually all patients with canal compromise of 25% or more on computed tomographic scan had evidence of some degree of cord compression on magnetic resonance imaging, but a large number of patientswith less than 25% canal compromise on computed tomographic scan also had evidence on magnetic resonance imaging of cord compression. Conclusions. In patients with cervical spinal cord injury, the midsagittal T1- and T2-weighted magnetic resonance imaging provides an objective, quantifiable, and reliable assessment of spinal cord compression that cannot be adequately assessed by computed tomography alone.

Original languageEnglish (US)
Pages (from-to)605-613
Number of pages9
JournalSpine
Volume24
Issue number6
DOIs
StatePublished - Mar 15 1999
Externally publishedYes

Keywords

  • Cervical spinal cord injury
  • Clinical trial
  • Computed tomography
  • Magnetic resonance imaging
  • Outcome measure

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

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