Investigative Magnetic Resonance Imaging

Korean Society of Magnetic Resonance in Medicine (대한자기공명의과학회)
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The Secondary Contiguous or Non-contiguous Subchondral Bone Impactions in Subaxial Cervical Spinal Injury: Incidence and Associated Primary Injury Patterns

축추이하 경추 손상에서 이차적으로 발생하는 연속적, 비연속적 연골하골 압박손상의 빈도와 원발부위 손상 패턴

  • Han, Jun Gu (Department of Radiology, Inha University Hospital) ;
  • Kim, Yeo Ju (Department of Radiology, Inha University Hospital) ;
  • Yoon, Seung Hwan (Department of Neurosurgery, Inha University Hospital) ;
  • Cho, Kyu Jung (Department of Orthopedics, Inha University Hospital) ;
  • Kim, Eugene (Department of Radiology, Inha University Hospital) ;
  • Kang, Young-Hye (Department of Radiology, Inha University Hospital) ;
  • Lee, Ha Young (Department of Radiology, Inha University Hospital) ;
  • Cho, Soon Gu (Department of Radiology, Inha University Hospital) ;
  • Kim, Mi Young (Department of Radiology, Inha University Hospital)
  • Received : 2014.07.17
  • Accepted : 2014.09.03
  • Published : 2014.09.30
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Abstract

Purpose : To evaluate the incidence of secondary contiguous or non-contiguous subchondral bone impactions (SBI) in subaxial cervical spinal injury and associated primary injury patterns. Materials and Methods: A retrospective review of computed tomography, magnetic resonance imaging, and medical records was carried out for 47 patients who had sustained a subaxial cervical spinal injury. Presence, number, level, and sites of secondary contiguous or non-contiguous SBI were recorded. To evaluate primary injury patterns, the level and number of primary injury sites of subaxial cervical spine injury, injury morphology, anterior/posterior discoligamentous complex (ADC/PDC) injury, posterior ligamentous complex (PLC) injury, spinal cord injury, and mechanism of injury (MOI) were analyzed. Differences in primary injury pattern of subaxial cervical spine injury and MOI between patients with and without SBI, and between contiguous or non-contiguous SBI were analyzed using the Mann-Whitney U test, Pearson's chi square test and Fisher's exact test. Results: Eighteen patients (18/47, 38.29%) had developed contiguous (n=9) or non-contiguous (n=9) SBI, most commonly involving T3 (15/47, 31.91%) and 3 levels (6/18, 33.33%). All SBIs had developed near the anterosuperior region of the body and the superior endplate and were the result of a high-impact MOI. SBIs were statistically significant in association with injury morphology and PLC injury (P=0.001, P=0.009, respectively) at the primary injury site. Non-contiguous SBI was more frequently accompanied by upper cervical spinal injuries in association with PDC injuries, as opposed to contiguous SBI, with statistical significance (P=0.009), while no other statistically significant differences were found. Conclusion: Secondary SBIs are common and probably associated with subaxial cervical spinal injuries with high energy compressive flexion forces.

목적: 축추이하 경추 손상시 발생하는 연속적, 비연속적 연골하골 압박손상의 빈도와 원발부위 손상 패턴에 대해 알아보고자 하였다. 대상과 방법: 축추이하 경추 손상이 있는 환자 47명의 전산화 단층촬영, 자기공명영상, 의무기록을 후향적으로 검토하여 연속적, 비연속적 연골하골 압박손상의 발생유무와 수, 레벨, 손상 부위를 기록하였다. 원발부위 손상 패턴을 알아보기 위하여 손상된 원발부위의 레벨, 수, 손상 형태, 전/후방 추간판인대복합체의 손상유무, 후방인대복합체의 손상유무, 척수 손상유무를 분석하고 손상 기전을 분석하였다. 분석된 원발손상 패턴과 손상기전은 Mann-Whitney U test, Pearson's chi square test, Fisher's exact test의 통계적 기법으로 연골하 압박손상의 발생유무와 연관성을 조사하였다. 결과: 총 18명에게서 (18/47, 38.29%) 연골하 압박손상이 발생했으며 그 중 9명은 원발부위와 인접하여 연속적으로, 다른 9명은 원발부위와 떨어져 비연속적으로 발생하였다. 3번 흉추에 가장 흔하게 발생하였고 (15/47, 31.91%), 세 개의 레벨에 걸쳐있는 경우가 가장 많았다 (6/18, 33.33%). 모든 연골하 압박손상은 척추체의 전상방 부위나 상종판 주변에 발생하였으며 강한 외력의 외상과 연관되었다. 연골하 압박손상의 발생은 원발부위의 손상형태와 후방인대복합체의 손상과 통계학적으로 유의한 연관성을 보였다. 비연속적 연골하 압박손상은 연속적 연골하 압박손상에 비해 비교적 상부 경추에 원발 손상부위가 있고 후방추간판인대 복합체의 손상을 동반하는 경우가 통계학적으로 유의하게 많았다. 그외 분석한 다른 인자들은 통계학적으로 유의한 결과를 보이지 않았다. 결론: 이차성 연골하 압박손상은 흔하며 강한 외력에 의한 굴곡압박성 경추 외상과 관련 있을 것이다.

Keywords

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