Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
권호 표지
DOI QR코드

DOI QR Code

Comparison of Magnetic Resonance Imaging and Operation Waiting Times in Patients Having Traumatic Cervical Spinal Cord Injury; with or without Bony Lesions

  • Heo, Jeong (Department of Orthopedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine) ;
  • Min, Woo-Kie (Department of Orthopedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine) ;
  • Oh, Chang-Wug (Department of Orthopedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine) ;
  • Kim, Joon-Woo (Department of Orthopedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine) ;
  • Park, Kyeong-hyeon (Department of Orthopedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine) ;
  • Seo, Il (Department of Orthopedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine) ;
  • Park, Eung-Kyoo (Department of Orthopedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine)
  • Received : 2019.02.18
  • Accepted : 2019.03.25
  • Published : 2019.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: To compare the time intervals to magnetic resonance imaging (MRI) and surgical treatment in patients having traumatic cervical spinal cord injury (SCI) with and without bony lesions. Methods: Retrospectively analyzed adult patients visited Kyungpook National University Hospital and underwent surgical treatment for cervical SCI within 24 hours. The patients who were suspected of having cervical SCI underwent plain radiography and computed tomography (CT) upon arrival. After the initial evaluation, we evaluated the MRI findings to determine surgical treatment. Waiting times for MRI and surgery were evaluated. Results: Thirty-four patients were included. Patients' mean age was 57 (range, 23-80) years. Patients with definite bony lesions were classified into group A, and 10 cases were identified (fracture-dislocation, seven; fracture alone, three). Patients without bony lesions were classified into group B, and 24 cases were identified (ossification of the posterior longitudinal ligament, 16; cervical spondylotic myelopathy, eight). Mean intervals between emergency room arrival and start of MRI were 93.60 (${\pm}60.08$) minutes in group A and 313.75 (${\pm}264.89$) minutes in group B, and the interval was significantly shorter in group A than in group B (p=0.01). The mean times to surgery were 248.4 (${\pm}76.03$) minutes in group A and 560.5 (${\pm}372.56$) minutes in group B, and the difference was statistically significant (p=0.001). The American Spinal Injury Association scale at the time of arrival showed that group A had a relatively severe neurologic deficit compared with group B (p=0.046). There was no statistical significance, but it seems to be good neurological recovery, if we start treatment sooner among patients treated within 24 hours (p=0.198). Conclusions: If fracture or dislocation is detected by CT, cervical SCI can be easily predicted resulting in MRI and surgical treatment being performed more rapidly. Additionally, fracture or dislocation tends to cause more severe neurological damage, so it is assumed that rapid diagnosis and treatment are possible.

Keywords

References

  1. National Spinal Cord Injury Statistical Center. Spinal cord injury facts and figures at a glance [Internet]. Birmingham: University of Alabama at Birmingham 2016 [cited 2018 Dec 24]. Available from: https://www.nscisc.uab.edu/Public/Facts%202016.pdf.
  2. Kraus J, Silberman T, McArthur D. Epidemiology of spinal cord injury. Principles of spinal surgery. New York: McGraw-Hill;1996:41-58.
  3. Fehlings MG, Rao SC, Tator CH, Skaf G, Arnold P, Benzel E, et al. The optimal radiologic method for assessing spinal canal compromise and cord compression in patients with cervical spinal cord injury. Part II: results of a multicenter study. Spine 1999;24:605-13. https://doi.org/10.1097/00007632-199903150-00023
  4. Sekhon LH, Fehlings MG. Epidemiology, demographics, and pathophysiology of acute spinal cord injury. Spine 2001;26(24 Suppl):S2-12. https://doi.org/10.1097/00007632-200112151-00002
  5. Epstein N, Epstein JA, Benjamin V, Ransohoff J. Traumatic myelopathy in patients with cervical spinal stenosis without fracture or dislocation: methods of diagnosis, management, and prognosis. Spine 1980;5:489-96. https://doi.org/10.1097/00007632-198011000-00001
  6. Bernhardt M, Hynes RA, Blume HW, White AA 3rd. Cervical spondylotic myelopathy. J Bone Joint Surg Am 1993;75:119-28. https://doi.org/10.2106/00004623-199301000-00016
  7. Katoh S, Ikata T, Hirai N, Okada Y, Nakauchi K. Influence of minor trauma to the neck on the neurological outcome in patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine. Paraplegia 1995;33:330-3.
  8. Moiel RH, Raso E, Waltz TA. Central cord syndrome resulting from congenital narrowness of the cervical spinal canal. J Trauma 1970;10:502-10. https://doi.org/10.1097/00005373-197006000-00010
  9. Eismont FJ, Clifford S, Goldberg M, Green B. Cervical sagittal spinal canal size in spine injury. Spine 1984;9:663-6. https://doi.org/10.1097/00007632-198410000-00001
  10. Matsuura P, Waters RL, Adkins RH, Rothman S, Gurbani N, Sie I. Comparison of computerized tomography parameters of the cervical spine in normal control subjects and spinal cordinjured patients. J Bone Joint Surg Am 1989;71:183-8. https://doi.org/10.2106/00004623-198971020-00003
  11. Fehlings MG, Vaccaro A, Wilson JR, Singh A, W Cadotte D, Harrop JS, et al. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the surgical timing in acute spinal cord injury study (STASCIS). PloS One 2012;7:e32037. https://doi.org/10.1371/journal.pone.0032037
  12. La Rosa G, Conti A, Cardali S, Cacciola F, Tomasello F. Does early decompression improve neurological outcome of spinal cord injured patients? Appraisal of the literature using a metaanalytical approach. Spinal Cord 2004;42:503-12. https://doi.org/10.1038/sj.sc.3101627
  13. Lee DY, Park YJ, Song SY, Hwang SC, Kim KT, Kim DH. The importance of early surgical decompression for acute traumatic spinal cord injury. Clin Orthop Surg 2018;10:448-54. https://doi.org/10.4055/cios.2018.10.4.448
  14. Fehlings MG, Martin AR, Tetreault LA, Aarabi B, Anderson P, Arnold PM, et al. A clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on the role of baseline magnetic resonance imaging in clinical decision making and outcome prediction. Global Spine J 2017;7(3 Suppl):221S-30S. https://doi.org/10.1177/2192568217703089
  15. Bozzo A, Marcoux J, Radhakrishna M, Pelletier J, Goulet B. The role of magnetic resonance imaging in the management of acute spinal cord injury. J Neurotrauma 2011;28:1401-11. https://doi.org/10.1089/neu.2009.1236
  16. Torg JS, Pavlov H, Genuario SE, Sennett B, Wisneski RJ, Robie BH, et al. Neurapraxia of the cervical spinal cord with transient quadriplegia. J Bone Joint Surg Am 1986;68:1354-70. https://doi.org/10.2106/00004623-198668090-00008
  17. Pavlov H, Torg JS, Robie B, Jahre C. Cervical spinal stenosis: determination with vertebral body ratio method. Radiology 1987;164:771-5. https://doi.org/10.1148/radiology.164.3.3615879
  18. Aebli N, Wicki AG, Ruegg TB, Petrou N, Eisenlohr H, Krebs J. The Torg-Pavlov ratio for the prediction of acute spinal cord injury after a minor trauma to the cervical spine. Spine J 2013;13:605-12. https://doi.org/10.1016/j.spinee.2012.10.039
  19. Morishita Y, Naito M, Hymanson H, Miyazaki M, Wu G, Wang JC. The relationship between the cervical spinal canal diameter and the pathological changes in the cervical spine. Eur Spine J 2009;18:877-83. https://doi.org/10.1007/s00586-009-0968-y