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Abstract
Several clinico-imageological factors affect the neurological outcome following cervical
cord injury. Studying these factors is essential for predicting the outcome. Thirty-three
patients with acute cervical cord injury who were treated at our institute from 2000–2003,
were assessed by the American Spinal Injury Association (ASIA) scoring and magnetic
resonance imaging (MRI) of cervical spine. MR patterns of cord injury and length of
damage were evaluated by senior neuroradiologist. They were followed up with ASIA
score at the end of one year. Four factors were analyzed for their possible influence
on outcome namely age, initial neurological status, timing of surgery, MR findings.
Patients were divided into groups based on the factor studied, and the improvement
was compared amongst the groups. Chi Square analysis was done to study the statistical
association. All patients with ASIA Grade ‘D’ improved whereas none improved in ASIA
grade ‘A’. Patients with cord edema showed good recovery (52%) compared to patients
with cord contusion (0%). Among the patients with cord edema, improvement was better
in three or less than three segments (84.6%) compared to more than three segments
(16.66%). There was no significant difference in improvements between age groups<
40 years (45%) and > 40 years (46.1%) (p>0.05). The difference in improvements between early surgery (60%) and delayed surgery
(33.33%) was also not significant (p>0.05). The single most important factor, which determines the outcome, is the initial
neurological status following injury. The age of the patient and the timing of surgery
do not seem to influence the outcome. MRI pattern of cord edema with less than three
segments has best prognosis for recovery.
Keywords
ASIA scoring - magnetic resonance imaging features - neurological outcome
