The Relationship between the Functional Abilities of Patients with Cervical Spinal Cord Injury and the Severity of Damage Revealed by MR Imaging
Adam E. Flanders,a,
Claire M. Spettella,
David P. Friedmana,
Ralph J. Marinoa and
Gerald J. Herbisona
a From the Departments of Radiology (A.E.F., C.M.S., D.P.F.) and Rehabilitation Medicine (R.J.M., G.J.H.), Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia.
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FIG 1. Method for locating the level of injury on sagittal MR images. Locations are named for the nearest vertebral segment. Each segment is subdivided into three parts: the upper half of the vertebral body, the lower half of the vertebral body, and the intervertebral disk below the named body. In the example shown, the edema spans two segments between the C4 and C5 intervertebral disk (designated C4.3) to the upper half of C6 (designated C6.1). The hemorrhagic center of the injury spans one segment corresponding to the lower half of the C5 vertebral body (designated C5.2). Reprinted with permission from (12)
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FIG 2. Effect of spinal cord hemorrhage on change in mean self-care subscore between admission to and discharge from rehabilitation. Two-way interaction, F (1.45) = 10.01; P < .0028
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FIG 3. Effect of spinal cord hemorrhage on change in mean mobility subscore between admission to and discharge from rehabilitation. Two-way interaction, F (1.45) = 7.74; P < .0079
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FIG 4. Poor recovery from a high-cervical hemorrhagic lesion in a 62-year-old woman with a C4 neurologic level injury (ASIA grade A) sustained after a fall. A T2-weighted midsagittal image (2000/102; ETL, 8) shows a focus of intramedullary hemorrhage (arrow) surrounded by edema centered at the C3–C4 level. The total FIM score obtained at admission was 13 (subscores: self-care = 6, sphincter control = 2, mobility = 3, locomotion = 2). There was no improvement at discharge from rehabilitation. The presence of frank hemorrhage within the lesion and the high cervical location are indicative of a poor recovery
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FIG 5. Average task scores by category obtained at admission to rehabilitation for patients with and without spinal cord hemorrhage. The values shown represent the mean value of the individual items (tasks) that are used to derive the motor scale. Each task is rated on a 7-point scale, ranging from 1 (indicating the need for maximal assistance from a helper or a device to complete the task) to 7 (indicating an ability to perform the task independent of another person or a device)
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FIG 6. Average task scores by category obtained at discharge from rehabilitation for patients with and without spinal cord hemorrhage. The values shown represent the mean value of the individual items (tasks) that are used to derive the motor scale. Each task is rated on a 7-point scale, ranging from 1 (indicating the need for maximal assistance from a helper or a device to complete the task) to a score of 7 (indicating an ability to perform the task independent of another person or a device)
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FIG 7. Moderate recovery associated with a nonhemorrhagic, low-cervical lesion in a 24-year-old man with a C4 neurologic level injury (ASIA grade B) sustained after a diving accident. T2-weighted midsagittal image (2000/85; ETL, 8) shows a long segment of spinal cord edema with an epicenter at the fractured C5 vertebral body (arrow). The total motor FIM scores were 16 at admission to and 27 at discharge from rehabilitation. The changes in FIM subscores between admission and discharge were as follows: self-care, from 9 to 14; sphincter control, from 2 to 2; mobility, from 3 to 4; and locomotion, from 2 to 7. The lower level of the lesion and the lack of hemorrhage accounts for the clinical improvement.FIG 8. Marked recovery associated with a minor amount of SCI in a 61-year-old man with a C5 neurologic level injury (ASIA grade C) sustained after a motor vehicle accident. Midsagittal, T2-weighted image (2000/102; ETL, 8) shows a spondylitic disk herniation compressing the spinal cord at C6–C7. There is minimal spinal cord edema (arrow) and no evidence of parenchymal hemorrhage. The total motor FIM scores were 23 at admission to and 59 at discharge from rehabilitation. Improvement was noted in all subscores: self-care, from 13 to 35; sphincter control, from 2 to 10; mobility, from 6 to 11; and locomotion, from 2 to 3. The minimal amount of cord injury and the low cervical location account for the large improvement in FIM scores
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