Prediction of neurologic outcome in acute spinal cord injury: the role of CT and MR.

PURPOSE 1) To determine whether MR appearances of the spinal cord in acute trauma correlate with clinical prognosis, and 2) to identify other MR and CT prognostic factors in acute spinal trauma.

METHODS Retrospective evaluation of MR, CT, and clinical examinations in 32 acute spinal trauma patients examined between 1987 and 1990.

RESULTS All 21 patients with abnormal spinal cords on MR had complete motor paralysis at presentation, compared to only three of 11 patients with normal cords. Whereas cord transection and hemorrhagic contusion had poor prognoses, 73% of patients with cord edema and 100% of patients with normal cord had useful motor function at outcome. At follow-up MR, areas of cord contusion developed into cysts, while edema resolved, leaving residual areas of myelomalacia. Associated spinal fractures, ligament injury, and cord compression were associated (P < .05) with a worse prognosis. Spondylotic changes were a significant risk factor for spinal cord injury, mediated by cord compression.

CONCLUSIONS MR and CT are valuable techniques for quantifying injury and predicting prognosis in acute spinal trauma.