Neurovascular injuries of the spinal cord

doi:10.1016/S0720-048X(02)00044-X

European Journal of Radiology

Volume 42, Issue 2, May 2002, Pages 117-126

https://doi.org/10.1016/S0720-048X(02)00044-X Get rights and content

Abstract

Neurovascular spinal cord injuries are very prevalent and in a busy trauma center radiology practice these injuries are commonly seen. Imaging neurovascular injuries has been greatly facilitated by magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). The histopathological changes that occur with spinal cord trauma have been found to correlate well with what is seen on MRI examinations. The MRI findings in spinal cord trauma have also been found to be useful in determining patient prognosis. Spinal cord infarcts due to arterial injury from trauma are relatively rare, but it has been shown by imaging that vertebral artery injuries are not an unusual occurrence. The specific findings associated with neurovascular injuries will be described with an emphasis on the findings on MRI and MRA examinations. MRI and MRA techniques have become the procedure of choice for evaluating neurovascular injuries because of their proven accuracy and because they are non-invasive. Conventional angiography, although, does remain quite useful for evaluating arterial injuries.

Introduction

The evaluation of neurovascular injuries due to spinal trauma was revolutionized with the introduction of magnetic resonance imaging (MRI). MRI allows for a very sensitive in-vivo analysis of the internal status of the spinal cord in trauma patients [1], [2], [3], [4], [5], [6]. MRI and magnetic resonance angiography (MRA) have dramatically facilitated the analysis of vascular injuries, particularly of the vertebral arteries, associated with spinal trauma [7], [8]. MRI is better than conventional spinal radiography, myelography, and computed tomography with or without myelography for demonstrating the soft tissue injuries that occur in spinal trauma.

Section snippets

Pathological changes of acute spinal cord injury

The pathological changes of traumatic spinal cord injuries have been thoroughly studied in humans and in animal models [9], [10], [11], [12], [13]. The early pathological changes that occur as a result of trauma in the spinal cord include edema, hemorrhage, mechanical axonal disruption, and severing of the nerve roots [9], [10], [11], [12], [13]. Traumatized nerve fibers undergo swelling, fragmentation, and disintegration of both axons and of myelin [9], [13].

Pathophysiologically different

Technical considerations

Acute spinal cord hemorrhages imaged with high field MRI (1.5 and 2.0 Tesla (T)) appear hypointense on T2-weighted images (Fig. 1a) [14], [16], [17]. Overall, at lower field strengths (≤0.5 T), blood product appearance and detection has been more variably reported than in series performed at higher field strengths. At 0.5 T acute hemorrhages have been reported to appear hyperintense and hypointense on T2-weighted images in the spinal cord [2], [19], [20], [21]. Larger hemorrhages imaged at 0.5

Spinal cord trauma in humans

The MRI findings of spinal cord injury in humans in-vivo corresponds to what is seen in animal models of spinal cord trauma. Hemorrhage and edema have been well documented in the spinal cord, and the more rarely occurring cord transection is also nicely demonstrated. Cord swelling is also shown at the regions of injury on MRI examinations. The presence of compression of the spinal cord is also well demonstrated on MRI whether it is from bone fragments, disc material, or hemorrhage. Normal

Vascular injury

The arteries that supply the spinal cord and the arteries adjacent to the spinal column are at an increased risk of injury when spinal trauma occurs. The arterial injuries associated with spinal trauma can result in devastating neurological deficits but this rarely occurs [29], [30]. It is known that the vertebral arteries are not infrequently injured due to cervical spinal trauma but that these injuries do not usually result in neurological deficits.

When the vertebral arteries are dissected or

Vertebral artery injury

The vertebral arteries are closely related to the cervical spine and this places them at particular risk of injury due to cervical spine trauma. A vertebral artery extends cranially from its origin and usually enters the transverse foramen of C6. Then the vertebral artery is nearly vertically oriented as it runs through the transverse processes of C6–C1. At C1 the artery extends posteriorly and horizontally from the transverse foramen along the posterior arch of C1 before it pierces the dura

Conclusion

MRI accurately demonstrates areas of hemorrhage and edema in the spinal cord due to traumatic injury, and the hemorrhagic component is better demonstrated at higher field strengths. The presence of hemorrhage and larger areas of edema in the spinal cord due to trauma both indicate a worse neurological outcome for a patient. Conventional angiography nicely demonstrates arterial dissections, but it is an invasive technique. MRA and MRI, which are non-invasive, can both be utilized to demonstrate

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Neurovascular injuries of the spinal cord

Abstract

Introduction

Section snippets

Pathological changes of acute spinal cord injury

Technical considerations

Spinal cord trauma in humans

Vascular injury

Vertebral artery injury

Conclusion

Clin. Radiol.

Injury

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

Am. J. Neuroradiol.

The impact of magnetic resonance on the diagnostic evaluation of acute cervicothoracic spinal trauma

Skeletal Radiol.

Acute cervical spine injuries: prospective MR imaging assessment at a level 1 trauma center

Radiology

Magnetic resonance imaging and computer tomography of acute spinal cord trauma

Clin. Orthop.

Acute cervical spine trauma: correlation of MR imaging findings with degree of neurologic deficit

Radiology

Acute spinal cord injury: MR imaging at 1.5T1

Radiology

Dissection of cranial arteries in the neck: correlation of MRI and arteriography

Neuroradiology

MRI and MR angiography of vertebral artery dissection

Neuroradiology

Experimental traumatic paraplegia: the vascular and pathological changes seen in reversible and irreversible spinal-cord lesions

J. Bone Joint Surg. Am.

Edema of the spinal cord following experimental impact trauma

J. Neurosurg.

Pathology of spinal injuries

Cent. Nerv. Syst. Trauma

Review of the secondary injury theory of acute spinal cord trauma with emphasis on vascular mechanisms

J. Neurosurg.

High-resolution magnetic resonance imaging of experimental spinal cord injury in the rat

Neurosurgery

MR imaging of acute spinal cord injury: results of an experimental study in dogs

Am. J. Neuroradiol.

MR imaging of acute spinal cord trauma

Am. J. Neuroradiol.

Histopathologic correlation of magnetic resonance imaging signal patterns in a spinal cord injury model

Spine

Hemorrhage and edema in acute spinal cord compression: demonstration by MR imaging

Radiology

Acute spinal cord injury: magnetic resonance imaging correlated with myelopathy

Br. J. Radiol.

MR imaging in acute cervical spine trauma

J. Comput. Assist. Tomogr.