MRI's Role In The Prognosis Of Cervical Spinal Cord Injury Without Fracture And Dislocation

Cervical spinal cord injury without fracture and dislocation, also named Spinal cord injury without radiology abnormality (SCIWRA),indicate special spinal cord injury with significant clinic symptoms buy without fracture and dislocation observed by common X-ray or CT examination. SCIWRA happened in cervical spinal cord mostly. Before MRI being used, SCIWRA was only a presumption for no observed fracture or dislocation by X-ray examination. No correct treatment has been taken for SCIWRA and there was not an objective standard to decide weather to take operation or not. Here we studied the treatment, efficiency and prognosis of SCIWRA according to its MRI results.We collected 35 SCIWRA cases that were be treated in the Third Hospital of Jilin University and showed no fracture or dislocation by X-ray film. All cases have the history of hyperextension injury of cervical spinal cord. The causes include tumble 12 cases (34.3%), traffic accident 18 cases (51.4%), falling from high place 5 cases (14.3%). 11 cases among them are cervical flexion injury and 24 cases are hyperextension injury. All the cases have been examined by X-ray film and MRI. There was no fracture and dislocation but degeneration of cervical vertebrae on X-ray films. MRI examination includes routine anteroposterior and axial view, T1 and T2 weighed image scanning. Among them, 4 cases has ossification of posterior longitudinal ligament,ossification involved C3-C5; 19 cases has cervical intervertebral hernia and abnormal signal of spinal cord. 12 cases have only 1 intercalated disc hernia, and 5 cases have 2 intercalated disc hernia. 12 cases have no intervertebral hernia but abnormal signal of spinal cord. The patients have been classified according to Frankel spinal cord classification and improved Frankel spinal cord classification. Among 35 cases, 2 cases are Franke A, 15 cases are Franke B, 11 cases are Franke C and 7 cases are Franke D. According to Yamashita classification, based on the T1/T2 signal intensity (N, Low and Hi), patients can be classified to 4 types: Type 1, both T1 and T2 are N signals; Type 2: T1 is N signals and T2 is Hi signals; T3: T1 is Low signals and T2 is Hi signals; Type 4: Both T1 and T2 are Hi signals. According to the MRI results, 4 cases are Type 1, 21 cases are Type 2, 9 cases are Type 3 and 1 case is Type 4. 31 of 35 cases have been taken operation on as treatment. Anterior cervical decompression combined with bone grafting has been taken on 13 cases. Posterior cervical spine canal open-door laminoplasty were taken on 15 cases. 3 cases were treated with both. Most of patients have degeneration and damage of intercalated discs. 11 cases have longitudinal ligament rupture. 18 cases obvious spinal cord compression caused by intercalated discs hernia, ossification of posterior longitudinal ligament and flaval ligaments hypertrophy. All these compressions were relieved. The follow-up visit of 35 cases we studied has been made. The periods differ from 3 month to 25 month, 6 month averagely. No graft loosening, falling or breakage happened in patients treated with anterior cervical decompression combined with bone grafting. Patients treated with posterior cervical spine canal open-door laminoplasty did not show close-door, and no instability has been found in broad decompression. Only 5 cases didn't recovery obviously and all the others got recovery at different level.We have found pathological changes characteristic with intraspinal cord hematoma in a few cases in the case group we studied. Acute central spinal cord injury was often caused by hyperextension injury of cervical spinal cord for excessive diminish of sagittal diameter of vertebral canal. The case group we studied showed obvious spinal cord swelling and almost loss of reserved gap of vertebral canal by MRI.According to patients'nerve system symptom, identification of damage location by CT and MRI examination, corresponding operation should be taken. These patients'symptoms being worse or recovered temporally then worse, compression can be found by imaging examination and keep exist. That's the sign for operation and the operation should be taken as soon as possible. The compression of the spinal cord can cause ischemia, hypoxia, hydropsia and congresion, and will aggravate the injury of spinal cord. The early relief of compression at spinal cord can improve the local blood supply, eliminate edema, and improve the spinal injury, furthermore promote the recovery of spinal cord function. Most of the SCIWRA patients recovered after operation. The recovery sequence of the body is lower limbs, bladder function, upper limbs and hand. This might be related with damage of motor neuron of cornu anterius medullae spinalis. For patients with intervertebral disk hernia and compression of spinal cord, good prognosis can be got after operation for decompression. All the patients has II-III level recovery by Frankel classification. However, the recovery of the patient with spinal cord edema or hemorrhage is not good, especially for the patients with intramedullary hemorrhage. This result is identical with reports abroad. Above all, good prognosis of the SCIWRA patients can be got by early operation treatment.In the study of Yamashita typing of the MRI result of these patients, we found that in the acute period of the spinal cord injury, clinic symptoms of type 1 (N/N) was gentle and prognosis is best. Type 2 (N/High) was worse in clinic symptoms and prognosis is moderate. Type 3 (Low/High) was very serious. Most patients are almost paraplegia and only a few just has limb debility and numbness. Type 4 (High/High) was worst clinically, and patients have palsy absolutely. The prognosis of this type is worst.Above all, MRI is an important method to diagnosis the SCIWRA. Decompression by operation can improve the patients'conditions and prognosis.