Early MRI finding in adult spinal cord injury without radiologic abnormalities does not correlate with the neurological outcome: a retrospective study.

Abstract

Adult spinal cord injury without radiologic abnormalities (SCIWORA) is evidenced to be underreported. Some abnormalities that were not present on computed tomography (CT) were identified on magnetic resonance imaging (MRI), but the diagnostic reliability of early MRI remains considerable disagreement. The present study was retrospectively designed to assess a potential correlation between clinical and imaging findings in adults experiencing SCIWORA. A total of 2964 adult patients (age >18 or older) with acute cervical spine injury presented to the single institution between January 2009 and June 2014. Fifty-nine patients with SCIWORA were included in the study. Initial MRI findings at admission were analyzed, and a 6-month follow-up was performed. On admission, complete spinal cord injury was found in 32 patients, incomplete spinal cord injury in 20 patients and central cord syndrome in seven patients. MRI findings showed varying degrees of degenerative or spondylotic changes in 45% of the patients (n=27). The cord contusion was shown in 12 patients, cord edema in 7, cord hemorrhage in 2 and ligamentum flavum bulging in 4 patients. In all, two of these patients had no positive findings on the initial MRI, but presented with positive abnormalities on repeat MRI 72 h after trauma. At discharge, most of the patients presented with complete remission, but some of the patients presented with partial remission. After 6 months, all patients significantly improved, and only two patients did not show full recovery. Early use of MRI added little in the determination of stability of the cervical spine in the presence of a negative CT. Our study suggested that the neurological outcome did not correlate with early MRI findings.