Extent of intramedullary short tau inversion recovery signal change predicts traumatic cervical spinal cord injury outcomes in surgically treated older adults: a multicenter study in Japan.
retrospective_cohort · Level III
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- Record sourced from PubMed, PMID 42419916.
- Also identified by DOI 10.31616/asj.2025.0748.
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Abstract
A retrospective multicenter study. To determine whether the extent of intramedullary hyperintensity on initial fat-suppressed short tau inversion recovery (STIR) magnetic resonance imaging (MRI) predicts neurological outcomes in elderly patients with traumatic cervical spinal cord injury (CSCI) undergoing surgery. Prognostic stratification in elderly patients with CSCI remains challenging because neurological recovery varies widely. Studies focusing exclusively on surgical populations evaluating imaging predictors-particularly STIR signal changes-are limited. We retrospectively reviewed patients aged ≥65 years with traumatic CSCI treated at 33 institutions. All patients underwent surgery. Based on initial STIR MRI findings, patients were categorized as H0 (no intramedullary signal change), H1 (single-level change), or H2 (multilevel change). Neurological status was evaluated using the American Spinal Injury Association Impairment Scale (AIS) at injury and final follow-up. A good outcome was defined as AIS grade D/E at follow-up without deterioration or improvement of ≥1 AIS grade. A poor outcome was defined as AIS grade C or worse without improvement. After excluding cases with missing data, inverse probability of treatment weighting (IPTW) was applied for multivariate adjustment in 622 patients (H0=132, H1=350, H2=140). Good outcomes were observed in 92% of H0, 80% of H1, and 68% of H2. Compared with H0, both H1 and H2 were independently associated with higher odds of poor outcomes (IPTW-adjusted odds ratio: 2.4 for H1 vs. H0 and 3.2 for H2 vs. H0). In surgically treated elderly patients with traumatic CSCI, the presence of intramedullary STIR hyperintensity at presentation-particularly across multiple levels-was strongly associated with poorer neurological recovery. The extent of STIR signal change may aid initial risk stratification and clinical decision-making.