Impact of Baseline Magnetic Resonance Imaging on Neurologic, Functional, and Safety Outcomes in Patients With Acute Traumatic Spinal Cord Injury

Authors

Shekar N. Kurpad, Medical College of WisconsinFollow
Allan R. Martin, University of Toronto; Toronto Western HospitalFollow
Lindsay A. Tetreault, Toronto Western HospitalFollow
Dena J. Fischer, Spectrum Research, Inc
Andrea C. Skelly, Spectrum Research, Inc
David J. Mikulis, University of Toronto; Toronto Western Hospital
Adam E. Flanders, Thomas Jefferson UniversityFollow
Bizhan Aarabi, University of Maryland, BaltimoreFollow
Thomas E. Mroz, Cleveland Clinic
Eve Tsai, Ottawa Hospital Research Institute; University of OttawaFollow
Michael G. Fehlings, University of Toronto; Toronto Western HospitalFollow

Document Type

Article

Publication Date

9-1-2017

Comments

This article has been peer reviewed. It is the author’s final published version in Global Spine Journal

Volume 7, Issue 3 Supplement, September 2017, Pages 151S-174S

The published version is available at DOI: 10.1177/2192568217703666. Copyright © Kurpad et al.

Abstract

Study Design: Systematic review. Objective: To perform a systematic review to evaluate the utility of magnetic resonance imaging (MRI) in patients with acute spinal cord injury (SCI). Methods: An electronic search of Medline, EMBASE, the Cochrane Collaboration Library, and Google Scholar was conducted for literature published through May 12, 2015, to answer key questions associated with the use of MRI in patients with acute SCI. Results: The literature search yielded 796 potentially relevant citations, 8 of which were included in this review. One study used MRI in a protocol to decide on early surgical decompression. The MRI-protocol group showed improved outcomes; however, the quality of evidence was deemed very low due to selection bias. Seven studies reported MRI predictors of neurologic or functional outcomes. There was moderate-quality evidence that longer intramedullary hemorrhage (2 studies) and low-quality evidence that smaller spinal canal diameter at the location of maximal spinal cord compression and the presence of cord swelling are associated with poor neurologic recovery. There was moderate-quality evidence that clinical outcomes are not predicted by SCI lesion length and the presence of cord edema. Conclusions: Certain MRI characteristics appear to be predictive of outcomes in acute SCI, including length of intramedullary hemorrhage (moderate-quality evidence), canal diameter at maximal spinal cord compression (low-quality evidence), and spinal cord swelling (low-quality evidence). Other imaging features were either inconsistently (presence of hemorrhage, maximal canal compromise, and edema length) or not associated with outcomes. The paucity of literature highlights the need for well-designed prospective studies. © 2017, © The Author(s) 2017.

Recommended Citation

Kurpad, Shekar N.; Martin, Allan R.; Tetreault, Lindsay A.; Fischer, Dena J.; Skelly, Andrea C.; Mikulis, David J.; Flanders, Adam E.; Aarabi, Bizhan; Mroz, Thomas E.; Tsai, Eve; and Fehlings, Michael G., "Impact of Baseline Magnetic Resonance Imaging on Neurologic, Functional, and Safety Outcomes in Patients With Acute Traumatic Spinal Cord Injury" (2017). Department of Radiology Faculty Papers. Paper 50.
https://jdc.jefferson.edu/radiologyfp/50

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