Midsagittal Tissue Bridges as Predictors of Neurological Recovery in Traumatic Cervical Spinal Cord Injury

This study aimed to explore the relationship between intramedullary injury and midsagittal tissue bridges at the epicenter of subacute traumatic cervical spinal cord injury (SCI) and long-term clinical recovery.

Imaging and clinical data from 57 traumatic cervical SCI patients at the First Affiliated Hospital of Nanchang University were retrospectively assessed. Midsagittal T2-weighted scans at 1 month postinjury were used to quantify lesion size and tissue bridge width. Correlation analyses were performed to determine the association among tissue bridge width, lesion size, and long-term clinical recovery.

At 1 month after SCI, ventral midsagittal tissue bridges (VMTB), dorsal midsagittal tissue bridges (DMTB), and total midsagittal tissue bridges (TMTB) were associated with better American spinal injury association Impairment Scale grades at 1 year postinjury. Shorter intramedullary lesion length (IMLL) and smaller intramedullary lesion width (IMLW) were linked to better outcomes. TMTB exhibited a stronger correlation with improved American spinal injury association Impairment Scale grades compared to VMTB, DMTB, IMLL, and IMLW. Moreover, IMLL and IMLW were significantly higher, while the DMTB, VMTB, and TMTB widths were significantly lower in patients with a poor prognosis than in those with a good prognosis. Receiver operating characteristic analysis showed TMTB had better predictive performance than other measures.

The observed association between clinical prognosis and midsagittal tissue bridges underscores the clinical relevance of these structures as neuroimaging biomarkers in patients with subacute SCI. Thus, midsagittal tissue bridges may serve as promising and reliable magnetic resonance imaging biomarkers during the transition from acute to chronic phase for stratifying, treating, and evaluating patient subgroups in clinical trials.