Clinically complete spinal cord injury is not always anatomically complete

Area of Science:

• Neuroscience
• Radiology
• Trauma Surgery

Background:

• Traditional classification of traumatic spinal cord injury (SCI) uses the ASIA Impairment Scale (AIS) to distinguish complete from incomplete injuries.
• The correlation between clinical assessment of SCI completeness and actual anatomical integrity is often complex and misunderstood.

Purpose of the Study:

• To examine the anatomical basis of clinically complete SCI.
• To analyze MRI-detected lesion patterns in SCI.
• To discuss the clinical and therapeutic implications of clinico-radiological dissociation in SCI.

Main Methods:

• This study is a narrative review.
• It synthesizes existing literature on SCI pathology.
• It includes MRI-based lesion characterization and neurological outcome correlations.

Main Results:

• Clinically complete SCI (AIS A) does not always mean anatomical transection; MRI reveals varied lesion types like edema, contusion, and hemorrhage.
• Intramedullary hemorrhage and extensive damage correlate with poor outcomes, while edema may indicate preserved tissue.
• Neurological classification alone is insufficient for assessing SCI severity; MRI biomarkers are crucial for prognosis.

Conclusions:

• The discrepancy between clinical and anatomical findings in SCI necessitates a multidimensional assessment combining neurological exams and advanced imaging.
• This integrated approach refines prognostic accuracy and informs surgical decisions, neuroprotection, therapies, and rehabilitation for SCI.