Non-contiguous spinal injury: clinical and imaging features, and postulated mechanism

In an attempt to identify possible mechanisms for remote or non-contiguous spinal injury, clinical records and magnetic resonance (MR) images were analysed in 71 consecutive patients admitted for management of acute cervicothoracic spinal trauma. Seven patients (10%) were identified with clinical or MR evidence of non-contiguous spinal injury, and either more than one neurological level, or a cord lesion remote from the imaging abnormality. Five of these had radiographic and MRI findings suggesting that the second lesion was due to cord stretching, following local tethering at the first level, including three patients with a small extramedullary haematoma at the site of the distant cord lesion. The other two patients had underlying multilevel degenerative spinal canal stenosis, explaining the second cord lesion. Non-contiguous spinal injury is an infrequent manifestation of acute spinal trauma, and, in contrast to most forms of cord injury associated with spinal trauma, which are due to cord compression, this entity may represent the sequel of cord stretching.