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Forecasting motor recovery after cervical spinal cord injury: value of MR imaging
A E Flanders1, C M Spettell, L M Tartaglino
1Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
Purpose:
To determine whether magnetic resonance (MR) imaging quantification of cervical spinal cord damage improves the prediction of motor recovery after spinal cord injury.
Materials And Methods:
The extent of cervical spinal cord injury was measured on MR images obtained in 104 patients (aged 17-70 years) within 72 hours of spinal cord injury. The effects of hemorrhage and edema length on motor outcome were examined for at least 12 months.
Results:
Patients with spinal cord hemorrhage had significantly lower upper and lower extremity motor scores at the time of injury and at 12 months than did patients without hemorrhage (P < .001). There was little recovery of lower extremity function even in patients without hemorrhage. Upper extremity motor function improved significantly in all patients (P < .001); patients without hemorrhage showed the largest improvements. The motor recovery rates for patients without hemorrhage were 0.74 (upper extremities; range, 0-1) and 0.55 (lower extremities; range, 0-1); those for patients with hemorrhage were 0.31 (range, 0-1) and 0.091 (range, 0-1). Stepwise multiple regression analyses indicated that MR information on hemorrhage and the length of edema increases the ability to predict clinical outcome by 16%-33% over that with initial clinical scores alone.
Conclusion:
An initial MR imaging evaluation of the spinal cord after spinal cord injury provides supplemental prognostic information on the recovery of motor function in the upper and lower extremities.