Therapeutics and Clinical Risk Management (Jan 2021)
The Assessment of Dynamic Spinal Cord Impingement by Kinematic Magnetic Resonance Imaging in Patients with Traumatic Central Cord Syndrome
Abstract
Jia Li,1,2,* Da Shi,1,2,* Zijian Hua,1,2 Linfeng Wang1,2 1Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, People’s Republic of China; 2The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, People’s Republic of China*These authors contributed equally to this workCorrespondence: Linfeng Wang No. 139, Ziqiang Road, Shijiazhuang, Hebei, People’s Republic of ChinaTel +86-311-88602016Fax +86-311-88602015Email [email protected]: There are few reports describing the imaging features of traumatic central cord syndrome (TCCS) in kinematic magnetic resonance imaging (kMRI) scans. The current study aimed to assess and characterize dynamic spinal cord impingement (DSCI) using kMRI and evaluate the risk factors for poor outcomes in patients with TCCS after surgery.Methods: This retrospective study included 63 patients with TCCS who underwent surgery in the authors’ hospital. The American Spinal Injury Association impairment scale grade and Japanese Orthopedic Association (JOA) score were collected preoperatively and at the final follow-up to assess neurological function. Patients were divided into two groups based on the JOA score (> or < 50%), and clinical and radiographic evaluations were compared. The metrics examined included age at the time of surgery, gender, type of trauma, the interval from injury to surgery, surgical approach, pathological signs, range of motion, DSCI and the length of intramedullary hyperintensity signal (LIHS).Results: There were statistical differences in the LIHS, DSCI and preoperative JOA score between good (JOA > 50%; n = 50) and poor (JOA < 50%, n =13) recovery patient groups (P< 0.05). Logistic regression, with poor outcomes as the dependent variable, suggested independent risk associations with preoperative JOA score (P< 0.05), DSCI (P< 0.05) and LIHS (P< 0.05).Conclusion: kMRI can be effective for decision-making in the treatment of TCCS. The lower preoperative JOA score, longer high signal cord and higher dynamic spinal cord impingement were risk factors for poor outcomes in patients with TCCS after surgery.Keywords: dynamic spinal cord impingement, traumatic central cord syndrome kinematic magnetic resonance imaging, risk factor
