Factors affecting long-term outcome in acute cervical cord injury

Abstract

Several clinico-imageological factors affect the neurological outcome following cervical cord injury. Studying these factors is essential for predicting the outcome. Thirty-three patients with acute cervical cord injury who were treated at our institute from 2000-2003, were assessed by the American Spinal Injury Association (ASIA) scoring and magnetic resonance imaging (MRI) of cervical spine. MR patterns of cord injury and length of damage were evaluated by senior neuroradiologist . They were followed up with ASIA score at the end of one year. Four factors were analyzed for their possible influence on outcome namely age, initial neurological status, timing of surgery, MR findings. Patients were divided into groups based on the factor studied, and the improvement was compared amongst the groups. Chi Square analysis was done to study the statistical association. All patients with ASIA Grade ‘D’ improved whereas none improved in ASIA grade ‘A’. Patients with cord edema showed good recovery (52%) compared to patients with cord contusion (0%). Among the patients with cord edema, improvement was better in three or less than three segments (84.6%) compared to more than three segments (16.66%). There was no significant difference in improvements between age groups 40 years (46.1%) (p>0.05). The difference in improvements between early surgery (60%) and delayed surgery (33.33%) was also not significant (p>0.05). The single most important factor, which determines the outcome, is the initial neurological status following injury. The age of the patient and the timing of surgery do not seem to influence the outcome. MRI pattern of cord edema with less than three segments has best prognosis for recovery.

Keywords

• ASIA scoring
• magnetic resonance imaging features
• neurological outcome