Relationship between different types of traumatic cervicothoracic spine fractures on CT scan with acute spinal cord injury on MRI

Abstract

Trauma to the spine and spinal cord in most cases leads to significant neurological damage such as paraplegia, quadriplegia, or even death. Patients who develop a complete spinal cord injury without remaining motor or sensory function on the neurological examination have a very poor prognosis. Radiological investigations are very important in the diagnosis and treatment management of patients with spinal cord trauma. This study aims to investigate the relationship between types of traumatic fractures of the cervical and back spine in CT scan with acute spinal cord injury in MRI. Materials and Methods: In this retrospective cross-sectional study, CT scans of cervical and back spines of trauma patients who were referred to Imam Reza Hospital were evaluated and the morphological type of cervical and back spine fractures was determined in CT scans. Then MRI, which was performed for the patient in the acute phase of trauma (first week) of the cervical and back vertebrae, was checked for the presence and severity of spinal cord injury and the compressive effect on the spinal cord. Results: In this retrospective cross-sectional study, CT-Scan and MRI findings related to 196 patients with traumatic cervical and lumbar spine injuries were evaluated. The average age of the patients was 45.89 ± 18.05 years and 65.1% of them were male. Evaluation of CT-Scan findings in terms of fracture morphology showed 33.6% of compression cases, 33.6% of burst cases, and 32.8% of rotational/distraction cases. In cases of compression morphology, the most common cervical vertebrae involved are C2 and C6; And the most common dorsal vertebra involved was T6. In cases of burst morphology, the most common cervical vertebra involved was C2 and the most common dorsal vertebra involved was T12. In cases of rotational/distraction morphology, the most common cervical vertebra involved was C7 and the most common dorsal vertebra involved was T1. In terms of MRI imaging, there was spinal cord injury in 50.3% of cases, which was edema and cord transection in 49 patients and hemorrhage alone in 10 patients. Also, both findings were observed simultaneously in 39 patients. The most common accompanying findings included soft edema and bone inflammation. Traumatic disc herniation was observed in 17.9% of patients. Comparing the results of MRI with CT-Scan, it was observed that in cases of fracture with rotational/distraction morphology, CT-Scan has 65.31% sensitivity, 100% specificity, and 100% predictive value for determining spinal cord injury.