gms | German Medical Science

Objectives: Little is known about the correlation between spinal cord signal changes on MRI in acute burst fractures and neurological deficits.

Our aim was to describe the relationship between acute spinal cord changes on MRI and neurological impairment.

Methods: A retrospective analysis of our prospective database was conducted of patients presenting with burst fractures who obtained an MRI on day of hospital admission between 2017 and 2021. Hyperintense T2 signal (arbitrary units, AU) was noted at the lesion and compared to the intensity of the cerebrospinal fluid and the uninjured spinal cord above the injury.

Results and conclusion: A total of 42-patients met the inclusion criteria with a median ASIA score of E. Four patients were ASIA-A. At follow up all patients with ASIA-C improved and had no remaining neurological deficits. On MRI, signal alterations at the level of injury were observed in 97.6% with a mean hyperintensity of 205,317±56,824AU. This was significantly higher for patients with ASIA A and C compared to the patients without neurology (ASIA-A=249,500±43,928AU, p=0.01; ASIA-C=244,800±45,928AU p=0.01; ASIA-E=189,181±45,928AU). Similar findings were observed for the extent of spinal cord signal alterations which was highest for the ASIA A group with 58.3±23.3mm (p<0.005).

Whilst the presence of signal alterations does not necessarily mean that neurological impairment is present, hyperintensity is significantly higher in ASIA-A and C compared to ASIA-E and D groups. This suggests more acute decompressions should be considered in these groups, especially when a thorough neurological assessment is difficult.