Traumatic spinal cord injury
Updates to Article Attributes
Traumatic spinal cord injury (SCI) can manifest as a wide variety of clinical syndromes resulting from damage to the spinal cord or its surrounding structures. It can result from minor injury if the spine is weakened from disease such as ankylosing spondylitis or if there is pre-existing spinal stenosis. It is an emergency which can require urgent surgical intervention to prevent long term neurological complications of spinal cord injury.
Clinical presentation
In addition to neurological signs of altered sensation, limb weakness, autonomic dysfunction, and sphincter disruption there is usually pain due to related injury to the musculoskeletal components of the spine.
Recognised neurological syndromes of spinal injury from trauma include:
- anterior cord syndrome
- Brown-Séquard syndrome
- cauda equina syndrome
- central cord syndrome
- conus medullaris syndrome
- spinal cord transection
Pathology
There are several types of traumatic SCI 3,4,5:
- spinal cord swelling
- spinal cord contusion/oedema
- cord oedema only: most favourable prognosis
- cord oedema and contusion: intermediate prognosis
- cord contusion only: worse prognosis
- intramedullary haemorrhage
- extrinsic compression, e.g. from fracture fragment or disc herniation
- spinal cord transection
Mechanism
The mechanism of injury varies and can include:
- road traffic accidents
- sports injuries
- assault or gunshot injury
- falls
Classification
Injuries can be complete or incomplete at a specified level. The most common system is the Internal Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) from the American Spinal Injury Association (ASIA) 2.
Radiographic appearancefeatures
Plain radiograph
These have no real role in traumatic cord injury in patients with significant trauma as they have limited sensitivity for detecting spinal cord trauma and bony injuries associated with it.
CT
This is best for assessing the associated bony injuries which may need concomitant treatment consideration but does not assess the cord itself.
MRI
Apart from routine axial and sagittal T1 and T2 imaging additional sequences should be considered depending on the clinical concern. T2* sequences (e.g. gradient echo, SWI) are more sensitive for haemorrhage, while STIR sequences are more sensitive for associated ligamentous injury.
- spinal cord swelling
- focal cord enlargement at level of trauma without signal change 5 best seen on sagittal T1
- spinal cord oedema
- as per swelling but with additional increased T2 signal
- spinal cord contusion
- thick high T2 signal rim around small central low T1 signal above or below level of trauma 5
- blooming on T2* sequences
- intramedullary haemorrhage
- thin high T2 signal rim around large central low T1 signal 5
- blooming on T2* sequences
- see ageing blood on MRI for other timescales
- spinal cord transection
- discontinuity of cord best seen on sagittal sequences
-</ul><h4>Classification</h4><p>Injuries can be complete or incomplete at a specified level. The most common system is the <a href="/articles/internal-standards-for-neurological-classification-of-spinal-cord-injury">Internal Standards for Neurological Classification of Spinal Cord Injury</a> (ISNCSCI) from the American Spinal Injury Association (ASIA) <sup>2</sup>.</p><h4>Radiographic appearance</h4><h5>Plain radiograph</h5><p>These have no real role in traumatic cord injury in patients with significant trauma as they have limited sensitivity for detecting spinal cord trauma and bony injuries associated with it.</p><h5>CT</h5><p>This is best for assessing the associated bony injuries which may need concomitant treatment consideration but does not assess the cord itself.</p><h5>MRI</h5><p>Apart from routine axial and sagittal T1 and T2 imaging additional sequences should be considered depending on the clinical concern. T2* sequences (e.g. <a href="/articles/gradient-echo-sequences-1">gradient echo</a>, <a href="/articles/susceptibility-weighted-imaging-1">SWI</a>) are more sensitive for haemorrhage, while STIR sequences are more sensitive for associated ligamentous injury.</p><ul>- +</ul><h4>Classification</h4><p>Injuries can be complete or incomplete at a specified level. The most common system is the <a href="/articles/internal-standards-for-neurological-classification-of-spinal-cord-injury">Internal Standards for Neurological Classification of Spinal Cord Injury</a> (ISNCSCI) from the American Spinal Injury Association (ASIA) <sup>2</sup>.</p><h4>Radiographic features</h4><h5>Plain radiograph</h5><p>These have no real role in traumatic cord injury in patients with significant trauma as they have limited sensitivity for detecting spinal cord trauma and bony injuries associated with it.</p><h5>CT</h5><p>This is best for assessing the associated bony injuries which may need concomitant treatment consideration but does not assess the cord itself.</p><h5>MRI</h5><p>Apart from routine axial and sagittal T1 and T2 imaging additional sequences should be considered depending on the clinical concern. T2* sequences (e.g. <a href="/articles/gradient-echo-sequences-1">gradient echo</a>, <a href="/articles/susceptibility-weighted-imaging-1">SWI</a>) are more sensitive for haemorrhage, while STIR sequences are more sensitive for associated ligamentous injury.</p><ul>
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