Rafael Martínez-Pérez
MRI sequences are constantly evolving, and new techniques enable not only improved diagnostic but also prognostic information. The ability of MRI to predict outcomes in cervical spine trauma has, however, been relatively limited to the detection of cord compression, edema, and intramedullary hematoma. Our group believes that these factors explain only part of the pathologic process determining the ultimate neurologic outcome. The STIR sequence is known to be sensitive and specific for cervical ligamentous disruption, and we have used it to investigate the extent of cervical spinal cord injury.
Our initial work explained the importance of the state of the cervical soft tissues, particularly the ligaments, in predicting the extent of spinal cord injury. We believe that this information can change the accepted treatment paradigms. We found that injury to the ligamentum flavum, best shown with sagittal STIR images, is associated with more severe spinal cord injury. In patients who are sedated, have decreased levels of consciousness or other injuries precluding neurological examination, or in whom no cord abnormality is demonstrated on MRI, the presence of signal abnormality in the ligamentum flavum can be predictive of a significant cord injury. Our group has subsequently shown that the pattern of ligamentous injury is more predictive of a poor neurologic outcome at 1 year than vertebral body or pedicle fracture, both of which have been used to justify surgical fixation (TLICS scale). We believe that the current cervical injury classifications do not adequately address or quantify the role of MRI signal changes in spinal ligaments.
Interestingly, the pattern of ligamentous injury may have relevance to another subgroup of patients with cervical spine injury, those classified as “SCIWORA”, or Spinal Cord Injury Without Radiological Abnormality. This