The role of magnetic resonance imaging in acute trauma of the cervical spine in children

Aim. To evaluate the role of magnetic resonance imaging (MRI) as a diagnostic method in children with acute trauma of the cervical spine and spinal cord, to compare the correspondence of MRI results with neurologic symptoms in accordance with the ASIA scale.

Materials and methods. 156 children with acute trauma of spine and spinal cord at the age from 6 months up to 18 years were studied. MRI was performed on a Phillips Achieva 3T scanner. The standard protocol included MYUR (myelography) in coronal and sagittal projections, STIR and T2VI FS SE in sagittal projection, T2VI SE or T2 * VI FSGE (axial projection), 3D T1VI FSGE before and after contrast enhancement. Contrast substance was injected intravenously in the form of a bolus at the rate of 0.1 mmol/kg (equivalent to 0.1 ml/kg) at a rate of 3 to 4 ml.

Results. The causes of cervical spine blunt trauma were: road accidents (55), catatrauma (60), “diver” trauma (21), blunt trauma (20). Intramedullary lesions of the spinal cord were detected: concussion (49), bruising / crushing (27), hematomia (34), disruption with divergence of segments (21), accompanied by edema (141); extramedullary lesions: epi- and subdural, intralesive and sub-connective and soft tissues hematomas (68), ruptures of bundles (48), fractures (108), dislocation and subluxation of the vertebrae (35), traumatic disc herniation (37), spinal cord compression and/or rootlets (63), statics violation (134), instability (156).

Conclusion. MRI is the optimal method for spinal cord injury diagnostics. In the acute period of injury this technique has limited application, but it can however serve as a primary diagnostic method in these patients. MRI should be performed no later than the first 72 hours after injury. The most optimal for visualization of cervical spine trauma and spinal cord are T2VI SE and STIR in sagittal projection with suppression of signal from fat. MRI results correlate with neurologic symptoms at the time of performance according to the ASIA scale, and therefore MRI should be performed in all patients with acute cervical spine trauma, whenever possible.

1. Krylov V.V., Galankina I.E., Pozdnyakov A.V., Grin A.V., Popov A.A. Causes of deaths and diagnostic errors in spine and spinal cord injury in patients with concomitant injury. Neurohirurgiya. 2003; 3: 17–21. (In Russian)

2. Akhadov T.A., Panov V.O., Ayhhoff U. Spine and spinal cord injury and its consequences. Monograph. Acad. Russian Science. M., 2000: 586–633. (In Russian)

3. Akhadov T.A., Rushanov I.I., Panova M.M. Magnetic resonance imaging in diagnosis of diseases of spine and spinal cord. Part 2. Diseases semiotics. Novosti nauki i tehniki. 1997; 2. (In Russian)

4. Akhadov T.A., Sarukhanyan O.O., Keshishyan R.A. Magnetic resonance imaging of spinal injury in children. M.: Kommercheskie tehnologii, 2012: 123–135. (In Russian)

5. Bagley L.J. Imaging of spinal trauma. Radiol. Clin. N. Am. 2006; 44 (1): 1–12.

6. Flanders А. Spine Cervical injury. Radiology Assistant. 2008.

7. Harrop J.S., Jeyamohan S., Sharan A., Ratliff J., Flanders A., Maltenfort M., Falowski S., Vaccaro A. Acute Cervical Fracture or Congenital Spinal Deformity. J. Spinal Cord. Med. 2008; 31: 83–87.

8. Hadley M.N., Walters B.C., Grabb P.A., Oyesiku N.M., Przybylski G.J., Resnick D.K., Ryken T.C. Radiographic assessment of the cervical spine in symptomatic trauma patients. Neurosurgery. 2002; 50 (3): 30–35.

9. Hadley M.N., Walters B.C., Grabb P.A., Oyesiku N.M., Przybylski G.J., Resnick D.K., Ryken T.C. Radiographic assessment of the cervical spine in symptomatic trauma patients. Neurosurgery. 2002; 50 (3): 36–43.

10. Chakeres D.W., Flickinger F., Bresnahan J.C., Beattie M.S., Weiss K.L., Miller C., Stokes B.T. MR imaging of acute spinal cord trauma. Am. J. Neuroradiol. 1987; 8 (1): 5–10.

11. Colombo N., Maccagnano C., Corona C., Beltramello A., Scialfa G. Cervical Spine Trauma: A Guide to Neuroradiological Diagnosis. Rivista di Neuroradiol. 1997; 10 (1): 63–103.

12. Martínez-Pérez R., Paredes I., Cepeda S., Ramos A., Castaño-León A.M., García-Fuentes C., Lobato R.D., Gómez P.A., Lagares A. Spinal cord injury after blunt cervical spine trauma: correlation of soft-tissue damage and extension of lesion. Am. J. Neuroradiol. 2014. 35 (5): 1029–1034. DOI: https://doi.org/10.3174/ajnr.A3812.

13. Kumar Y., Hayashi D. Role of magnetic resonance imaging in acute spinal trauma: a pictorial review. BMC Musculoskelet Disord. 2016. DOI: 10.1186/s12891-016-1169-6.

14. Dundamadappa S.K., Cauley K.A. MR imaging of acute cervical spinal ligamentous and soft tissue trauma. Emerg. Radiol. 2016. 19 (4): 277–286. DOI: 10.1007/s10140-012-1033-4.

15. Miranda P., Gomez P., Alday R. Acute traumatic central cord syndrome: analysis of clinical and radiological correlations. J. Neurosurg. Sci. 2008; 52: 107–112.

16. Kawakyu-O'Connor D., Bordia R., Nicola R. Magnetic resonance imaging of spinal emergencies. Magn. Reson. Imaging Clin. N. Am. 2016. 24: 325–344. DOI: 10.1016/j.mric.2015.11.004.

17. Miyanji F., Furlan J.C., Aarabi B., Arnold P.M., Fehlings M.G. Acute cervical traumatic spinal cord injury: MR imaging findings correlated with neurologic outcome: prospective study with 100 consecutive patients. Radiology. 2007; 243: 820–827.

18. Leypold B.G., Flanders A.E., Burns A.S. The early evolution of spinal cord lesions on MR imaging following traumatic spinal cord injury. Am. J. Neuroradiol. 2008; 29: 1012–1016.

19. Goradia D., Linnau K.F., Cohen W.A., Mirza S., Hallam D.K., Blackmore C.C. Correlation of MR imaging findings with intraoperative findings after cervical spine trauma. Am. J. Neuroradiol. 2007; 28: 209–215.

20. Bozzo A., Marcoux J., Radhakrishna M., Pelletier J., Goulet B. The role of magnetic resonance imaging in the management of acute spinal cord injury. J. Neurotrauma. 2011; 28: 1401–1411.

21. Pizones J., Izquierdo E., Sánchez-Mariscal F., Zúñiga L., Álvarez P., Gómez-Rice A. Sequential damage assessment of the different components of the posterior ligamentous complex after magnetic resonance imaging interpretation: prospective study 74 traumatic fractures. Spine. 2012; 37: E662–667.

22. Talbott J.F., Whetstone W.D., Readdy W.J., Ferguson A.R., Bresnahan J.C., Saigal R., Hawryluk G.W., Beattie M.S., Mabray M.C., Pan J.Z., Manley G.T., Dhall S.S. The Brain and Spinal Injury Center score: a novel, simple, and reproducible method for assessing the severity of acute cervical spinal cord injury with axial T2-weighted MRI findings. J. Neurosurg. Spine. 2015; 23: 495–504. DOI: 10.3171/2015.1.SPINE141033.

23. Dare A.O., Dias M.S., Li V. Magnetic resonance imaging correlation in pediatric spinal cord injury without radiographic abnormality. J. Neurosurg. 2002; 97: 33–39.

24. Carrino J.A., Manton G.L., Morrison W.B., Vaccaro A.R., Schweitzer M.E., Flanders A.E. Posterior longitudinal ligament status in cervical spine bilateral facet dislocations. Skeletal Radiol. 2006; 35: 510–514.

25. Zhang J.S., Huan Y. Multishot diffusion-weighted MR imaging features in acute trauma of spinal cord. Eur. Radiol. 2014; 24: 685–692. DOI: 10.1007/s00330-013-3051-3.

26. Kulkarni M.V., McArdle C.B., Kopanicky D., Miner M., Cotler H.B., Lee K.F., Harris J.H. Acute spinal cord injury: MR imaging at 1.5 T. Radiology. 1987; 164 (3): 837–843. DOI: 10.1148/radiology.164.3.3615885.

27. Andreoli C., Colaiacomo M.C., Rojas Beccaglia M., Di Biasi C., Casciani E., Gualdi G. MRI in the acute phase of spinal cord traumatic lesions: relationship between MRI findings and neurological outcome. Radiol. Med. 2005; 110: 636–645.

28. Liao C.C., Lui T.N., Chen L.R., Chuang C.C., Huang Y.C. Spinal cord injury without radiological abnormality in preschool-aged children: correlation of magnetic resonance imaging findings with neurological outcomes. J. Neurosurg. 2005; 103: 17–23.

29. Rihn J.A., Fisher C., Harrop J., Morrison W., Yang N., Vaccaro A.R. Assessment of the posterior ligamentous complex following acute cervical spine trauma. J. Bone J. Surg. Am. 2010; 92: 583–589.

30. Pizones J., Sánchez-Mariscal F., Zúñiga L., Álvarez P., Izquierdo E. Prospective analysis of magnetic resonance imaging accuracy in diagnosing traumatic injuries of the posterior ligamentous complex of the thoracolumbar spine. Spine. 2013; 38: 745–751. DOI: 10.1097/BRS.0b013e31827934e4.

31. Kang J.D., Figgie M.P., Bohlman H.H. Sagittal measurements of the cervical spine in subaxial fractures and dislocations: an analysis of two hundred and eighty-eight patients with and without neurological deficits. J. Bone J. Surg. Am. 1994; 76 (11): 1617–1628.

32. Radcliff K., Su B.W., Kepler C.K., Rubin T., Shimer A.L., Rihn J.A., Harrop J.A., Albert T.J., Vaccaro A.R. Correlation of posterior ligamentous complex injury and neurological injury to loss of vertebral body height, kyphosis, and canal compromise. Spine. 2012; 37 (13): 1142–1150.

33. Harrop J.S, Jeyamohan S., Sharan A., Ratliff J., Flanders A., Maltenfort M., Falowski S., Vaccaro A. Acute Cervical Fracture or Congenital Spinal Deformity. J. Spinal Cord. Med. 2008; 31 (1): 83–87.