Traumatic spinal cord injury

Dr Zishan Sheikh et al.

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.

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:

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

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.

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 echoSWI) 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
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Article Information

rID: 39788
Section: Gamuts
Synonyms or Alternate Spellings:
  • Spinal cord trauma
  • Acute spinal cord injury
  • Acute SCI
  • Traumatic SCI

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Cases and Figures

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    Case 1: cord oedema
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    Case 2: focal contusion and oedema
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    Case 3
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    Case 4
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