International Journal of Medicine and Medical Sciences, ISSN: 2051-5731, Vol.46, Issue. 4 1379
© RECENT SCIENCE PUBLICATIONS ARCHIVES| November 2013|$25.00 | 27702752 |
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Relationship between MRI Findings and Treatment
Outcomes in Spinal Cord Injury Victims
Ochie K.
Department of Medical Radiography and Radiological Sciences, Faculty of Health Science and Technology
University of Nigeria Enugu Campus Enugu State, Nigeria
Okpala O.C.
Radiology Department, Nnamdi Azikiwe University Teaching Hospital Nnewi, Anambra State
Ohagwu C.C.
Department of Radiography/Radiological Sciences, Faculty of Health Sciences and Technology Nnamdi Azikiwe
University Nnewi Campus Nnewi, Nigeria
Eze C.U.
Department of Radiation Biology, Radiotherapy, Radio diagnosis and Radiography College of Medicine
University of Lagos, Nigeria
Corresponding Author E mail: mature_ohagwu@yahoo.ie
ABSTRACT
BACKGROUND: MRI is the medical imaging modality
of choice in spinal cord injury because of its use in
deciding the prognosis of the injury. This is because it is
thought that MRI-detectable lesions have correlation with
neurological outcome of the patient.
AIM: To investigate the relationship between MRI
findings in spinal cord injury and treatment outcomes.
PATIENTS AND METHODS: A retrospective
evaluation of MRI findings, neurological classification and
treatment outcomes of 90 patients with spinal cord injury
who presented at the Lagos University Teaching Hospital,
Lagos, Nigeria from 2006 to 2012 was carried out. The
hospital records and documentations of MRI findings were
retrieved from the medical records archive.
RESULTS: The pre-treatment neurological classification
according to ASIA scale shows that majority of the
victims (53.3%, n = 48) were in very poor neurological
state (ASIA A) while only 4.4% (n = 4) had no
neurological signs (ASIA E). ASIA A and B groups have
haemorrhage and haemorrhage with cord oedema as the
main findings while ASIA C and D groups have only cord
oedema. ASIA E group neither haemorrhage nor cord
oedema. Patients with the severest neurological problem
(ASIA A group) had a total of 48 (53.3%); 20 (22.2%) of
who had haemorrhage only and 24 (26.7%) had both
haemorrhage and cord oedema. Only 4 (4.4%) who had
haemorrhage only showed incomplete recovery while the
rest did not recover at all and another 4 (4.4%) who had
both haemorrhage and cord oedema showed incomplete
recovery while the rest did not recover. The patients
classified as ASIA B had 20 (22.2%) patients. Six (6.7%)
had haemorrhage only out of which 2 (2.2%) recovered
fully and 4 (4.4%) did not recover at all. Twelve (13.3%)
had cord oedema only at MRI and 8 (8.9%) of them
recovered fully and 4 (4.4%) recovered incompletely. Two
(2.2%) had both haemorrhage and oedema, and recovered
incompletely. For ASIA C, there were 8 (8.9%) victims
and they all had cord oedema only at MRI and all of them
recovered completely. Also, ASIA D group had 10
(11.1%) who had cord oedema only at MRI and all
recovered completely. For ASIA E group, there were 4
(4.4%) victims and they had cord oedema only at MRI and
they all recovered fully.
CONCLUSION: There was a significant reduction of
neurological impairment which followed a pattern of not
finding cord haemorrhage at MRI (p < 0.05). Prognosis of
spinal cord injury depends on the nature of lesions seen at
MRI and the modality should be used for its management
wherever possible.
Keywords-Spinal cord injury -MRI Findings -Treatment
outcome
1. INTRODUCTION
Spinal cord injury refers to trauma affecting the spinal
cord directly or indirectly. When the injury is direct, there
is a direct impact of traumatic force on the spinal cord
which could result from automobile accident, gunshot,
sport injury and industrial accident amongst others. In
indirect injury, the trauma affects blood vessels,
lymphatics, bones and other tissues around the spinal cord
and indirectly affects it.
Spinal cord injury is an important public health issue in
Nigeria and many other countries. There is usually male
gender preponderance of victims and this is quite serious
from economic point of view. According to Howlett[1],
spinal injury arises mostly from road traffic accidents
(RTA) and falls, and is a major cause of death and
disability in Africa. Males aged between 20 and 40 years
are the main risk group affected. Nwadinigwe et al.[2] and
Obalum et al.[3] in their respective studies in Nigeria
reported that spinal cord injuries affect mostly young male
adults with cervical spine injury predominating.
Recovery from spinal cord injury is painfully slow. Often,
the victim ends up with permanent disability and becomes
a perpetual economic and social burden to his relations.
Therefore, management of spinal cord injury is taken