Prognosticating Neurological Recovery in Patients with Spinal Cord Injury without Radiological Abnormality (SCIWORA) - One Year Follow Up Study

Abstract

Background: Magnetic resonance Imaging (MRI) allows early assessment of spinal cord lesion in SCIWORA, but its prognostication for recovery yielded conflicting results in previous studies.

Objective: Study was aimed to assess the clinico - radiological parameters that influence neurological recovery in patients admitted with spinal cord injury without radiographic abnormality (SCIWORA).

Methods: Patients above the age of eighteen years hospitalized with SCIWORA and neurological impairment as per American spinal injury association (ASIA) score, analyzed by MRI evaluation were included and followed up to one year and the relationship between MRI abnormality and neurological outcome were analyzed at presentation and at one year follow up.

Results: Fourteen adult patients (14 males) with SCIWORA were identified (mean age of 44.86 ± 11.56 years). Significant negative correlation was seen with MRI score (score one to four indicative of increasing severity of cord damage) and ASIA score (A to E) at presentation (Pearson' coefficient -0.664:95% CI -0.88 - -0.21; p=0.004), and improvement in ASIA score (neurological recovery) at one year (Pearson' coefficient -0.834:95% CI -0.95 - -0.54; p=0.00003). Bivariate analysis of factors which favored neurological recovery at one year were age less than 50 years (p=0.05), spinal cord edema in MRI at presentation (100% recovery) and spinal cord contusion (66.6% recovery; p=0.029). Cord hemorrhage had the least chance of recovery (25%).

Conclusion: In patients with SCIWORA, spinal cord edema, cord contusion and age at presentation were the best predictors of neurological recovery and worst outcomes occurred with cord hemorrhage.