The usage of tractography of the spinal cord as a predictor of neurological disorders regression in patients with severe cervical spine and spinal cord injury
Keywords:spinal cord tractography, diffusion-tensor imaging, prognosis, cervical spine injury, spinal cord lesions
Objective: the primary assessment of the prognostic features of tractography in patients with severe subaxial cervical spine and spinal cord injury.
Materials and methods. The clinical group consisted of 5 patients admitted to the Department of Spine Surgery of Romodanov Neurosurgery Institute during the period from April to July 2019 with severe traumatic injury of the cervical spine and spinal cord. MRI was performed in the following modes: T1W, T2W, FLAIR, STIR, T2W FFE, CSF flow and DTI in 5–7 days after surgery. The dynamics of neurological disorders regression were evaluated according to the International Standards for Neurological Classification of Spinal Cord Injury. The level of spinal canal traumatic stenosis was determined by SCT both before and after surgical correction. Due to the small clinical group, statistical processing of the obtained digital indicators was not performed. The main task was to identify general patterns in order to determine the direction of further detailed studies.
Results. Spinal cord edema at the damage level was observed in 100 % of patients that corresponded to the level of neurological disorders. The presence of hemorrhagic component was detected in 3 patients, while post-traumatic spinal stenosis was: more than 50 % — in one patient, up to 50 % — one patient and less than 25 % — one patient. Spinal cord parenchyma edema was accompanied by varying degrees of compression of the cerebrospinal spaces, from subtotal to total, with the presence or absence of a hemorrhagic component that did not impact the intensity of cerebrospinal fluid flow disorders. Evaluation of DTI results showed a moderate inverse relationship between FA and MD indicators. Two patients presented with a regression of neurological disorders. Restoration of sensory-motor functions did not correlate with the degree of compression of the spinal canal or the nature of changes in the parenchyma of the spinal cord, but was noted in patients with maximum FA values and low MD.
Conclusions. Tractography is an informative predictor of the regression of neurological disorders in patients with severe spine and spinal cord injury. Further studies are needed to identify the optimal timing of its implementation and to establish diagnostically significant values of anisotropic diffusion indices.
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