Abstract
FACTORS AFFECTING LONG-TERM OUTCOME IN ACUTE CERVICAL CORD INJURY – A STUDY DONE IN TERTIARY CARE TEACHING HOSPITAL

*Dr. R. Selvan MS. MCh and Dr, S. Subikshavarthni MBBS MEM

ABSTRACT

Introduction: Spinal trauma is relatively a more common injury nowadays. Although its mortality is becoming low due to utmost care in intensive care unit, it is an important cause of long term disability. Magnetic resonance imaging (MRI) can accurately depict the presence and extent of spinal cord injury (SCI) in these patients. Several clinical and physical factors affect the outcome of cervical cord injury particularly neurological outcome. Analysing these influencing factors is must and will help in predicting the outcome in such patients. Methodology: Fifty patients with acute cervical cord injury who were treated in past five years (2013-2018) were evaluated by the American Spinal Injury Association (ASIA) scoring and magnetic resonance imaging (MRI) of cervical spine. MR patterns of cord injury and length of damage were evaluated by radiologist. They were followed up with ASIA score at the end of one year. Four factors were investigated for their effect on outcome - age, initial neurological status, timing of surgery, MR findings. Results: All patients with ASIA Grade „D‟ improved whereas none improved in ASIA grade „A‟. Patients with cord edema showed good recovery compared to patients with cord contusion. Among the patients with cord edema, improvement was better in three or less than three segments compared to more than three segments. There was no significant influence by age. The difference in improvements between early surgery and delayed surgery was also not significant. Conclusion: The prime factor which defines the outcome, is the initial neurological status following injury in the patients. The age of the patient and the timing of surgery do not seem to influence the outcome. MRI pattern of cord edema with less than three segments has best prognosis for recovery.

Keywords: ASIA scoring; Magnetic Resonance Imaging features; neurological outcome.


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