Correlation of blunt cervical spinal cord injury magnetic resonance imaging tractography with the American Spinal Injury Association impairment scale motor scores

Abstract

Background: The introduction of the Subaxial Cervical Spine Injury Classification system has created the need for a holistic imaging approach that encompasses both functional (neurological) and morphological information. Objectives: This study aimed to determine if there was a correlation between the blunt cervical spinal cord injury diffusion tensor imaging (DTI) fraction anisotropy (FA) value and the American Spine Injury Association (ASIA) impairment scale motor score. Method: Diffusion tensor imaging was performed on 26 patients with blunt cervical spine injury (all men with a median age of 46 years) admitted to the Pelonomi Tertiary Hospital spinal unit. Imaging was performed using the 1.5T Siemens Magnetom Aera machine’s built-in spine DTI protocol. Sagittal FA values were acquired at four different cervical spine regions (medulla oblongata, above the injury site, at the injury site and below the injury site). Results: Eight of the 26 patients had complete neurological fallout. Of the participants, 30% had injuries at the C4/C5 level, whilst injuries involving segments below and above C4/C5 affected 15% and 55% of participants, respectively. Injury site FA values (median 0.30) were significantly lower (p < 0.001) than the above injury site FA (median 0.46, p = 0.26) and below injury site FA (median 0.42 and p = 0.019). A significant correlation was noted between the injury site FA values and the ASIA impairment scale motor scores (p = 0.001, r = 0.87). Conclusion: FA value showed excellent correlation with the ASIA impairment scale motor scores.