Can MRI findings predict the outcome of cervical spinal cord Injury? a systematic review

Introduction MRI is the established gold standard for imaging acute spinal cord injury (SCI). Our aim was to identify the prognostic value, in terms of neurological outcome, of extradural and intradural features detected on MRI performed acutely following traumatic cervical SCI. Materials and methods Several databases were systematically searched to identify potentially eligible articles until December 2019. Using a standard PRISMA template, 2606 articles were initially identified. Results A final 6 full-text articles met the inclusion criteria and were analyzed. An extradural factor, namely the maximal spinal cord compression, was associated with poor neurological outcome and statistically significant (P = 0.02 andP = 0.001 in 2 out of 3 studies). The intradural factors of length of the cord edema (P = 0.001, P = 0.006, andP < 0.001 in 3 studies), intramedullary hemorrhage (P = 0.002,P < 0.001,P < 0.001, andP = 0.002 in 4 studies), and the length of intramedullary hemorrhage (P = 0.028,P = 0.022 in 2 studies) also significantly correlated with poor neurological recovery at follow-up. Conclusion While early MRI is established as a gold standard imaging of acute spinal trauma, it also serves to provide prognostic value on the neurological recovery. From our systematic review, there is a strong association of the extradural finding of maximal spinal cord compression,intradural MRI findings of length of cord edema, intramedullary hemorrhage, and length of intramedullary hemorrhage with neurological recovery in traumatic cervical spinal cord injuries.