168 Impact of Initial Clinical and Imaging Parameters on Long-Term Neurological Outcomes in Acute Traumatic Cervical Spinal Cord Injury.

INTRODUCTION: The influence of initial clinical and imaging parameters on long-term outcomes following spinal cord injury (SCI) has been examined in previous studies, often with inconsistent or contradictory findings. In this study, we evaluated a comprehensive set of admission parameters and analyzed their relationships with long-term neurological recovery.

METHODS: Institutional databases were used to retrospectively identify consecutive patients with cervical SCI admitted between 2008 and 2015. Admission MR studies were independently examined by 2 reviewers and stratified according to the axial T2 Brain and Spinal injury score (BASIC; score 0-4), length of intramedullary T2 lesion (IML), maximal canal compromise (MCC) and maximal spinal cord compression (MSCC). A combined axial and sagittal score (CASS) was also derived by summing the BASIC and IML scores.

RESULTS: A total of 91 patients with a mean age of 50.9 ± 19.1 years were included. Patients with an injury severity score <25, central cord syndrome, and no associated fracture had comparatively improved neurological recoveries (positive ASIA conversion) at 1 year (P < .001). Higher initial BASIC scores and IML length significantly correlated with severe neurological deficits at admission (r = 0.81 and 0.72, respectively; P < .001) and 1 year (r = 0.82 and 0.79, respectively; P < .001). Patients with BASIC scores 3 and 4, and IML length >40 mm had decreased chance of neurological recovery (P = .036, 0.012, and 0.031, respectively). CASS scores of 4 to 5 and 6 to 7 were similarly associated with higher risk of severe neurological deficit on admission (P = .010 and P < .001, respectively) and decreased chance of neurological recovery at 1 year (P = .021 and P < .001, respectively). Neurological outcome parameters were not affected by MCC or MSCC.

CONCLUSION: Taken together, the extent of early axial and longitudinal MRI T2-signal changes appear to reliably correlate with neurological outcomes. The CASS provides a measurement of overall early T2-signal lesion load and appears to sensitively predict neurological recovery at 1-year follow-up.