J Korean Neurosurg Soc.  2018 Sep;61(5):582-591. 10.3340/jkns.2017.0222.

Predictive Values of Magnetic Resonance Imaging Features for Tracheostomy in Traumatic Cervical Spinal Cord Injury

• Jeong TS
• Lee SG
• Kim WK
• Ahn Y
• Son S

• KMID: 2420066
• DOI: http://doi.org/10.3340/jkns.2017.0222

Abstract

OBJECTIVE
To evaluate the magnetic resonance (MR) imaging features that have a statistically significant association with the need for a tracheostomy in patients with cervical spinal cord injury (SCI) during the acute stage of injury.
METHODS
This study retrospectively reviewed the clinical data of 130 patients with cervical SCI. We analyzed the factors believed to increase the risk of requiring a tracheostomy, including the severity of SCI, the level of injury as determined by radiological assessment, three quantitative MR imaging parameters, and eleven qualitative MR imaging parameters.
RESULTS
Significant differences between the non-tracheostomy and tracheostomy groups were determined by the following five factors on multivariate analysis : complete SCI (p=0.007), the radiological level of C5 and above (p=0.038), maximum canal compromise (MCC) (p=0.010), lesion length (p=0.022), and osteophyte formation (p=0.015). For the MCC, the cut-off value was 46%, and the risk of requiring a tracheostomy was three times higher at an interval between 50-60% and ten times higher between 60-70%. For lesion length, the cut-off value was 20 mm, and the risk of requiring a tracheostomy was two times higher at an interval between 20-30 mm and fourteen times higher between 40-50 mm.
CONCLUSION
The American Spinal Injury Association grade A, a radiological injury level of C5 and above, an MCC ≥50%, a lesion length ≥20 mm, and osteophyte formation at the level of injury were considered to be predictive values for requiring tracheostomy intervention in patients with cervical SCI.

Keyword

Spine; Spinal cord; Injuries; Tracheostomy; Magnetic resonance imaging

MeSH Terms

Cervical Cord*
Humans
Magnetic Resonance Imaging*
Multivariate Analysis
Osteophyte
Retrospective Studies
Spinal Cord
Spinal Injuries
Spine
Tracheostomy*

Figure

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  Fig. 1. Measurement of maximum canal compromise, maximum spinal cord compression, and lesion length. Midsagittal (A) T1-weighted and (B and C) T2-weighted MR images obtained in a 44-year-old man with acute traumatic cervical spinal cord injury. A : Maximum canal compromise=1-DiDa+Db/2 ×100%. B : Maximum spinal cord compression=1-DiDa+Db/2 ×100%. C : Lesion length is measured by the distance from the most cephalic extent (a) to the most caudal extent (b) of the injury. Di: the anteroposterior canal diameter at the level of maximum injury, Da: the anteroposterior canal diameter at the nearest normal level above the level of injury, Db: the anteroposterior canal diameter at the nearest normal level below the level of injury, di: the anteroposterior cord diameter at the level of maximum injury, da: the anteroposterior cord diameter at the nearest level above the level of injury, db: the anteroposterior cord diameter at the nearest normal level below the level of injury.

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  Fig. 2. Receiver operating characteristic curve. A : Maximum canal compromise. B : Lesion length. AUC : area under the receiver operating characteristic curve.

Reference

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