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Spinal Cord Contusion-Hematoma


KEY FACTS

Terminology

  • Spinal cord injury (SCI)

  • Traumatic axonal injury, cord edema, &/or hemorrhage

Imaging

  • Abnormal cord signal on MR in setting of trauma

  • Most common level of adult SCI is C4-C6

  • Commonly associated fracture or subluxation in younger adults (16-45 years)

  • Underlying degenerative change (canal stenosis) predisposes to cord injury in older population

  • SCI without radiographic abnormality is common in pediatric population (< 8 years)

  • Cord injury typically occult on CT

Pathology

  • Overall incidence of SCI in trauma estimated at 3.7%

  • High-velocity mechanisms more common in youth and young adults

  • If > 45 years, more likely due to fall; short falls (< 1 m) may result in significant injury in elderly patients

Clinical Issues

  • Edema without hemorrhage: Good prognosis for recovery

  • Hematoma: Poor prognosis, often without recovery

    • Extent of intramedullary hemorrhage and cord swelling are key predictors of neurologic recovery after traumatic cervical cord injury

  • 30-60 new cases per million per year in USA

  • Annual cost of SCI in USA estimated to be $9.73 billion in 1996

Diagnostic Checklist

  • Sagittal STIR is key sequence

    • Sensitive to cord edema

    • Ligamentous/muscular injury

    • Marrow edema

  • Sagittal and axial gradient-echo images for cord hemorrhage

Sagittal T2WI MR of a patient presenting days after an MVA with upper > lower extremity weakness shows congenital narrowing of the canal with multiple disc bulges and levels of canal stenosis, worst at C4-C5
. Caudally, mild, patchy T2 hyperintensity shows nonhemorrhagic cord contusion
.

Sagittal T2WI MR in a child shows diffuse contusion
in the cord from C1 through the upper thoracic cord. The patient presented with 4 extremity neurologic deficits after fall. Plain films would be normal.

Sagittal T2 MR in this trauma patient shows low signal intensity cord hemorrhage at C4
with surrounding edema in the setting of severe cervical canal stenosis. Prevertebral edema is present
.

Sagittal T2WI shows a midthoracic burst fracture
and disruption of ligamentum flavum
. There is complete transection of the spinal cord
, demonstrated by a cerebrospinal fluid-filled cleft, with adjacent edema.

TERMINOLOGY

Abbreviations

  • Spinal cord injury (SCI)

Definitions

  • Traumatic axonal injury, cord edema, &/or hemorrhage

IMAGING

General Features

  • Best diagnostic clue

    • Abnormal cord signal on MR in setting of trauma

  • Location

    • Most common level of adult SCI is C4-C6

      • –

        Injury at higher levels in children due to larger heads, weaker musculature, and ligamentous laxity

    • With paraplegia, most common levels are T10-L1

Radiographic Findings

  • Radiography

    • Commonly associated fracture or subluxation in younger adults (16-45 years)

    • Underlying degenerative change (canal stenosis) predisposes to cord injury in older population

    • SCI without radiographic abnormality (SCIWORA) is common in pediatric population (< 8 years)

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