Cervical traumatic spinal cord injury

Spinal cord injury (SCI) typically affects the cervical level of the spinal cord (50%) with the single most common level affected being C5 1).

Cervical spine fracture is the leading cause of morbidity and mortality in trauma patients, and bone fracture is associated with 56% of cervical spinal cord injury.

see High cervical spinal cord injury.

Patients with acute cervical spinal cord injury present complex clinical challenges. These injuries may result in motor and sensory deficits and also in cardiovascular and respiratory perturbations. Increased attention to critical care support has led to improved survival and recovery in many patients. The methods and technology used to diagnose and classify these injuries as well as medical and surgical treatments have evolved significantly in recent decades 2).

The cord-canal-area ratio (> 0.8) or the space available for the spinal cord (< 1.2 mm) measured on MR images can be used to reliably identify patients at risk for acute CSCI after a minor trauma to the cervical spine. However, there does not seem to be any association between spinal canal imaging characteristics and the severity of or recovery from CSCI after a minor trauma 3).

Magnetic resonance imaging (MRI) has become an important tool in the evaluation of cervical spinal cord injury. In the acute posttraumatic period, intramedullary signal abnormalities on MRI may signify disruption of the intramedullary microstructure, sensory tracts, and motors tracts as previously demonstrated with diffusion tensor imaging (DTI). Such disruption often results in edema and posttraumatic inflammation manifesting as T2 hyperintensity 4).

A prospective cohort study aimed to evaluate the recovery of penetration/aspiration and functional feeding outcome in patients with acute TCSCI.

Tampere University Hospital, Tampere, Finland

Forty-six patients with TCSCI were enrolled. All the patients received speech therapeutic interventions based on their clinical needs and were examined with a videofluoroscopic swallowing study (VFSS) at enrollment. The incidence of VFSS-verified laryngeal penetration/aspiration according to Rosenbek's Penetration-Aspiration Scale (PAS) served as the primary outcome. The secondary outcome was the level of functional oral intake (as per the Functional Oral Intake Scale; FOIS). Based on the PAS results, the patients were divided into two groups: (i) penetrator/aspirators (PAS score ≥3) and (ii) non-penetrator/aspirators (PAS score ≤2). Follow-up VFS studies were primarily conducted on the patients with penetration/aspiration in prior VFS studies. The follow-up VFS studies were scheduled on the basis of clinical demand.

Of the 46 patients, 48% had penetration/aspiration in the first VFSS. The second VFSS was conducted on 20 patients, of whom 6 patients (30%) had penetration/aspiration. The third VFSS was conducted on 9 patients. Of these, only two (22%) patients were still penetrator/aspirators. The majority (n = 37, 88%) of the patients presented a total oral intake without restrictions at the time of the final follow-up. Only one patient (2%) was still tube-dependent with consistent oral intake.

Swallowing physiology in patients with TCSCI improved during the first months after injury, and the number of penetrator/aspirators decreased progressively 5).

Hachem LD, Ahuja CS, Fehlings MG. Assessment and management of acute spinal cord injury: From point of injury to rehabilitation. J Spinal Cord Med. 2017 Nov;40(6):665-675. doi: 10.1080/10790268.2017.1329076. Epub 2017 Jun 1. Review. PubMed PMID: 28571527; PubMed Central PMCID: PMC5778930.
Ropper AE, Neal MT, Theodore N. Acute management of traumatic cervical spinal cord injury. Pract Neurol. 2015 Aug;15(4):266-72. doi: 10.1136/practneurol-2015-001094. Epub 2015 May 18. Review. PubMed PMID: 25986457.
Rüegg TB, Wicki AG, Aebli N, Wisianowsky C, Krebs J. The diagnostic value of magnetic resonance imaging measurements for assessing cervical spinal canal stenosis. J Neurosurg Spine. 2015 Mar;22(3):230-6. doi: 10.3171/2014.10.SPINE14346. Epub 2014 Dec 19. PubMed PMID: 25525959.
Song T, Chen WJ, Yang B, et al. Diffusion tensor imaging in the cervical spinal cord. Eur Spine J. 2011;20(3):422-428.
Ihalainen T, Luoto TM, Rinta-Kiikka I, Ronkainen A, Korpijaakko-Huuhka AM. Traumatic cervical spinal cord injury: recovery of penetration/aspiration and functional feeding outcome. Spinal Cord. 2018 Oct;56(10):1000-1007. doi: 10.1038/s41393-018-0091-1. Epub 2018 Mar 12. PubMed PMID: 29531267.
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