MRI imaging is giving neurosurgeons good insight into whether patients with serious spinal cord injuries can recover, a new study shows.
Within 48 hours of the injury, these images should be able to provide a reasonable prediction of a patient’s fate, Canadian researchers reported n the June issue of the journal Radiology.
Currently, MRIs are commonly but inconsistently performed on spinal cord injury patients, noted study co-author Dr. Michael G. Fehlings, professor of neurosurgery at the University of Toronto. In light of the study results, they should become the “standard of care, unless pressing medical circumstances preclude the test from being done,” he said.
The U.S. National Spinal Cord Injury Association estimates that between 250,000 to 400,000 Americans now have spinal cord injuries or other spinal cord problems. Motor vehicle accidents are responsible for about 44 percent of spinal cord injuries in the United States.
In the new study, Fehlings and colleagues examined 100 patients — 79 men and 21 women — with severe spinal cord injuries, mostly as a result of motor vehicle accidents. The patients underwent MRI scans that “allow doctors to see the site of spinal cord injury and to appreciate whether the spine is fractured and whether there is pressure on the spinal cord,” Fehlings said.
His team found that three factors — severity of spinal cord compression, bleeding and spinal cord swelling — were directly connected to poor outcomes. Essentially, the factors indicate “a more severe injury with less opportunity for recovery,” Fehlings said.
But the prognosis was good for patients without these symptoms, even if they were severely injured.
In addition to predicting the likelihood of recovery, MRI images can help doctors determine whether patients should undergo spinal cord decompression surgery, Fehlings said.
There is, of course, a potential downside to a bleak prediction: It could leave patients with little hope for the future. But Fehlings said that’s not necessarily so.
“Communication with patients is an art. It is important for physicians to communicate a sense of hope even in the setting of a severe spinal cord injury,” he said.
From another perspective, one doctor said it’s important for patients “to understand the bleakness of the future” if there are signs of those factors discussed in the study.
“Better to know than to be given false hope,” reasoned Dr. Robert Quencer, a radiologist at the University of Miami/Jackson Memorial Medical Center.
By Randy Dotinga