Evaluation of Spinal Cord Injury and Lesion with the Help of CT and MRI

In a nutshell Spinal Cord Injury (SCI) is an unexpected beginning disturbance to the neuronal tissue inside the spinal waterway bringing about spinal line harm, which happens because of injury, sickness or degeneration. Any harm to the spinal rope is an exceptionally perplexing physical issue. The spine is made up of 33 vertebrae that is twelve thoracic vertebrae, 7 cervical vertebrae, five fused sacral vertebrae, 5 lumbar vertebrae and four fused coccygeal vertebrae. The spinal rope connects the mind and the fringe nerves, sending engine data from the cerebrum to the muscles, tissues, and organs, as well as tangible data from these places back to the cerebrum. Imaging innovation is a significant piece of the analytic course of intense or constant spinal string wounds. Spinal string wounds can be recognized utilizing various kinds of imaging, which relies upon the sort of fundamental pathology.  Computed Tomography (CT) can detect delicate tissue changes such as line oedema, localised necrosis, demyelination, pimples, or abscesses, which result in decreased signal thickness, whereas haemorrhages and calcifications increase signal thickness. When spinal equipment in place makes MRI difficult, a combination of processed tomography and myelography better describes anomalies in the spinal trench than registered tomography alone. Extradural sores (growth, arteriovenous malformations) and channel split the difference are notably visible in figured tomography myelograms.

Spinal cord is cylindrical structure that goes from brain stem to lower back, passing through the core of spine. It's a fragile structure made up of nerve bundle of nerves and cells that transmit instructions from brain to rest of body. The spinal cord is considered to be the most important component of nervous system.

Figure 1: Spinal cord injury

A sudden, severe trauma to the vertebrae causes the majority of spinal cord injuries.  Spinal cord and nerves are then damaged by the fragmented bones. An injury can totally sever or split the spinal cord in rare cases.

Figure 2: spinal cord with injury

Types of Spinal Cord Injury

There are four sections of the spinal cord that impact level of spinal cord injury: cervical, thoracic, lumbar and sacral. Each section of the spine protects different groups of nerves that control body. The types and severity of spinal cord injuries can depend on the section of the spine that is injured.

Cervical spinal cord injuries

Cervical spinal cord injuries attack the head and neck region above shoulders. It is the most severe level of spinal cord injury.

Thoracic Spinal Cord Injuries

Thoracic spinal cord injuries attack the upper chest, mid-back and abdominal muscles. Arm and hand function is usually normal with this level of spinal cord injury.

Figure 3

Lumbar spinal cord injuries

Lumbar spinal cord injuries affect hips and legs. Individuals may need a wheelchair or walk with braces with this level of spinal cord injury.

Figure 4

Sacral Spinal Cord Injuries

Sacral spinal cord injuries affect hips, back of the thighs, buttocks and pelvic organs. Individuals are most likely able to walk with this level of spinal cord injury [9,10,11].

Figure 5

Diagnosis of spinal cord injuries

The following imaging tests can help in diagnosis of a spinal cord injury:

• A CT scan to check for shattered bones, blood clots, or damage to blood vessels.

• Magnetic resonance imaging (MRI) to examine the spinal cord and/or soft tissues.

• X-ray to see if there are any fractured or dislocated bones (bones knocked out of place).

An electromyogram (EMG) can be used to monitor electrical activity in muscles and nerve cells if there is co-existing peripheral nerve injury. (An EMG is rarely necessary in case of a spinal cord injury) [4].                                    

Equip mentation

MRI: Magnetic Resonance Imaging

MRI which is a medical imaging technique that is primarily used in radiology and nuclear medicine to investigate anatomy and physiology of body and detect pathologies such as tumors, inflammation, muscle and joint disorders, neurological complications such as stroke, and abnormalities in heart and blood vessels. Chemicals like contrast can be injected intravenously or into joint to improve image and aid diagnosis. MRI does not generate ionizing radiation, unlike CT and X-ray, making it a safe method to diagnose children and repeat runs. Patients having cochlear implants, non-ferromagnetic metal implants, and cardiac pacemakers can now get an MRI despite effects of strong magnetic fields [3].

CT scan

It gives 3dimensional cross sectional pictures of inward organs and designs. CT filter gives three-layered data on a solitary plane. The CT scanners are utilized to see pictures of inner organs, bones, delicate tissues and veins. It gives data on the size and area of organs. When a restricted light emission beam is directed at a patient, it surrounds the body, which sends signal that are constrained by machine's PC to make cross-sectional images or "cuts" of body. These cuts are alluded to as tomographic pictures, since they consist more data than conventional x-beams. When the machine's PC has gathered various progressive cuts, they can be carefully "stacked" together to produce a three-layered picture of the patient, making it simpler to distinguish and find fundamental designs as well as thought cancers or abnormalities [5].

Figure 6

Case No: 1

PATIENT- Age: 9 months old/M

HISTORY: flaccid paraplegia following a road traffic accident 7 months ago.

Case discussion: there is an irregularity of the dorsal spinal string from D2 to D5 level with areas of cystic cavitation as well as stringy tissue groups associating the cranial and caudal edges of the injury with regards to a constant spinal rope injury.

Figure 7

Impression: Case showing the chronic MRI appearances of traumatic spinal cord injury.[15]

Case No 2: Cervical trauma

PATIENT: AGE: 40 years old/M   HISTORY:  trauma from 15 days ago, no initial image after trauma with increasing intensity of pain 2 days ago.

Figure 8

Impression: Post-traumatic multiple injuries of the cervical spine include: C3 hyperextension teardrop fracture. Anterior translation of C6 over C7 with C6-7 perched facet joint on the left side. C6 left spondylolysis

Case No 3: Burst fracture L1

PATIENT: Age:40 years old/M

HISTORY: fall from height

Figure 9: Sagittal T2; Sagittal T1

Impression: Burst fracture of L1 vertebrae with retro pulsed fragment, which narrows the central canal causing local spinal cord compression. Burst fractures are a form of compression fracture that occurs when a vertebral body and the posterior vertebral body cortex are disrupted which results in high-energy axial loading spinal trauma [17].

Case No 4: Traumatic L1 vertebral body fracture

PATIENT -AGE: 29 years old/F

HISTORY: vertebral body fracture at L1 following a motor vehicle accident.

Figure 10

Impression: L1 vertebral body fracture and Two column injury at the thoracolumbar junction [18].

Case No 5: Traumatic spinal cord injury

PATIENT -Age: 50 years/F HISTORY: road traffic accident.

Figure 12: Axial bone window; B. sagittal bone window; C. coronal bone

Impression: The patient presented with quadriplegia. This case shows severe cervical spinal cord injury secondary to fractures with retropulsion fragments causing severe cord compression [19].

Computed Tomography (CT) can detect delicate tissue changes such as line oedema, localised necrosis, demyelination, pimples, or abscesses, which result in decreased signal thickness, whereas haemorrhages and calcifications increase signal thickness.  When spinal equipment in place makes MRI difficult, a combination of processed tomography and myelography better describes anomalies in the spinal trench than registered tomography alone. Extradural sores (growth, arteriovenous malformations) and channel split the difference are notably visible in figured tomography myelograms. Imaging plays an important role in the evaluation of acute and chronic spinal injury. Spinal cord and soft-tissue injuries are best evaluated by magnetic resonance imaging (MRI), whereas spinal fractures are better characterized by computed tomography (CT). Vascular injuries can be evaluated using CT or MR angiography. Specifically, the NICE guideline recommends MRI in the presence of abnormal neurological examination to exclude injuries to the C-spine disc, spinal cord, and ligaments following a prior positive or negative CT finding.