Spinal Cord Trauma and Related Diseases Workup

Updated: Aug 28, 2020
  • Author: Francisco de Assis Aquino Gondim, MD, PhD, MSc, FAAN; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Laboratory Studies

Laboratory studies are performed as indicated for the evaluation of a patient with trauma. While no specific tests for the evaluation of SCI are indicated for acute cases, these may be required with long-term medical complications of SCI. Analysis of spinal fluid may be necessary for the evaluation of nontraumatic causes of SCI such as transverse myelitis and to rule out other conditions when diagnosis is uncertain.


Imaging Studies

Anteroposterior, lateral, and special view (eg, odontoid and neuroforaminal) radiography is important to show alignment of bony structures. If cervical fracture is suspected, visualizing the T1 is important to avoid missing low cervical fractures or subluxation. Radiography can miss facet fractures, and dynamic radiographic views are often warranted. However, in the immediate setting, they are contraindicated and computerized tomographic (CT) imaging and magnetic resonance imaging (MRI) are the preferred methods. If one fracture is found, other levels should be carefully checked for additional injury. The absence of fractures does not ensure spinal column stability.

CT imaging is better for bone definition and is important when radiography shows injury or when an area is poorly visualized. CT imaging can also show soft tissue changes, cord edema, demyelination, cysts, abscesses, hemorrhage, and calcifications. CT myelography is preferred for better evaluation of spinal canal abnormalities.

MRI is the best method for definition of neural tissues. MRI findings correlate with neurologic status and help to establish prognosis. Patients with spinal cord injury without radiographic abnormality (SCIWORA) should undergo MRI testing of the suspected area, radiographic screening of the entire spinal cord, assessment of spinal stability with flexion-extension radiographs (in the acute setting and late follow-up, even with negative MRI), but neither spinal angiography or myelography is recommended.

See the image below.

A T1-weighted MRI that depicts a lesion with high A T1-weighted MRI that depicts a lesion with high signal enhancement inside the cervical spinal cord. This type of signal enhancement is consistent with blood and is most commonly observed secondary to cord trauma.

Other Tests

Studies such as functional MRI, magnetoencephalography, positron emission tomography, transcranial magnetic stimulation, somatosensory evoked potentials, electromyography, and nerve conduction studies are used as research tools but are not indicated routinely.