Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Predictive Values of Magnetic Resonance Imaging Features for Tracheostomy in Traumatic Cervical Spinal Cord Injury

  • Jeong, Tae Seok (Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine) ;
  • Lee, Sang Gu (Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine) ;
  • Kim, Woo Kyung (Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine) ;
  • Ahn, Yong (Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine) ;
  • Son, Seong (Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine)
  • Received : 2017.08.02
  • Accepted : 2017.09.23
  • Published : 2018.09.01
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Abstract

Objective : To evaluate the magnetic resonance (MR) imaging features that have a statistically significant association with the need for a tracheostomy in patients with cervical spinal cord injury (SCI) during the acute stage of injury. Methods : This study retrospectively reviewed the clinical data of 130 patients with cervical SCI. We analyzed the factors believed to increase the risk of requiring a tracheostomy, including the severity of SCI, the level of injury as determined by radiological assessment, three quantitative MR imaging parameters, and eleven qualitative MR imaging parameters. Results : Significant differences between the non-tracheostomy and tracheostomy groups were determined by the following five factors on multivariate analysis : complete SCI (p=0.007), the radiological level of C5 and above (p=0.038), maximum canal compromise (MCC) (p=0.010), lesion length (p=0.022), and osteophyte formation (p=0.015). For the MCC, the cut-off value was 46%, and the risk of requiring a tracheostomy was three times higher at an interval between 50-60% and ten times higher between 60-70%. For lesion length, the cut-off value was 20 mm, and the risk of requiring a tracheostomy was two times higher at an interval between 20-30 mm and fourteen times higher between 40-50 mm. Conclusion : The American Spinal Injury Association grade A, a radiological injury level of C5 and above, an MCC ${\geq}50%$, a lesion length ${\geq}20mm$, and osteophyte formation at the level of injury were considered to be predictive values for requiring tracheostomy intervention in patients with cervical SCI.

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References

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