Publication: Papel pronóstico de la resonancia magnética en el trauma cervical
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2019-01-29
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Universidad Complutense de Madrid
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Abstract
La Lesión Medular Aguda (LMA) traumática tiene lugar a nivel cervical en las dos terceras partes de los casos. Por ello, el trauma cervical es una potencial fuente de incapacidad a largo plazo. La estructura interna de la médula espinal y la integridad delos ligamentos cervicales se visualiza mejor mediante los estudios de Resonancia Magnética (RM). Desde comienzos de los años 90, algunos estudios han analizado la importancia de algunos hallazgos radiológicos en la RM cervical en pacientes con LMA traumática. La relación entre la longitud de la lesión y la evolución neurológica ha quedado suficientemente demostrada. Sin embargo, la importancia de otros hallazgos como la lesión de los ligamentos cervicales, así como el verdadero valor pronóstico delas variables radiológicas cuando la exploración neurológica inicial es considerada como factor predictor permanecen sin resolver. De modo similar, existe un grupo de pacientes dentro de la LMA pero sin evidencia tomográfica de traumatismo (SCIWOCTET) al que se ha considerado como un subgrupo con una evolución favorable, aunque este hecho no se ha corroborado en estudios con un número sustancial de pacientes y los factores pronósticos no se han determinado con exactitud
Acute traumatic spinal cord injury (SCI) is located at the cervical level in two thirds of cases. Thus, cervical trauma is potentially the source of long-term disability because of its associated risk of SCI. The internal architecture of the spinal cord and integrity of cervical ligaments are best visualized with Magnetic Resonance imaging (MRI). Since the early 1990s, several studies have investigated the role of several radiologic findings in patients with traumatic SCI. The correlation between lesion length and neurologic outcome has been sufficiently demonstrated in the acute phase after cervical trauma. However, the importance of other radiological findings, such as the injury of the cervical ligaments, and the real prognostic value of the radiological variables when the initial neurological examination comes into consideration remains unresolved. In a similar manner, there is a group of patients with SCI but without computed tomography (CT) evidence of trauma (SCIWOCTET), whose neurological outcome has been suggested to be favorable, although this finding has never been corroborated in larger studies and the prognostic factors in this entity are still unknown...
Acute traumatic spinal cord injury (SCI) is located at the cervical level in two thirds of cases. Thus, cervical trauma is potentially the source of long-term disability because of its associated risk of SCI. The internal architecture of the spinal cord and integrity of cervical ligaments are best visualized with Magnetic Resonance imaging (MRI). Since the early 1990s, several studies have investigated the role of several radiologic findings in patients with traumatic SCI. The correlation between lesion length and neurologic outcome has been sufficiently demonstrated in the acute phase after cervical trauma. However, the importance of other radiological findings, such as the injury of the cervical ligaments, and the real prognostic value of the radiological variables when the initial neurological examination comes into consideration remains unresolved. In a similar manner, there is a group of patients with SCI but without computed tomography (CT) evidence of trauma (SCIWOCTET), whose neurological outcome has been suggested to be favorable, although this finding has never been corroborated in larger studies and the prognostic factors in this entity are still unknown...
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Tesis de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 08-09-2017