Magnetic resonance imaging pattern and mechanisms of spinal injury at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Traumatic spinal injury is a debilitating disease as it may lead to paresis or paralysis. Prompt and accurate diagnosis is needed so as to determine the appropriate method of management and prevent further complications. Magnetic Resonance Imaging is a powerful diagnostic tool and has been proven to be superior to other imaging modalities when it comes to characterization of spinal injuries as it has a high resolution, no bone artefacts therefore high specificity and sensitivity leading to high accuracy and therefore has been referred to as the gold standard in neuroradiology. The most common mechanism of spinal trauma has been found to be as a result of motor vehicle accidents but in some countries falls have been the leading cause. Objective: To determine the mechanism of injury and their association to the Magnetic Resonance Imaging scan findings in adult patients with acute traumatic spinal injury at Moi Teaching and Referral Hospital. Methods: This was a cross sectional descriptive study carried out in the Radiology and Imaging department of MTRH between March 2019 and February 2020. Census was used to recruit 94 patients with acute spinal injury sent for MRI and who met inclusion criteria. A structured interviewer administered questionnaire was used to collect data on the demographics, history of trauma and imaging findings interpreted by the researcher and at least two radiologists. Categorical variables were analysed as frequencies and their corresponding percentages while the numerical variables were analysed as median and their corresponding interquartile ranges. Chi Square and Fischer‘s Exact test were used to assess association of MRI findings with causes of spinal injury. P value of less than 0.05 was considered significant. Data was presented in tables and figures. Results: Majority of the participants were male (77%). Median age was 32 (IQR: 25- 41) years. Most patients had spinal injury as a result of motor vehicle accident 80 (85.11%) followed by falls (11.70%) and the least being gunshot injury (1.06%). 69.15% of the subjects sustained spinal cord injuries, 59.57% had marrow oedema while vertebral fractures were present in 54.26%. Only 7.45 % had ligamentous injuries, 35.11% had disc injures and half of the participants had other soft tissues injuries. Cord oedema (55.32%) was the most prevalent pattern on the cord, no hemorrhage was noted and only one patient had cord transection. Lumbar vertebrae had the most fractures at 39.20%, thoracic 31.37%, cervical 27.45% and cervicothoracic 1.96%. Disc herniation 31.91% were the majority in disc injuries while 3.19% had disc rupture. Two patients had anterior longitudinal ligament injury while 5 had posterior ligamentous complex involvement. Spinal cord injuries, fractures, ligamentous injuries and disc injuries had no association with mechanism of injury (P= >0.99, 0.71, >0.99 and 0.88 respectively). Conclusion: Majority of the patients (85%) sustained injuries as a result of road traffic accident with the least being gunshot injuries. Spinal cord injuries (69.15%) were the most common followed by bone oedema and fractures. Ligamentous injury was the least common finding. There was no significant association of MRI findings with mechanism of traumatic spinal injury Recommendation: Similar studies with larger sample size to ascertain the strength of association.