Cervicothoracic translational injury: Radiological analysis and risk factors of spinal cord injury

Purpose: To determine various radiological parameters predicting spinal cord injury (SCI) in patients with cervicothoracic translational injury. Materials and Methods: Forty-four patients operated for cervicothoracic (C7-T1) translational injury between January 2009 and 2019 were reviewed to obtain demographic details, mechanism of injury (based on Allen Ferguson classification), and neurology at the time of presentation (American Spinal Injury Association [ASIA] grade). Preoperative computed tomography scans were used to measure parameters like anterior translation, local kyphotic angle, residual canal diameter (RCD) at injury level/cranial level/caudal level, and magnetic resonance imaging scans were used to measure maximum canal compromise (MCC), maximum spinal cord compression (MSCC), and length of cord edema. Patients were divided into group 1 (complete neurodeficit), group 2 (incomplete neurodeficit), and group 3 (normal neurology), and the radiological predictors were compared. Results: In our study, anterior translation (P < 0.001), RCD at the injury level (P < 0.001), RCD at the caudal level (P < 0.001), MSCC (P < 0.001), and MCC (P < 0.001) were associated with the increased risk of SCI at the time of presentation. Comparison among all three patient groups showed significant differences in the above parameters. The optimal cutoff for risk of SCI is 7.8 mm for anterior translation, 8.6 mm for RCD at the injury level, 11.9 mm for RCD at the caudal level, 30% for MCC, and 24% for MSCC. Conclusion: Our data highlight that in addition to the amount of anterior translation, canal diameter, and the degree of spinal cord compression at the injury level, the RCD at the caudal level also determines the incidence of SCI in cervicothoracic translational injuries.