LAUSR

BACKGROUND Early decompression after acute spinal cord injury (SCI) is recommended. Acute care is crucial but optimal management is unclear. OBJECTIVES To investigate the role of preoperative MRI on top of CT scans on the surgical decision-making for acute cervical SCI. METHODS This study was performed at the Trauma Center Murnau, Germany. We included all cervical SCI patients between 2008-2016 with preoperative CT and MRI (n=63). Then, we completed a survey among 10 experienced spine surgeons (5 neurosurgeons, 5 trauma surgeons) regarding the surgical management. At first, clinical information and CT scans were demonstrated. After 2 months, the survey was repeated with additional MRI. Corresponding percentages of change/agreement were obtained for each rater and survey item. Finally, results from both parts of the survey were compared with the definitive treatment option (i.e. "real world decision"). RESULTS MRI modified the surgical timing in a median of 41% (IQR: 38-56%). In almost every fifth patient (17%) no surgery would have been indicated with the CT alone. The advocated surgical approach was changed in almost half of cases (median: 48%, IQR: 33-49). Surgically addressed levels (others, additional or different levels) were changed in a median of 57% (IQR: 56-60%). MRI led to higher agreement with the "real-world decision" concerning the addressed level(s) (median: 35 versus 73%), timing (median: 51 versus 57%) and approach (median: 44 versus 65%). CONCLUSION Preoperative MRI influenced surgical decision-making substantially in our cohort and has become a new standard for cervical SCI patients in our institution if medically possible.