Chronic spinal cord injury in the pediatric population: does magnetic resonance imaging correlate with the International Standards for Neurological Classification of Spinal Cord Injury examination?

STUDY DESIGN Prognostic, retrospective case series. OBJECTIVE.: This study is part of a larger investigation to develop and validate a standardized and reliable method to evaluate and classify the neurologic consequence of spinal cord injury (SCI) in children. Such an instrument may also find use in the evaluation of patients with concomitant brain injury and/or cognitive impairment. We examined the relationship between the International Standards for Neurologic Classification of Spinal Cord Injury (ISCSCI) examination and magnetic resonance imaging (MRI) findings in a pediatric SCI population. SUMMARY OF BACKGROUND DATA Recently, the reliability of the ISCSCI in young children with SCI who are unable to cognitively engage in the examination has been called into question. This has important implications as appropriate classification of these patients is necessary for prognostication, follow-up care, and appropriate placement into clinical trials. METHODS Our longitudinal pediatric SCI database was reviewed for children with chronic SCI (>6 months), ISCSCI examinations performed by experienced testers, and adequate MRIs of the spine. ISCSCI results were correlated with MRI findings. Twenty-six subjects were identified. RESULTS Overall, good to excellent relationships between ISCSCI neurologic level (NL) and MRI level of injury were found [Kendall tau correlation coefficient 0.90 (P < 0.001)]. The ISCSCI NL was on an average, two-thirds of a vertebral level cephalad to the center of the lesion on MRI. One child with MRI evidence of cord disruption tested incomplete at ISCSCI examination. CONCLUSION The ISCSCI examination was found to have good to excellent relationships with MRI level in children with chronic SCI. Our results suggest MRI may be a useful adjunct for the determination of NL in children unable to participate with the examination. Our results also suggest caution in using the ISCSCI for the determination of completeness in young children. Further research into new methods (e.g., diffusion tensor imaging) to determine completeness of injury is warranted.