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Abstract

OBJECTIVE:

In patients with sub-acute spinal cord injury (SCI), the motor system undergoes progressive structural changes rostral to the lesion, which is predictive of motor outcome. The extent to which the sensory system is affected and how this relates to sensory outcome is uncertain.
METHODS:

Changes in the sensory system were prospectively followed by applying a comprehensive MRI protocol to fourteen patients with sub-acute traumatic SCI at baseline, two months, six months, and twelve months, combined with a full neurological examination and comprehensive pain assessment. Eighteen controls underwent the same MRI protocol. T1-weighted volumes and myelin-sensitive magnetisation transfer saturation (MT) and longitudinal relaxation rate (R1) mapping provided data on spinal cord and brain morphometry and microstructure. Regression analysis assessed the relationship between MRI readouts and sensory outcomes.
RESULTS:

At twelve months from baseline, sensory scores were unchanged and below-level neuropathic pain became prominent. Compared with controls, patients showed progressive degenerative changes in cervical cord and brain morphometry across the sensory system. At twelve months, MT and R1 were reduced in areas of structural decline. Sensory scores at twelve months correlated with rate of change in cord area and brain volume and decreased MT in the spinal cord at twelve months.
INTERPRETATION:

This study has demonstrated progressive atrophic and microstructural changes across the sensory system with a close relation to sensory outcome. Structural MRI protocols remote from the site of lesion provide new insights into neuronal degeneration underpinning sensory disturbance and have the potential as responsive biomarkers of rehabilitation and treatment interventions. This article is protected by copyright. All rights reserved.