Introduction:
ln the last century, conventional radiography, computed tomography and myelography were currently used as first-line investigation for acute spinal injury. Nevertheless, with these modalities, the diagnosis of spinal cord injury was made only indirectly, either by abnormal spinal alignment, relative spinal canal narrowing or presence of bone fragment within the spinal canal. Further characterization of cord lesion with these modalities were and is still poor. Magnetic resonance imaging (MRI) can directly visualize the spinal cord and is nowadays the gold standard to explore spinal cord disease and particularly non traumatic cord lesions. However, due to the worldwide limited access to magnetic resonance imaging in emergency context, indications to perform an urgent spinal magnetic resonance scan are often postponed for hours or days, increasing costs and delays to the patient, and referring physician. The Lausanne University Hospital is the first Hospital in Switzerland with a 3 Tesla magnetic resonance scan in the emergency department, used in daily practice since the 1st of May 2018, this facility optimizes the diagnosis and the management of patients with neurological symptoms or deficits in the emergency department. This retrospective study focuses on its use in the context of spinal injuries with the aim of making an analysis of the pathologies identified as well as the demographic characteristics of these patients and their flow in this emergency context
Material and methods
All patients over 18 years old for which no refusal was documented and who underwent an entire spine magnetic resonance imaging to the emergency department at Lausanne University Hospital between the 1st of January 2018 and the 31st of December 2020 have been enrolled. All these exams are available in the institutional Picture Archiving and Communication System (PACS) of the Lausanne University Hospital. Demographics, clinical and biological data for every patient are available in the institutional patient file (SOARIAN). From the radiological reports, we first differentiated between pathological and non-pathological examinations and each pathological findings were classified in different categories according to the etiology (traumatic, tumoral, inflammatory, infectious, vascular, malformities, degenerative, other). All data were collected on secure Excel spreadsheets for statistical analysis.
Results and discussion
During the first three years of use, 622 whole-spine MRI were performed on a total of 569 patients. In 86.8% of patients, one or more pathological findings, most commonly at the meningeal-disc-vertebral level, were identified. These findings were mostly of degenerative origin. Spinal cord involvement was detected in 19.5% of patients, and in these cases, neoplastic lesions were the most common cause of the injuries. The patient population was composed of 52.5% men and 47.5% women, with a mean age of 60.7 years. These demographic characteristics varied according to the etiologies. These results demonstrate a relatively similar trend to current literature data with some specificities, particularly related to the emergency context of this study.