• Lukas Grassner, Christof Wutte, Georg Zimmermann, Andreas Grillhösl, Katharina Schmid, Thomas Weiβ, Walter Maier, Stefan Hauck, Tobias Hollerith, Matthias Vogel, Michael Bierschneider, Jan Vastmans, Claudius Thomé, Oliver Gonschorek, and Martin Strowitzki.
• Department of Neurosurgery, BG Trauma Center Murnau, Murnau, Germany; Center for Spinal Cord Injuries, BG Trauma Center Murnau, Murnau, Germany; Institute for Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria; Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria. Electronic address: Lukas.grassner@googlemail.com.
• World Neurosurg. 2019 Nov 1; 131: e586-e592.

ObjectiveEarly decompression after acute spinal cord injury (SCI) is recommended. Acute care is crucial, but optimal management is unclear. The aim of this study was to investigate the role of preoperative magnetic resonance imaging (MRI) in addition to computed tomography (CT) in surgical decision making for acute cervical SCI.MethodsAll patients with cervical SCI between 2008 and 2016 who had preoperative CT and MRI (n = 63) at the Trauma Center Murnau, Germany, were included. We administered a survey to 10 experienced spine surgeons (5 neurosurgeons, 5 trauma surgeons) regarding the surgical management. First, the surgeons were shown clinical information and CT scans. Two months later, the survey was repeated with additional MRI. Corresponding percentages of change and 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).ResultsMRI modified surgical timing in a median of 41% of patients (interquartile range 38%-56%). In almost every fifth patient (17%), no surgery would have been indicated with CT alone. The advocated surgical approach was changed in almost half of patients (median 48%, interquartile range 33%-49%). Surgically addressed levels were changed in a median of 57% of patients (interquartile range 56%-60%). MRI led to higher agreement with the real-world decision concerning addressed levels (median 35% vs. 73%), timing (median 51% vs. 57%), and approach (median 44% vs. 65%).ConclusionsPreoperative MRI influenced surgical decision making substantially in our cohort and has become a new standard for patients with cervical SCI in our institution if medically possible.Copyright © 2019 Elsevier Inc. All rights reserved.

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