Singh R, Gautam S, Aggarwal S, Kaur S, Jain M. Correlation of magnetic resonance imaging biomarkers (tissue bridges) with neurological recovery following traumatic spinal cord injury. World J Orthop 2025; 16(11): 110426 [DOI: 10.5312/wjo.v16.i11.110426]
Corresponding Author of This Article
Mantu Jain, MD, Additional Professor, Department of Orthopaedics, All India Institute of Medical Sciences Bhubaneswar, Sijua, Bhubaneswar 751019, Odisha, India. montu_jn@yahoo.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Prospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Roop Singh, Department of Orthopaedic Surgery, Paraplegia & Rehabilitation, Rohtak 124001, Haryāna, India
Sachin Gautam, Department of Orthopedics, Sharma PGIMS, Rohtak 124001, Haryāna, India
Shalini Aggarwal, Department of Radiodiagnosis, Sharma PGIMS, Rohtak 124001, Haryāna, India
Svareen Kaur, Baba Saheb Ambedkar Medical College, New Delhi 110085, Delhi, India
Mantu Jain, Department of Orthopaedics, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar 751019, Odisha, India
Author contributions: Singh R was responsible for conceptualization, methodology, writing the original draft, and revising the draft; Gautam S was responsible for conceptualization, methodology, recruitment, critical inputs, and revising the draft; Aggarwal S was responsible for methodology, recruitment, critical inputs, and revising the draft; Kaur S was responsible for writing the original draft and revision of drafts; Jain M was responsible for writing the original draft and revision of drafts.
Clinical trial registration statement: The registration identification number is CTRI/2023/10/059194.
Informed consent statement: Informed consent was taken for the patients.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other co-authors who contributed their efforts in this manuscript.
Data sharing statement: Consent for data sharing was taken from the patient. The first author has the excel sheet, if needed.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mantu Jain, MD, Additional Professor, Department of Orthopaedics, All India Institute of Medical Sciences Bhubaneswar, Sijua, Bhubaneswar 751019, Odisha, India. montu_jn@yahoo.com
Received: June 7, 2025 Revised: July 9, 2025 Accepted: October 10, 2025 Published online: November 18, 2025 Processing time: 161 Days and 15.9 Hours
Abstract
BACKGROUND
Spinal cord injury (SCI) imposes enduring physical impairments and substantial socio-economic burdens. These injuries are either traumatic incidents or ischemic but exhibit comparable clinical recoveries. This suggests shared underlying neurodegenerative mechanisms, such as neuronal cell death, demyelination, and axonal degeneration, regardless of aetiology.
AIM
To investigate the relationship between the magnetic resonance imaging (MRI) biomarkers (tissue bridges) and clinical outcome in acute traumatic SCI.
METHODS
In this prospective study adult patients with acute SCI who were examined clinically and radiologically within first 48 hours and subsequently at intervals were included. Clinical assessment included sensory score, motor score and zone of partial preservation. Radiological scores included measurement kyphotic deformities - sagittal index, regional kyphosis, gardener segmental kyphotic deformity. MRI on 3 Tesla machine was done to evaluate quantitative & qualitative parameters, and tissue bridges at one and 6 months.
RESULTS
There were 47 patients with a mean age of 40.43 ± 10.73 years and male/female ratio of 34:13. There was a significant (P < 0.05) improvement in clinical, radiological, and MRI parameters at 6 months. Maximum spinal cord compression (MSCC), maximal canal compression, lesion length, width, and area; dorsal tissue bridges; ventral tissue bridges, total width of tissue bridges; and midsagittal tissue bridge ratios at one month significantly (P < 0.05) correlated with the 6-month total motor score and total sensory score. Further, the regression analysis demonstrated clinical improvement to dimensions of tissue bridges at 6 months.
CONCLUSION
The MRI imaging biomarkers in SCI patients demonstrated substantial improvement over time. There was a negative correlation between neurological recovery, MSCC, maximum canal compromise, and lesion dimensions (lesion length, lesion width, and lesion area). Higher canal compromise and lesion dimensions were associated with a poorer outcome. The evaluation of the midsagittal tissue bridge (including the ventral tissue bridge, dorsal tissue bridge, total width of the tissue bridge, and tissue bridge ratios) at 1 and 6 months showed a positive correlation with the neurological recovery.
Core Tip: This prospective study highlights the prognostic value of magnetic resonance imaging (MRI) biomarkers, particularly tissue bridges, in acute spinal cord injury (SCI). Quantitative MRI parameters, especially midsagittal tissue bridge dimensions assessed at 1 and 6 months, positively correlated with motor and sensory recovery. Conversely, greater spinal canal compromise and lesion size predicted poorer outcomes. These findings underscore the utility of early MRI-based assessment in predicting neurological recovery and guiding management in traumatic SCI.
