In some instances, individuals with SCI may not present with any radiographic abnormalities. Although this is considered less common it is still worth noting. Spinal cord injury without radiological abnormality accounts for approximately 10% of SCIs and can be an indication for MRI. The few studies which have found no radiographic abnormalities are presented in Table 2 below.
Only two studies meeting our inclusion criteria examined individuals diagnosed with SCI without radiographic abnormality (Martinez-Perez et al., 2017, Ouchida et al. 2016). Martinez-Perez et al. (2017) assessed individuals who had normal CT scans and did not find any significant associations between physiological outcome and neurological improvement, except for in lesion length as seen on MRI. In this case, shorter lesion length was significantly associated with neurological improvement. Ouchida et al. (2016) found that MRI signal intensity was not significantly associated with the Japanese Orthopaedic Association scoring system, but prevertebral hyper-intensity range was. The first study suggests that an early MRI may pick up traumatic lesions in cases where CT has been negative. These studies also loosely suggest that MRI is less useful as a prognostic indicator of outcome and status in individuals diagnosed with SCI without radiographic abnormality compared to those with SCI who demonstrate radiographic abnormalities.
There is level 5 evidence (from one observational study: Martinez-Perez et al. 2017) that an early MRI may have prognostic value in individuals with SCI without CT evidence of trauma.
There is level 5 evidence (from an observational study: Ouchida et al. 2016) that MRI may not be an effective diagnostic or prognostic indicator of injury in individuals diagnosed with SCI without radiographic abnormality.