David Lawrence MD, Abstract Co-Author: Nothing to Disclose

Michael Gregory Fox MD, Presenter: Stockholder, Pfizer Inc

Brian Michael Trotta MD, Abstract Co-Author: Nothing to Disclose

Michelle S. Barr MD, Abstract Co-Author: Nothing to Disclose

Prashant Raghavan MD, Abstract Co-Author: Nothing to Disclose

Francis H. Shen MD, Abstract Co-Author: Consultant, Johnson & Johnson Consultant, Globus Medical, Inc Royalties, Globus Medical, Inc Royalties, Reed Elsevier

Determine characteristics of post-traumatic cervical spinal extra-arachnoid collections that may allow for conservative management instead of surgical decompression.

IRB approval obtained. Over a 17 month period, we retrospectively reviewed cervical spine MRIs on all patients >16-years-old with post-traumatic extra-arachnoid fluid collections. Patients were divided into 4 groups: 1) fusion for unstable spinal injuries (n=21); 2) small collections that required no treatment or follow-up (n=18); 3) surgical evacuation for neurologic deficits (n=1); and 4) moderate to large collections with follow-up MRI within 30 days (n=9). Group 4 collections were then evaluated for size, morphology and MR signal intensity.

No group 4 collection enlarged and no patient (mean age-40 years) developed worsening neurologic symptoms. 78% (7/9) of the collections demonstrated thin, tapered margins, extended >9.5 cm in length and had variable signal characteristics: hyper-T1/iso-T2 (n=1), iso-T1/T2 (n=3), hyper-T1/hypo-T2 (n=3), and mixed-T1/T2 (n=1). Follow-up MRI demonstrated complete resolution or significant decrease (n=4) between 1 to 12 days; stable or slight decrease (n=3) between 2 to 11 days. Two neurologically intact patients refused surgery for 2 mass-like collections that were then managed conservatively. These collections measured 2-3 levels in length, were confined to <90 degrees of the spinal canal diameter. One collection was slightly smaller after 1 day and 1 resolved after 31 days.

Post traumatic extraarachnoid spinal collections that have ventral and dorsal components with long, thin tapered margins will often resolve rapidly, irrespective of the signal characteristics.

Conservative management of post-traumatic extra-arachnoid collections that have long thin tapered margins with serial neurologic checks and follow-up MRIs is safe in neurologically asymptomatic or stable patients.  

Lawrence, D, Fox, M, Trotta, B, Barr, M, Raghavan, P, Shen, F, Post-traumatic Cervical Spine Extra-Arachnoid Collections: Characteristics that May Allow for Conservative Management.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14016699.html