Keywords:
Acute, Surgery, Outcomes analysis, MR, Neuroradiology spine, Musculoskeletal spine, Emergency
Authors:
H. M. A. OBrien, G. Karnati, J. Kasznia-Brown, S. King, P. Burn; Taunton/UK
DOI:
10.26044/ecr2019/C-1124
Results
A total of 250 acute OOH spinal MRIs were performed in this time period.
Figure 1 demonstrates the number of scans performed over the 4 year period per quarter per annum.
When comparing the first 6 month period in 2014 with the same time period in 2018 we demonstrated a 3 fold increase in the number of scans performed before midnight and a 13 fold increase in the number of scans performed after midnight (See Figure 2).
However,
the frequency of overnight spinal surgery over the same 4 year period has remained stable (See Figure 3).
On MRI,
25 patients (10%) had positive findings of cord/cauda compression,
with the following causes: tumour (12 patients),
disc herniation (4),
epidural abscess (3),
epidural haematoma (2),
post-surgical complications (3) and traumatic fracture (1).
Of these,
6 patients (24%; 6/25) had same night surgery (2.4%; 6/250 patients) for the following causes: disc herniation (3 patients),
post-surgical collection/haematoma (2),
and traumatic fracture (1). 44% (n=11) had surgery within 5 days of the MRI being performed and 32% (n=8) did not undergo surgical intervention and were managed conservatively (4) and with radiotherapy (4).
Figures 4-6 demonstrate three cases of MRIs that were performed for CES or MSCC as emergency OOH scans.
Figure 4 demonstrates a positive scan with CES and this patient had emergency OOH spinal surgery on the same night as their scan.
Figure 5 demonstrates MRI findings similar to those in figure 4,
however,
this patient had surgery 16 hours after their MRI was performed.
Figure 6 demonstrates a case with MSCC but this patient did not have surgical management for this. They had progression of their metastatic disease and were a candidate for palliative care only.