Prognostic value of MRI variables combined with neutrophil-to-lymphocyte ratio in patients with cervical traumatic spinal cord injury

We aimed to explore the prognostic significance of preoperative magnetic resonance imaging (MRI) variables and novel inflammatory indicators in predicting neurological recovery post-cervical traumatic spinal cord injury (TSCI) in the study. We enrolled a total of 244 patients diagnosed with acute cervical TSCI from two hospitals and evaluated the prognostic value of MRI variables (intramedullary hemorrhage, intramedullary lesion length (IMLL), maximum spinal cord compression (MSCC), and maximum canal compromise (MCC)) and novel inflammatory indicators (neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammatory index (SII)) in patients with acute cervical TSCI. Among the 244 patients, 140 (57.38%) exhibited improved AIS grade conversion at 1-year follow-up. The results revealed intramedullary hemorrhage, IMLL, MCC, neutrophils, and NLR were significantly different compared with follow-up AIS grade. Furthermore, IMLL, MCC, WBCs, neutrophils, NLR, and LMR correlated with the follow-up AIS grade by Spearman's correlation analysis. Multivariate analysis showed IMLL, intramedullary hemorrhage, NLR and admission AIS grade emerged as independent predictors of AIS grade conversion. The receiver operating characteristic curve (ROC) analysis showed that the novel model (combination of MRI variables, NLR and admission AIS grade) produced a larger area under the curve compared with using only intramedullary hemorrhage, IMLL, NLR or admission AIS grade individually. In conclusion, intramedullary hemorrhage and IMLL and NLR are predictors of AIS grade conversion after cervical TSCI. Therefore, we suggest the combination of MRI variables and NLR for the prognostic prediction of AIS grade conversion in patients with cervical TSCI.