Determining the neurological level of injury (NLI) is of paramount importance after spinal cord injury (SCI), although its accuracy depends on the neurologic examination’s reliability. Here, we determine if the anatomic location of cervical cord injury by MRI can predict NLI in the acute traumatic setting. A retrospective review was there of SCI patients with visible evidence of cervical cord injury from non-penetrating trauma, all of whom had undergone cervical spine MRI and complete neurologic testing. The recorded MRI information included cord lesion type (intra-axial edema, hemorrhage) and MRI locations of upper and lower lesion boundary and lesion epicenter. Pearson correlation and Bland–Altman analyses were used to assess the relationship between MRI levels of injury and NLI.

All five MRI parameters, namely (1) upper and (2) lower boundaries of cord edema, (3) lesion epicenter, and (4) upper and (5) lower limits of cord hemorrhage, demonstrated statistically significant, positive correlations with NLI. The doctors and researchers found the MRI locations of the upper and lower boundary of bleeding to have the strongest correlation with NLI. A weaker correlation existed between the lower edge of cord edema and NL. MRI level of injury can serve as a surrogate for NLI in instances where the neurologic examination is either unavailable or unreliable.