This is an X-ray image of EH post spine surgery. You can clearly see her vertebrae, as well as the metal screws and rod that were inserted between the fourth and sixth cervical vertebra to stabilize her spine. The overall goal of this surgery is to preserve or improve neurological function, provide stability, and decrease pain. The vertebrae and other bony structures are clearly depicted, whereas the spinal cord and any evidence of neurological changes are not visible.

Here we show a T ₂-weighted fast spin echo imaging of EH’s head and neck, in a midline sagittal slice. This MRI method has low sensitivity to magnetic field distortions that are often caused by metallic spinal fixation devices. Signal voids at the positions of the screws and plate across the C4–C6 vertebrae are clearly visible. The disruption to the spinal cord tissue at the same level is also clearly demonstrated. Although the cord tissue is clearly visible and the tissue disruption is evident in this image, there is no evidence of how neurological functions have been altered by the injury.

EH volunteered for research functional MRI studies with thermal stimulation on the right and left hands, on the little finger side of the palm, corresponding to the eighth cervical spinal cord segment, below the level of injury. The top panels show corresponding results from an age- and gender-matched person with no previous injury. Areas of the spinal cord and brainstem that responded to thermal stimulation of each hand are indicated on the anatomical images in red for positive responses and blue for negative responses. Transverse sections through the cord and brainstem are also shown for selected locations to illustrate the cross-sectional distribution of the responses detected with fMRI. These results demonstrate neural communication from below the level of injury to the brainstem, for both right-side and left-side stimulation. The activity detected on both sides is altered relative to the control participant example, but is nonetheless present. This is one of the few techniques that can be applied noninvasively in people that can show the neurological changes in the spinal cord as a result of injury.

Routine clinical imaging primarily consists of plain film X-ray, and, if there is evidence of neurological deficit, CT is often used. MRI is less commonly used, but is known to provide important supplementary information. While X-ray-based imaging methods clearly depict disruption to the bony structures, they only give evidence for or against suspected neurological damage. MRI can demonstrate tissue damage to the spinal cord, whereas to obtain any information about neurological changes as a result of traumatic spinal cord injury, functional MRI is needed. However, current fMRI methods are entirely experimental and are useful for clinical research but have not yet reached the stage of clinical use.