Background: Acute cervical spinal cord injury (CSCI) is an important cause of morbidity and mortality in adults due to respiratory distress and can prove fatal. Such patients may need definitive airway support. In this study, we analyzed MRI imaging factors in such patients that may suggest risk of respiratory failure.

Methods: Thirty–seven patients with CSCI over 18months were studied. Respiratory failure was considered when mechanical ventilation was required. Neurological function was assessed using ASIA scoring. Cervical spine MRI features were evaluated. Statistical analysis was done using SPSS.

Results: There were 35males and 2females. Mean age was 45.5years. Most common mechanism of injury was fall from height(28/37 pts). Spinal cord injury level was C2 in 3, C3 in 17, C4 in 15 and C5 in 2patients. Upper level of cord edema was at C2–3 in 20/37patients. Respiratory failure occurred in 21/37(56.7%) patients. All patients with respiratory failure had a neurological level of C5 or above.

Conclusion: MRI can accurately localize CSCI and identify patients at–risk of respiratory failure. Cord edema extending to C2–3 strongly predicts respiratory involvement. Bony level correlates poorly with respiratory distress. Definitive airway may be established early in high–risk patients.