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Deep tissue injury in patients with spinal cord injury: a magnetic resonance imaging–based risk assessment study

Spinal Cord (2025)Cite this article

Subjects

Abstract

Study design

Cross-sectional observational study.

Objectives

Deep-tissue injury (DTI) originates in subcutaneous soft tissue and progresses outward without early skin changes, making diagnosis difficult in people with spinal-cord injury (SCI). We evaluated the incidence of DTI with magnetic resonance imaging (MRI) and sought associated risk factors.

Setting

Kibikogen Rehabilitation Center for Employment Injuries, Japan.

Methods

Fifty-six wheelchair-dependent adults with SCI of at least 1 month’s duration underwent pelvic sagittal STIR MRI screening. DTI-positive sites were defined by signal changes in subcutaneous fat or muscle. Ultrasonography, body composition, seating-related variables, and laboratory data were collected concurrently. Univariate and multivariate logistic-regression analyses identified independent risk factors.

Results

MRI detected subclinical DTI in 33 of 112 ischial regions (29.5%). Ultrasonography was concordant in only 15 sites (45.5%). Multivariable analysis showed that longer daily wheelchair use (p = 0.018), greater subcutaneous-tissue thickness at the ischial tuberosities (p = 0.028), and less-frequent pressure-relief manoeuvres (p = 0.031; protective) were independently associated with DTI. BMI, peak interface pressure, and routine haematologic or nutritional markers were not significant.

Conclusions

MRI screening revealed subclinical DTI in nearly one-third of wheelchair-dependent patients with SCI and outperformed ultrasonography for early detection. Extended sitting time, thicker subcutaneous fat at the ischial tuberosity, and infrequent pressure relief emerged as modifiable risk factors. A risk-based MRI surveillance strategy may enable timely preventive interventions and reduce progression to overt pressure ulcers.

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Fig. 1: Sagittal short-tau inversion-recovery (STIR) MRI demonstrating subclinical deep tissue injury.

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Data availability

De-identified data are available from the corresponding author upon reasonable request and with IRB approval.

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Author information

Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Wakayama Medical University, Wakayama, Japan

    Yasuhiro Sakata, Gen Yamada & Shinichi Asamura

  2. Department of Rehabilitation Medicine, Kibikogen Rehabilitation Center for Employment Injuries, Kibichuo, Japan

    Takanori Namba & Kazunari Furusawa

  3. Department of Rehabilitation Medicine, Sapporo Medical University, Sapporo, Japan

    Yasunori Umemoto

  4. Department of Rehabilitation Medicine, Sano Memorial Hospital, Izumisano, Japan

    Tatsuya Yoshikawa

Authors
  1. Yasuhiro Sakata
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  2. Takanori Namba
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  3. Yasunori Umemoto
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  4. Tatsuya Yoshikawa
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  5. Kazunari Furusawa
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  6. Gen Yamada
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  7. Shinichi Asamura
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Contributions

YS designed the study, performed MRI and ultrasonographic evaluations, analyzed data, and drafted the manuscript. TN contributed to study design, patient recruitment, and data interpretation. YU and TY contributed to data collection, clinical assessment, and critical review of the manuscript. KF supervised the clinical and statistical analysis and contributed to manuscript revision. GY assisted with data analysis and figure preparation. SA supervised the entire project, provided critical revisions, and approved the final version of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yasuhiro Sakata.

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Competing interests

The authors declare no competing interests.

Ethical approval

Approved by the Institutional Review Board of Wakayama Medical University (Approval No. 3303). All methods were performed in accordance with the relevant guidelines and regulations, including the Declaration of Helsinki. Written informed consent was obtained from all participants.

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Sakata, Y., Namba, T., Umemoto, Y. et al. Deep tissue injury in patients with spinal cord injury: a magnetic resonance imaging–based risk assessment study. Spinal Cord (2025). https://doi.org/10.1038/s41393-025-01150-5

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