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Objective:  To investigate the usefulness of the combination of neurological findings and magnetic resonance imaging (MRI) as a prognostic predictor in patients with motor complete cervical spinal cord injury (CSCI) in the acute phase. Design:  A cross-sectional analysis Setting:  Department of Orthopaedic Surgery, Spinal Injuries Center Participants/Methods:  Forty-two patients with an initial diagnosis of motor complete CSCI (AIS A,  n  = 29; AIS B,  n  = 13) within 72 h after injury were classified into the recovery group (Group R) and the non-recovery group (Group N), based on the presence or absence of motor recovery (conversion from AIS A/B to C/D) at three months after injury, respectively. The Neurological Level of Injury (NLI) at the initial diagnosis was investigated and the presumptive primary injured segment of the spinal cord was inferred from MRI performed at the initial diagnosis. We investigated whether or not the difference between the presumptive primary injured segment and the NLI exceeded one segment. The presence of a difference between the presumptive primary injured segment and the NLI was compared between Groups R and N. Results:  The number of cases with the differences between the presumptive primary injured segment and the NLI was significantly higher in Group N than in Group R. Conclusion:  The presence of differences between the presumptive primary injured segment and the NLI might be a poor improving prognostic predictor for motor complete CSCI. The NLI may be useful for predicting the recovery potential of patients with motor complete CSCI when combined with the MRI findings.

Significance of the neurological level of injury as a prognostic predictor for motor complete cervical spinal cord injury patients