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Ni M, Li S, Wen X, Wang B, Jiang C, Zhang X, Lang N, Jiang L, Yuan H. A matched case-control study of early cervical spondylotic myelopathy based on diffusion magnetic resonance imaging. Insights Imaging 2024; 15:25. [PMID: 38270768 PMCID: PMC10811301 DOI: 10.1186/s13244-023-01579-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/29/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Early cervical spondylotic myelopathy (CSM) is challenging to diagnose and easily missed. Diffusion MRI (dMRI) has the potential to identify early CSM. METHODS Using diffusion tensor imaging (DTI), diffusion kurtosis imaging (DKI), and neurite orientation dispersion and density imaging (NODDI), a 1:1 matched case-control study was conducted to evaluate the potential of dMRI in identifying early CSM and assessing uncompressed segments of CSM patients. CSM patients and volunteers were matched by age and spinal location. The differences in dMRI parameters between groups were assessed by the paired t-test, the multicollinearity of the dMRI parameters was evaluated by the variance inflation factor (VIF), and the value of dMRI parameters in distinguishing controls from CSM patients was determined by logistic regression. The univariate t-test was used to analyse differences between CSM patients and volunteers in adjacent uncompressed areas. RESULTS In total, 56 CSM patients and 56 control volunteers were included. Paired t-tests revealed significant differences in nine dMRI parameters between groups. Multicollinearity calculated through VIF and combined with logistic regression showed that the orientation division index (ODI) was significantly positively correlated (r = 2.12, p = 0.035), and the anisotropic water fraction (AWF) was significantly negatively correlated (r = -0.98, p = 0.015). The fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), isotropic volume fraction (ISOVF), ODI, and AWF were significantly different in the upper and lower uncompressed areas at all ages. CONCLUSION dMRI can noninvasively identify early CSM patients and potentially identify the extent of CSM lesions involving the cervical spinal cord. CRITICAL RELEVANCE STATEMENT Diffusion MRI (dMRI) can identify early cervical spondylotic myelopathy (CSM) and has the potential to help determine the extent of CSM involvement. The application of dMRI can help screen for early CSM and develop clinical surgical and rehabilitation treatment plans. KEY POINTS • Diffusion MRI can differentiate between normal and early-stage cervical spondylotic myelopathy patients. • Diffusion MRI has the ability to identify the extent of spinal cord involvement in cervical spondylotic myelopathy. • Diffusion MRI enables the early screening of cervical spondylotic myelopathy and helps guide clinical treatment.
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Affiliation(s)
- Ming Ni
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Shujing Li
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Xiaoyi Wen
- Institute of Statistics and Big Data, Renmin University of China, Beijing, China
| | - Ben Wang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Chenyu Jiang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | | | - Ning Lang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Liang Jiang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China.
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, Beijing, China.
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2
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Hesni S, Baxter D, Saifuddin A. The imaging of cervical spondylotic myeloradiculopathy. Skeletal Radiol 2023; 52:2341-2365. [PMID: 37071191 DOI: 10.1007/s00256-023-04329-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/12/2023] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
This review provides a detailed description of the imaging features of cervical spondylotic myelopathy and radiculopathy, with a focus on MRI. Where relevant, we will outline grading systems of vertebral central canal and foraminal stenosis. Whilst post-operative appearances of the cervical spine are outside the scope of this paper, we will touch on imaging features recognised as predictors of clinical outcome and neurological recovery. This paper will serve as a reference for both radiologists and clinicians involved in the care of patients with cervical spondylotic myeloradiculopathy.
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Affiliation(s)
- Susan Hesni
- Department of Radiology, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK.
| | - David Baxter
- Department of Surgery, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK
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3
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Locke KC, Randelman ML, Hoh DJ, Zholudeva LV, Lane MA. Respiratory plasticity following spinal cord injury: perspectives from mouse to man. Neural Regen Res 2022; 17:2141-2148. [PMID: 35259820 PMCID: PMC9083159 DOI: 10.4103/1673-5374.335839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/18/2021] [Accepted: 10/20/2021] [Indexed: 12/03/2022] Open
Abstract
The study of respiratory plasticity in animal models spans decades. At the bench, researchers use an array of techniques aimed at harnessing the power of plasticity within the central nervous system to restore respiration following spinal cord injury. This field of research is highly clinically relevant. People living with cervical spinal cord injury at or above the level of the phrenic motoneuron pool at spinal levels C3-C5 typically have significant impairments in breathing which may require assisted ventilation. Those who are ventilator dependent are at an increased risk of ventilator-associated co-morbidities and have a drastically reduced life expectancy. Pre-clinical research examining respiratory plasticity in animal models has laid the groundwork for clinical trials. Despite how widely researched this injury is in animal models, relatively few treatments have broken through the preclinical barrier. The three goals of this present review are to define plasticity as it pertains to respiratory function post-spinal cord injury, discuss plasticity models of spinal cord injury used in research, and explore the shift from preclinical to clinical research. By investigating current targets of respiratory plasticity research, we hope to illuminate preclinical work that can influence future clinical investigations and the advancement of treatments for spinal cord injury.
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Affiliation(s)
- Katherine C. Locke
- Department of Neurobiology & Anatomy, Drexel University, Philadelphia, PA, USA
- Marion Murray Spinal Cord Research Center, Philadelphia, PA, USA
| | - Margo L. Randelman
- Department of Neurobiology & Anatomy, Drexel University, Philadelphia, PA, USA
- Marion Murray Spinal Cord Research Center, Philadelphia, PA, USA
| | - Daniel J. Hoh
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Lyandysha V. Zholudeva
- Marion Murray Spinal Cord Research Center, Philadelphia, PA, USA
- Cardiovascular Disease, Gladstone Institutes, San Francisco, CA, USA
| | - Michael A. Lane
- Department of Neurobiology & Anatomy, Drexel University, Philadelphia, PA, USA
- Marion Murray Spinal Cord Research Center, Philadelphia, PA, USA
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4
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Fugazzotto D, Devoti CC, Cassano IA, Teani C, Berti E, Brusati M, Zeira O. Clinical and diagnostic imaging findings in a bengal tiger ( Panthera tigris tigris) with cervical spondylomyelopathy: A case report. BRAZILIAN JOURNAL OF VETERINARY MEDICINE 2022; 44:e003921. [PMID: 35749102 PMCID: PMC9179195 DOI: 10.29374/2527-2179.bjvm003921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/31/2022] [Indexed: 11/25/2022] Open
Abstract
An adult neutered male Bengal tiger (Panthera tigris tigris) presented with abnormal gait. Neurological examination showed poor left ambulatory hemiparesis, spontaneous proprioceptive deficit in the left anterior limb, and decreased flexor reflex in the forelimbs. The neurological symptoms suggested a caudal cervical spinal cord lesion. Pathological findings included increased cholinesterase and protein levels in the cerebrospinal fluid. Computed tomography examination revealed C2-C3 intervertebral disc herniation, C5-C6 intervertebral disc herniation associated with a reduction of the intervertebral space, and mild ventral dislocation of the C6 vertebra compared to C5. In addition, severe bilateral shoulder osteoarthritis and a hypoattenuating nodule in the left thyroid gland with an open etiology were observed. These findings were interpreted as indicating cervical spondylomyelopathy (CSM). Treatment included analgesic and steroidal anti-inflammatory therapy as well as movement restriction. Follow-up at 4 weeks showed modest improvement. Thus, CSM should be included in the differential diagnosis of tigers with neurological cervical signs.
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Affiliation(s)
- Domenico Fugazzotto
- Veterinarian, Ospedale Veterinario San Michele, Tavazzano con Villavesco, LO, Italy
- Correspondence Domenico Fugazzotto Ospedale Veterinario San Michele Via Primo Maggio 37 26838 Tavazzano con Villavesco, (LO), Italy E-mail:
| | - Chiara Costa Devoti
- Veterinarian, MSc, Ospedale Veterinario San Michele, Tavazzano con Villavesco, LO, Italy
| | - Ilaria Anna Cassano
- Veterinarian, Ospedale Veterinario San Michele, Tavazzano con Villavesco, LO, Italy
| | - Chiara Teani
- Veterinarian, MSc, Ospedale Veterinario San Michele, Tavazzano con Villavesco, LO, Italy
| | - Elisa Berti
- Head of Centro Tutela e Ricerca Fauna Esotica e Selvatica Sasso Marconi, (BO), Italy
| | - Marta Brusati
- Veterinarian, Ospedale Veterinario San Michele, Tavazzano con Villavesco, LO, Italy
| | - Offer Zeira
- Veterinarian, PhD, Head of Opsedale Veterinario San Michele, Tavazzano con Villavesco, (LO), Italy
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5
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Hansen HC, Wertheimer D, Soeffker G, Els T. [Irreversible loss of brain function : Requirements and Clinical diagnosis]. Med Klin Intensivmed Notfmed 2021; 116:459-471. [PMID: 34009402 DOI: 10.1007/s00063-021-00824-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/12/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
Brain death (irreversible loss of brain function), according to German regulations, is investigated exclusively by qualified specialists in a strictly hierarchical three-step pattern and a four-eyes principle. In step 1 all necessary prerequisites are to be checked and the pathophysiology of brain damage has to be classified. Step 2 comprises the clinical investigation of reactivity to external stimuli and the upper, middle and lower brain stem reflexes including apnea testing. Step 3 exclusively checks for irreversibility of this condition. The latter is achieved by appropriate technical investigations or by repeated clinical examinations within context-specified intervals (range 12-72 h). However, exclusion of contributing primarily infratentorial pathologies is necessary to avoid limitations of the clinical findings. In this paper, both the initiation of brain death diagnostics and the approved clinical tests regarding to their execution, their alternatives and limits are presented and special situations like conditions with extracorporeal membrane oxygenation (ECMO) are also examined.
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Affiliation(s)
- H-C Hansen
- Klinik für Neurologie, Friedrich-Ebert-Krankenhaus GmbH Neumünster, Universität Hamburg, 24534, Neumünster, Deutschland.
| | - D Wertheimer
- Neurologische Abteilung, Schön Klinik Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Deutschland
| | - G Soeffker
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - T Els
- Klinik für Neurologie und klinische Neurophysiologie, GFO-Kliniken Rhein-Berg, Betriebsstätte Marien-Krankenhaus, Dr.-Robert-Koch-Straße 18, 51465, Bergisch Gladbach, Deutschland
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6
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Sánchez JAS, Sharif S, Costa F, Rangel JAIR, Anania CD, Zileli M. Early Management of Spinal Cord Injury: WFNS Spine Committee Recommendations. Neurospine 2021; 17:759-784. [PMID: 33401855 PMCID: PMC7788427 DOI: 10.14245/ns.2040366.183] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 10/11/2020] [Indexed: 12/29/2022] Open
Abstract
Scientific knowledge today is being generated more rapidly than we can assimilate thus requiring continuous review of gold-standards for diagnosis and treatment of specific pathologies. The aim of this paper is to provide an update on the best early management of spinal cord injury (SCI), in order to produce acceptable worldwide recommendations to standardize clinical practice as much as possible.The WFNS Spine Committee voted recommendations regarding management of SCI based on literature review of the last 10 years. The committee stated 9 recommendations on 3 main topics: (1) clinical assessment and classification of SCI; (2) emergency care and early management; (3) cardiopulmonary management. American Spinal Injury Association impairment scale, Spinal Cord Independence Measure, and International Spinal Cord Injury Basic Pain Data Set are considered the most useful and feasible in emergency evaluation and follow-up in case of SCI. Magnetic resonance imaging is the most indicated examination to evaluate patients with symptomatic SCI. In early phase, correction of hypotension (systolic blood pressure < 90 mmHg), and bradycardia are strongly recommended. Surgical decompression should be performed as soon as possible with the ideal surgical time being within 8 hours for both complete and incomplete lesions.
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Affiliation(s)
| | - Salman Sharif
- Department of Neurosurgery, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | - Francesco Costa
- Department of Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | | | - Carla Daniela Anania
- Department of Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Mehmet Zileli
- Department of Neurosurgery, Ege University, Izmir, Turkey
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7
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Zhang H, Guan L, Hai Y, Liu Y, Ding H, Chen X. Multi-shot echo-planar diffusion tensor imaging in cervical spondylotic myelopathy. Bone Joint J 2020; 102-B:1210-1218. [PMID: 32862690 DOI: 10.1302/0301-620x.102b9.bjj-2020-0468.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIMS The aim of this study was to use diffusion tensor imaging (DTI) to investigate changes in diffusion metrics in patients with cervical spondylotic myelopathy (CSM) up to five years after decompressive surgery. We correlated these changes with clinical outcomes as scored by the Modified Japanese Orthopedic Association (mJOA) method, Neck Disability Index (NDI), and Visual Analogue Scale (VAS). METHODS We used multi-shot, high-resolution, diffusion tensor imaging (ms-DTI) in patients with cervical spondylotic myelopathy (CSM) to investigate the change in diffusion metrics and clinical outcomes up to five years after anterior cervical interbody discectomy and fusion (ACDF). High signal intensity was identified on T2-weighted imaging, along with DTI metrics such as fractional anisotropy (FA). MJOA, NDI, and VAS scores were also collected and compared at each follow-up point. Spearman correlations identified correspondence between FA and clinical outcome scores. RESULTS Significant differences in mJOA scores and FA values were found between preoperative and postoperative timepoints up to two years after surgery. FA at the level of maximum cord compression (MCL) preoperatively was significantly correlated with the preoperative mJOA score. FA postoperatively was also significantly correlated with the postoperative mJOA score. There was no statistical relationship between NDI and mJOA or VAS. CONCLUSION ms-DTI can detect microstructural changes in affected cord segments and reflect functional improvement. Both FA values and mJOA scores showed maximum recovery two years after surgery. The DTI metrics are significantly associated with pre- and postoperative mJOA scores. DTI metrics are a more sensitive, timely, and quantifiable surrogate for evaluating patients with CSM and a potential quantifiable biomarker for spinal cord dysfunction. Cite this article: Bone Joint J 2020;102-B(9):1210-1218.
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Affiliation(s)
- Hanwen Zhang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Li Guan
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yuzeng Liu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hongtao Ding
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaolong Chen
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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8
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Janzen RWC, Lambeck J, Niesen WD, Erbguth F. [Irreversible loss of brain function-Part 1: pitfalls in clinical diagnosis]. DER NERVENARZT 2020; 91:743-757. [PMID: 32705299 DOI: 10.1007/s00115-020-00952-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A significant change in the fourth update of the German guidelines on determining brain death is that it includes an explicit profile of requirements on physicians involved in ILBF diagnosis. These requisite qualification criteria have also been formulated due to the fact that, in many hospitals, ILBF diagnosis is only rarely carried out and, as a result, uncertainty frequently arises. Typical difficulties emerge at all stages of ILBF diagnosis, and numerous relevant pitfalls arise that need to be taken into consideration and which might also be relevant in the selection of the method(s) to detect irreversibility. The approaches presented here are suited to achieving a valid result in the evaluation of equivocal ILBF.
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Affiliation(s)
| | - J Lambeck
- Klinik für Neurologie und Neurophysiologie, Universitätsklinikum Freiburg, Breisacher Str. 64, 79106, Freiburg, Deutschland
| | - W-D Niesen
- Klinik für Neurologie und Neurophysiologie, Universitätsklinikum Freiburg, Breisacher Str. 64, 79106, Freiburg, Deutschland.
| | - F Erbguth
- Klinik für Neurologie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Klinikum Nürnberg, Nürnberg, Deutschland
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9
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Sabaghian S, Dehghani H, Batouli SAH, Khatibi A, Oghabian MA. Fully automatic 3D segmentation of the thoracolumbar spinal cord and the vertebral canal from T2-weighted MRI using K-means clustering algorithm. Spinal Cord 2020; 58:811-820. [PMID: 32132652 DOI: 10.1038/s41393-020-0429-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Method development. OBJECTIVES To develop a reliable protocol for automatic segmentation of Thoracolumbar spinal cord using MRI based on K-means clustering algorithm in 3D images. SETTING University-based laboratory, Tehran, Iran. METHODS T2 structural volumes acquired from the spinal cord of 20 uninjured volunteers on a 3T MR scanner. We proposed an automatic method for spinal cord segmentation based on the K-means clustering algorithm in 3D images and compare our results with two available segmentation methods (PropSeg, DeepSeg) implemented in the Spinal Cord Toolbox. Dice and Hausdorff were used to compare the results of our method (K-Seg) with the manual segmentation, PropSeg, and DeepSeg. RESULTS The accuracy of our automatic segmentation method for T2-weighted images was significantly better or similar to the SCT methods, in terms of 3D DC (p < 0.001). The 3D DCs were respectively (0.81 ± 0.04) and Hausdorff Distance (12.3 ± 2.48) by the K-Seg method in contrary to other SCT methods for T2-weighted images. CONCLUSIONS The output with similar protocols showed that K-Seg results match the manual segmentation better than the other methods especially on the thoracolumbar levels in the spinal cord due to the low image contrast as a result of poor SNR in these areas.
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Affiliation(s)
- Sahar Sabaghian
- Department of Software, School of Computer Engineering, Iran University of Science and Technology, Tehran, Iran.,Neuro Imaging and Analysis Group (NIAG), Research Center for Molecular and Cellular Imaging (RCMCI), Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Dehghani
- Neuro Imaging and Analysis Group (NIAG), Research Center for Molecular and Cellular Imaging (RCMCI), Tehran University of Medical Sciences, Tehran, Iran.,Department of Medical Physics and Biomedical Engineering, Faculty of Advanced Technologies in Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Seyed Amir Hossein Batouli
- Neuro Imaging and Analysis Group (NIAG), Research Center for Molecular and Cellular Imaging (RCMCI), Tehran University of Medical Sciences, Tehran, Iran.,Department of Neuroscience and Addiction studies, School of Advanced Technologies in Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Ali Khatibi
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Mohammad Ali Oghabian
- Neuro Imaging and Analysis Group (NIAG), Research Center for Molecular and Cellular Imaging (RCMCI), Tehran University of Medical Sciences, Tehran, Iran. .,Department of Medical Physics and Biomedical Engineering, Faculty of Advanced Technologies in Medicine, Tehran University of Medical Science, Tehran, Iran.
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10
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Seif M, David G, Huber E, Vallotton K, Curt A, Freund P. Cervical Cord Neurodegeneration in Traumatic and Non-Traumatic Spinal Cord Injury. J Neurotrauma 2019; 37:860-867. [PMID: 31544628 PMCID: PMC7071087 DOI: 10.1089/neu.2019.6694] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This study aimed to compare macrostructural and microstructural neurodegenerative changes remote from a cervical spinal cord injury in traumatic spinal cord injury (tSCI) and degenerative cervical myelopathy (DCM) patients using quantitative magnetic resonance imaging (MRI). Twenty-nine tSCI patients, 20 mild/moderate DCM patients, and 22 healthy controls underwent a high-resolution MRI protocol at the cervical cord (C2/C3). High-resolution T2*-weighted and diffusion-weighted scans provided data to calculate tissue-specific cross-sectional areas of the spinal cord and tract-specific diffusion indices of cord white matter, respectively. Regression analysis determined associations between neurodegeneration and clinical impairment. tSCI patients showed more impairment in upper limb strength and manual dexterity when compared with DCM patients. While macrostructural MRI measures revealed a similar extent of remote cord atrophy at cervical level, microstructural measures (diffusion indices) were able to distinguish more pronounced tract-specific neurodegeneration in tSCI patients when compared with DCM patients. Tract-specific neurodegeneration was associated with upper limb impairment. Despite clinical differences between severely impaired tSCI compared with mildly affected DCM patient, extensive cord atrophy is present remotely from the focal spinal cord injury. Diffusion indices revealed greater tract-specific alterations in tSCI patients. Therefore, diffusion indices are more sensitive than macrostructural MRI measures as these are able to distinguish between traumatic and non-traumatic spinal cord injury. Neuroimaging biomarkers of cervical cord integrity hold potential as predictors of recovery and might be suitable biomarkers for interventional trials both in traumatic and non-traumatic SCI.
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Affiliation(s)
- Maryam Seif
- Spinal Cord Injury Center, Balgrist University Hospital, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gergely David
- Spinal Cord Injury Center, Balgrist University Hospital, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Eveline Huber
- Spinal Cord Injury Center, Balgrist University Hospital, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kevin Vallotton
- Spinal Cord Injury Center, Balgrist University Hospital, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Center, Balgrist University Hospital, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London, United Kingdom.,Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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11
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McCoy DB, Dupont SM, Gros C, Cohen-Adad J, Huie RJ, Ferguson A, Duong-Fernandez X, Thomas LH, Singh V, Narvid J, Pascual L, Kyritsis N, Beattie MS, Bresnahan JC, Dhall S, Whetstone W, Talbott JF. Convolutional Neural Network-Based Automated Segmentation of the Spinal Cord and Contusion Injury: Deep Learning Biomarker Correlates of Motor Impairment in Acute Spinal Cord Injury. AJNR Am J Neuroradiol 2019; 40:737-744. [PMID: 30923086 DOI: 10.3174/ajnr.a6020] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/11/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to use 2D convolutional neural networks for automatic segmentation of the spinal cord and traumatic contusion injury from axial T2-weighted MR imaging in a cohort of patients with acute spinal cord injury. MATERIALS AND METHODS Forty-seven patients who underwent 3T MR imaging within 24 hours of spinal cord injury were included. We developed an image-analysis pipeline integrating 2D convolutional neural networks for whole spinal cord and intramedullary spinal cord lesion segmentation. Linear mixed modeling was used to compare test segmentation results between our spinal cord injury convolutional neural network (Brain and Spinal Cord Injury Center segmentation) and current state-of-the-art methods. Volumes of segmented lesions were then used in a linear regression analysis to determine associations with motor scores. RESULTS Compared with manual labeling, the average test set Dice coefficient for the Brain and Spinal Cord Injury Center segmentation model was 0.93 for spinal cord segmentation versus 0.80 for PropSeg and 0.90 for DeepSeg (both components of the Spinal Cord Toolbox). Linear mixed modeling showed a significant difference between Brain and Spinal Cord Injury Center segmentation compared with PropSeg (P < .001) and DeepSeg (P < .05). Brain and Spinal Cord Injury Center segmentation showed significantly better adaptability to damaged areas compared with PropSeg (P < .001) and DeepSeg (P < .02). The contusion injury volumes based on automated segmentation were significantly associated with motor scores at admission (P = .002) and discharge (P = .009). CONCLUSIONS Brain and Spinal Cord Injury Center segmentation of the spinal cord compares favorably with available segmentation tools in a population with acute spinal cord injury. Volumes of injury derived from automated lesion segmentation with Brain and Spinal Cord Injury Center segmentation correlate with measures of motor impairment in the acute phase. Targeted convolutional neural network training in acute spinal cord injury enhances algorithm performance for this patient population and provides clinically relevant metrics of cord injury.
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Affiliation(s)
- D B McCoy
- From the Departments of Radiology and Biomedical Imaging (D.B.M., S.M.D., J.N., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - S M Dupont
- From the Departments of Radiology and Biomedical Imaging (D.B.M., S.M.D., J.N., J.F.T.)
| | - C Gros
- NeuroPoly Lab (C.G., J.C.-A.), Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, Quebec, Canada
| | - J Cohen-Adad
- NeuroPoly Lab (C.G., J.C.-A.), Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, Quebec, Canada
| | - R J Huie
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - A Ferguson
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - X Duong-Fernandez
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - L H Thomas
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - V Singh
- Departments of Neurology (V.S.)
| | - J Narvid
- From the Departments of Radiology and Biomedical Imaging (D.B.M., S.M.D., J.N., J.F.T.)
| | - L Pascual
- Orthopedic Surgery (L.P.), Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California
| | - N Kyritsis
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - M S Beattie
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - J C Bresnahan
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - S Dhall
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - W Whetstone
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - J F Talbott
- From the Departments of Radiology and Biomedical Imaging (D.B.M., S.M.D., J.N., J.F.T.) .,Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.)
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12
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Vansteenkiste D, Martin-Vaquero P, Bonelli M, da Costa LB, da Costa RC. Long-term computed tomography follow-up in great Danes with or without signs of osseous- associated cervical Spondylomyelopathy. BMC Vet Res 2019; 15:90. [PMID: 30866937 PMCID: PMC6416867 DOI: 10.1186/s12917-019-1835-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 03/04/2019] [Indexed: 11/25/2022] Open
Abstract
Background Osseous- associated cervical spondylomyelopathy (OA-CSM) has a high prevalence in Great Danes. In order to understand the progression of osseous changes, we aimed to perform a long-term computed tomographic (CT) follow-up study of Great Dane dogs with and without OA-CSM. Canine CSM is comparable to a common neurologic disease often diagnosed in older people termed cervical spondylotic myelopathy or degenerative cervical myelopathy, which is progressive in nature. The natural history of cervical spondylotic myelopathy in people has been well described, whereas there is scarce information on the natural history of canine OA-CSM. Our first goal was to evaluate if follow-up CT studies showed any changes compared to initial CT studies in Great Dane dogs with a diagnosis of OA-CSM. Our second goal was to establish whether clinically normal Great Danes went on to develop any vertebral changes or clinical signs consistent with OA-CSM. We enrolled Great Danes diagnosed with OA-CSM and clinically normal Great Danes who had previously participated in a prospective study. All dogs had clinical and CT follow-up evaluations. Results Twelve Great Dane dogs were investigated: six OA-CSM affected and six clinically normal dogs. The median time between CT studies was 28 months (OA-CSM dogs) and 25 months (normal dogs). On follow-up CT, two OA-CSM-affected dogs developed new sites of stenosis, and two clinically normal dogs developed new sites of stenosis (one each). Disc spaces most commonly affected were C4-C5, C5-C6 and C6-C7. New sites of foraminal stenosis were noted in two of the CSM-affected and four of the clinically normal dogs. Morphometric evaluation showed no statistically significant differences between the initial and follow-up CT studies in the OA-CSM affected or normal groups. Conclusion Our long-term CT follow-up study documented progression of vertebral canal stenosis in four out of twelve dogs. The majority of dogs did not develop new sites of stenosis or show progression of vertebral lesions.
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Affiliation(s)
- Daniella Vansteenkiste
- College of Veterinary Medicine, The Ohio State University, 601 Vernon L. Tharp St, Columbus, OH, USA
| | | | - Marília Bonelli
- College of Veterinary Medicine, The Ohio State University, 601 Vernon L. Tharp St, Columbus, OH, USA
| | - Luciana B da Costa
- College of Veterinary Medicine, The Ohio State University, 601 Vernon L. Tharp St, Columbus, OH, USA
| | - Ronaldo C da Costa
- College of Veterinary Medicine, The Ohio State University, 601 Vernon L. Tharp St, Columbus, OH, USA.
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13
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Cummins DP, Connor JR, Heller KA, Hubert JS, Kates MJ, Wisniewski KR, Berliner JC, O’Dell DR, Elliott JM, Weber KA, Smith AC. Establishing the inter-rater reliability of spinal cord damage manual measurement using magnetic resonance imaging. Spinal Cord Ser Cases 2019; 5:20. [PMID: 31240117 PMCID: PMC6461921 DOI: 10.1038/s41394-019-0164-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 11/24/2022] Open
Abstract
Study design Retrospective study. Objectives To establish the inter-rater reliability in the quantitative evaluation of spinal cord damage following cervical incomplete spinal cord injury (SCI) utilizing magnetic resonance imaging (MRI). MRI was used to perform manual measurements of the cranial and caudal boundaries of edema, edema length, midsagittal tissue bridge ratio, axial damage ratio, and edema volume in 10 participants with cervical incomplete SCI. Setting Academic university setting. Methods Structural MRIs of 10 participants with SCI were collected from Northwestern University's Neuromuscular Imaging and Research Lab. All manual measures were performed using OsiriX (Pixmeo Sarl, Geneva, Switzerland). Intraclass correlation coefficients (ICC) were used to determine inter-rater reliability across seven raters of varying experience. Results High-to-excellent inter-rater reliability was found for all measures. ICC values for cranial/caudal levels of involvement, edema length, midsagittal tissue bridge ratio, axial damage ratio, and edema volume were 0.99, 0.98, 0.90, 0.84, and 0.93, respectively. Conclusions Manual MRI measures of spinal cord damage are reliable between raters. Researchers and clinicians may confidently utilize manual MRI measures to quantify cord damage. Future research to predict functional recovery following SCI and better inform clinical management is warranted.
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Affiliation(s)
| | | | | | | | - Megan J. Kates
- Regis University School of Physical Therapy, Denver, CO USA
| | | | | | - Denise R. O’Dell
- Regis University School of Physical Therapy, Denver, CO USA
- Craig Hospital, Englewood, CO USA
| | - James M. Elliott
- Faculty of Health Sciences, The University of Sydney, Northern Sydney Local Health District, St Leonards, Sydney, NSW Australia
- Northwestern University Department of Physical Therapy and Human Movement Sciences, Chicago, IL 60611 USA
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia
| | - Kenneth A. Weber
- Stanford University Department of Anesthesiology, Perioperative and Pain Medicine, Palo Alto, CA USA
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14
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Boban J, Thurnher MM, Van Goethem JW. Spine and Spinal Cord Trauma. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-68536-6_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Qin C, Zhang WH, Yang DG, Yang ML, Du LJ, Li JJ. Myelotomy promotes locomotor recovery in rats subjected to spinal cord injury: A meta-analysis of six randomized controlled trials. Neural Regen Res 2018; 13:1096-1106. [PMID: 29926838 PMCID: PMC6022467 DOI: 10.4103/1673-5374.233454] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE: To investigate the effects of myelotomy on locomotor recovery in rats subjected to spinal cord injury. DATA SOURCES: Electronic databases including PubMed, Science Citation Index, Cochrane Library, China National Knowledge Infrastructure, Chinese Journals Full-text Database, China Biology Medicine disc, and Wanfang Database were searched to retrieve related studies published before September 2017. The MeSH terms (the Medical Subject Headings) such as “myelotomy”, “spinal cord injuries”, “rats”, “randomized controlled trial” and all related entry terms were searched. DATA SELECTION: Randomized controlled trials using myelotomy for the treatment of acute spinal cord injury in rats were included. Basso, Beattie, and Bresnahan scores were adopted as the evaluation method. RevMan Software (version 5.3) was used for data processing. The χ2 and I2 tests were used to assess heterogeneity. Using a random-effects model, a subgroup analysis was conducted to analyze the source of the heterogeneity. OUTCOME MEASURES: Basso, Beattie, and Bresnahan scores were observed 1–6 weeks after spinal cord injury. RESULTS: Six animal trials were included, using a total of 143 lab rats. The included trials were divided into two subgroups by injury degrees (moderate or severe). The pooled results showed that, 1–6 weeks after spinal cord injury, the overall Basso, Beattie, and Bresnahan score was significantly higher in the myelotomy group than in the contusion group (weighted mean difference (WMD) = 0.60; 95% confidence interval (CI): 0.23–0.97; P = 0.001; WMD = 2.10; 95% CI: 1.56–2.64; P < 0.001; WMD = 2.65; 95% CI: 1.73–3.57; P < 0.001; WMD = 1.66; 95% CI: 0.80–2.52; P < 0.001; WMD = 2.09; 95% CI: 0.92–3.26, P < 0.001; WMD = 2.25; 95% CI: 1.06–3.44, P < 0.001). The overall heterogeneity was high (I2 = 85%; I2 = 95%; I2 = 94%; I2 = 88%; I2 = 91%; I2 = 89%). The results in the moderate injury subgroup showed that Basso, Beattie, and Bresnahan scores were significantly higher in the myelotomy group than in the contusion group (WMD = 0.91, 95% CI: 0.52–1.3, P < 0.001; WMD = 2.10; 95% CI: 1.56–2.64, P < 0.001; WMD = 2.65; 95% CI: 1.73–3.57, P < 0.001; WMD = 2.50, 95% CI: 1.72–3.28, P < 0.001; WMD = 3.29, 95% CI: 2.21–4.38, P < 0.001; WMD = 3.27; 95% CI: 2.31–4.23, P < 0.001). The relevant heterogeneity was low. However, there were no significant differences in Basso, Beattie, and Bresnahan scores between the myelotomy and contusion groups in the severe injury subgroup at 2 and 3 weeks after the injury (P = 0.75; P = 0.92). CONCLUSION: To date, this is the first attempt to summarize the potential effect of myelotomy on locomotor recovery in rats with spinal cord injury. Our findings conclude that myelotomy promotes locomotor recovery in rats with spinal cord injury, especially in those with moderate injury.
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Affiliation(s)
- Chuan Qin
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center; Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Wen-Hao Zhang
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center; Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - De-Gang Yang
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center; Beijing Key Laboratory of Neural Injury and Rehabilitation; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
| | - Ming-Liang Yang
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center; Beijing Key Laboratory of Neural Injury and Rehabilitation; China Rehabilitation Science Institute; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
| | - Liang-Jie Du
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center; Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Jian-Jun Li
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center; Beijing Key Laboratory of Neural Injury and Rehabilitation; China Rehabilitation Science Institute; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
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Botolin S, VanderHeiden TF, Moore EE, Fried H, Stahel PF. The role of pre-reduction MRI in the management of complex cervical spine fracture-dislocations: an ongoing controversy? Patient Saf Surg 2017; 11:23. [PMID: 28904564 PMCID: PMC5591568 DOI: 10.1186/s13037-017-0139-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 09/05/2017] [Indexed: 11/17/2022] Open
Abstract
Background Cervical spine fracture-dislocations in neurologically intact patients represent a surgical challenge due to the risk of inflicting iatrogenic spinal cord compression by closed reduction maneuvers. The use of MRI for early advanced imaging in these injuries remains controversially debated. Case presentation A 54-year old man sustained a fall over the handlebars of his racing bicycle. The helmeted patient sustained a fall on his head which resulted in a hyperflexion injury of the neck. He was neurologically intact on presentation. Initial CT imaging revealed a complex multisegmental cervical spine injury with a left-sided C6/C7 perched facet, a right sided C7/T1 fracture-dislocation, and a right-sided C6 and C7 traumatic laminotomy. The initial management consisted of temporary external Halo fixator application without closed reduction maneuver, to mitigate the risk of a delayed spinal cord injury. Subsequent advanced imaging by MRI revealed an acute traumatic C7/T1 disc herniation, with the intervertebral disc completely extruded into the spinal canal. Definitive surgical management was then accomplished by employing a three-stage anterior-posterior-anterior spinal decompression, realignment, fixation and fusion C4-T2 in one operative session. The patient recovered well and retained full neurological function. He resumed bicycle street racing within 10 months of the injury following successful spinal reconstruction. Conclusions The diagnostic evaluation of cervical fracture-dislocations should include advanced imaging by MRI in order to fully understand the injury pattern prior to proceeding with spinal reduction maneuvers which may impose the imminent threat of a devastating iatrogenic injury to the spinal cord. The presented staged management by initial Halo fixation without attempts for spinal reduction, followed by a surgical decompression and multilevel fusion, appears to represent a feasible and safe strategy for patients at risk of a delayed neurological injury.
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Affiliation(s)
- Sergiu Botolin
- Department of Orthopaedics, University of Colorado, School of Medicine and Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204 USA
| | - Todd F VanderHeiden
- Department of Orthopaedics, University of Colorado, School of Medicine and Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204 USA
| | - Ernest E Moore
- Department of Surgery, University of Colorado, School of Medicine and Denver Health Medical Center, Denver, CO 80204 USA
| | - Herbert Fried
- Department of Neurosurgery, University of Colorado, School of Medicine and Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204 USA
| | - Philip F Stahel
- Department of Orthopaedics, University of Colorado, School of Medicine and Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204 USA.,Department of Neurosurgery, University of Colorado, School of Medicine and Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204 USA
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