1
|
Burke CJ, Samim M, Babb JS, Walter WR. Utility of a 2D kinematic HASTE sequence in magnetic resonance imaging assessment of adjacent segment degeneration following anterior cervical discectomy and fusion. Eur Radiol 2024; 34:1113-1122. [PMID: 37594524 DOI: 10.1007/s00330-023-10133-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/26/2023] [Accepted: 07/04/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVES To evaluate a dynamic half-Fourier acquired single turbo spin echo (HASTE) sequence following anterior cervical discectomy and fusion (ACDF) at the junctional level for adjacent segment degeneration comparing dynamic listhesis to radiographs and assessing dynamic cord contact and deformity during flexion-extension METHODS: Patients with ACDF referred for cervical spine MRI underwent a kinematic flexion-extension sagittal 2D HASTE sequence in addition to routine sequences. Images were independently reviewed by three radiologists for static/dynamic listhesis, and compared to flexion-extension radiographs. Blinded assessment of the HASTE sequence was performed for cord contact/deformity between neutral, flexion, and extension, to evaluate concordance between readers and inter-modality agreement. Inter-reader agreement for dynamic listhesis and impingement grade and inter-modality agreement for dynamic listhesis on MRI and radiographs was assessed using the kappa coefficient and percentage concordance. RESULTS A total of 28 patients, mean age 60.2 years, were included. Mean HASTE acquisition time was 42 s. 14.3% demonstrated high grade dynamic stenosis (> grade 4) at the adjacent segment. There was substantial agreement for dynamic cord impingement with 70.2% concordance (kappa = 0.62). Concordance across readers for dynamic listhesis using HASTE was 81.0% (68/84) (kappa = 0.16) compared with 71.4% (60/84) (kappa = 0.40) for radiographs. Inter-modality agreement between flexion-extension radiographs and MRI assessment for dynamic listhesis across the readers was moderate (kappa = 0.41; 95% confidence interval: 0.16 to 0.67). CONCLUSIONS A sagittal flexion-extension HASTE cine sequence provides substantial agreement between readers for dynamic cord deformity and moderate agreement between radiographs and MRI for dynamic listhesis. CLINICAL RELEVANCE STATEMENT Degeneration of the adjacent segment with instability and myelopathy is one of the most common causes of pain and neurological deterioration requiring re-operation following cervical fusion surgery. KEY POINTS • A real-time kinematic 2D sagittal HASTE flexion-extension sequence can be used to assess for dynamic listhesis, cervical cord, contact and deformity. • The additional kinematic cine sequence was well tolerated and the mean acquisition time for the 2D HASTE sequence was 42 s (range 31-44 s). • A sagittal flexion-extension HASTE cine sequence provides substantial agreement between readers for dynamic cord deformity and moderate agreement between radiographs and MRI for dynamic listhesis.
Collapse
Affiliation(s)
- Christopher J Burke
- Department of Radiology, NYU Langone Orthopedic Hospital, New York, NY, USA.
| | - Mohammad Samim
- Department of Radiology, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - James S Babb
- Department of Radiology, NYU Langone Orthopedic Hospital, New York, NY, USA
- Department of Radiology, NYU Grossman School of Medicine, New York, USA
| | - William R Walter
- Department of Radiology, NYU Langone Orthopedic Hospital, New York, NY, USA
| |
Collapse
|
2
|
Pour-Rashidi A, Arabkheradmand J, Rahimian E, Aarabi J, Fallahpour M. Prone extension views in cervical MRI: A case-driven Novel approach. Heliyon 2024; 10:e23251. [PMID: 38163148 PMCID: PMC10755320 DOI: 10.1016/j.heliyon.2023.e23251] [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: 06/21/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
The cervical spinal canal has a wide range of motion and specific biomechanics involved with different pathologies that may cause dynamic cord compressions. This study has introduced new protocol for acquiring an extension view of cervical MRI to assess dynamic cervical spinal canal compromise. We posit that dynamic MRI comprising extension view in prone position could be a practical option when deciding the best approach in treating challenging patients.
Collapse
Affiliation(s)
| | | | | | - Judith Aarabi
- Community College of Baltimore County, School of Health Professions, Baltimore, MD, USA
| | - Mahshid Fallahpour
- Department of Public Health, San Diego State University (SDSU)-University of California San Diego (UCSD), San Diego, CA 92182, USA
| |
Collapse
|
3
|
Hutchins J, Hebelka H, Svensson PA, Myklebust TÅ, Lagerstrand K, Brisby H. Cervical Foraminal Changes in Patients with Intermittent Arm Radiculopathy Studied with a New MRI-Compatible Compression Device. J Clin Med 2023; 12:6493. [PMID: 37892631 PMCID: PMC10607115 DOI: 10.3390/jcm12206493] [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: 08/31/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Diagnosing cervical foraminal stenosis with intermittent arm radiculopathy is challenging due to discrepancies between MRI findings and symptoms. This can be attributed to the fact that MRI images are often obtained in a relaxed supine position. This study aims to evaluate the feasibility of the Dynamic MRI Compression System (DMRICS) and to assess possible changes in cervical foramina, with both quantitative measurements and qualitative grading systems, with MRI during a simulated Spurling test. Ten patients (five women and five men, ages 29-45) with previously confirmed cervical foraminal stenosis underwent MRI scans using DMRICS. MRI images were acquired in both relaxed and provoked states. A radiologist assessed 30 foramina (C4-C7) on the symptomatic side in both patient positions. Quantitative and qualitative measures were performed, including the numeric rating scale (NRS) and the Park and Kim grading systems. The provoked state induced concordant neck and arm pain in 9 of 10 patients. Significant shifts in Park and Kim foraminal gradings were noted: 13 of 27 Park gradings and 9 of 27 Kim gradings escalated post provocation. No quantitative changes were observed. This pilot study indicates that the DMRICS device has the potential to improve diagnostic accuracy for cervical radiculopathy, demonstrating induced cervical foraminal changes during a simulated Spurling test while performing MRI.
Collapse
Affiliation(s)
- John Hutchins
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE413 45 Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, SE413 45 Gothenburg, Sweden
| | - Hanna Hebelka
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE413 45 Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, SE413 45 Gothenburg, Sweden
| | - Pär-Arne Svensson
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE413 45 Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, SE413 45 Gothenburg, Sweden
| | - Tor Åge Myklebust
- Department of Registration, Cancer Registry Norway, 0379 Oslo, Norway
| | - Kerstin Lagerstrand
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE413 45 Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE413 45 Gothenburg, Sweden
| | - Helena Brisby
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE413 45 Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, SE413 45 Gothenburg, Sweden
| |
Collapse
|
4
|
Awada Z, Saba S, Harel A. Utility of Flexion and Extension MRI for Evaluating Isolated Cervical Spinal Cord Lesions: A Case Series. Cureus 2023; 15:e46932. [PMID: 38021920 PMCID: PMC10640669 DOI: 10.7759/cureus.46932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
The diagnosis of isolated spinal cord lesions is often challenging in clinical practice, and it is not uncommon for the etiology of such isolated lesions to remain unclear despite extensive workup and investigations. Magnetic resonance imaging (MRI) is extensively utilized for assessing spinal cord disease, despite certain radiological patterns suggesting certain pathologies, diagnostic uncertainty remains. Development of adjunct tests and techniques, radiographic or otherwise, is needed. Here, we present two cases in which flexion-extension cervical spine MRIs improved diagnostic ability by demonstrating dynamic cervical cord compression as an etiology for isolated intramedullary cervical spinal cord lesions.
Collapse
Affiliation(s)
- Zeinab Awada
- Neurology, Staten Island University Hospital and Lenox Hill Hospital, New York, USA
| | - Sami Saba
- Neurology, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine, New York, USA
| | - Asaff Harel
- Neurology, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine, New York, USA
| |
Collapse
|
5
|
Bédard S, Bouthillier M, Cohen-Adad J. Pontomedullary junction as a reference for spinal cord cross-sectional area: validation across neck positions. Sci Rep 2023; 13:13527. [PMID: 37598229 PMCID: PMC10439961 DOI: 10.1038/s41598-023-40731-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/16/2023] [Indexed: 08/21/2023] Open
Abstract
Spinal cord cross-sectional area (CSA) is an important MRI biomarker to assess spinal cord atrophy in various neurodegenerative and traumatic spinal cord diseases. However, the conventional method of computing CSA based on vertebral levels is inherently flawed, as the prediction of spinal levels from vertebral levels lacks reliability, leading to considerable variability in CSA measurements. Computing CSA from an intrinsic neuroanatomical reference, the pontomedullary junction (PMJ), has been proposed in previous work to overcome limitations associated with using a vertebral reference. However, the validation of this alternative approach, along with its variability across and within participants under variable neck extensions, remains unexplored. The goal of this study was to determine if the variability of CSA across neck flexions/extensions is reduced when using the PMJ, compared to vertebral levels. Ten participants underwent a 3T MRI T2w isotropic scan at 0.6 mm3 for 3 neck positions: extension, neutral and flexion. Spinal cord segmentation, vertebral labeling, PMJ labeling, and CSA were computed automatically while spinal segments were labeled manually. Mean coefficient of variation for CSA across neck positions was 3.99 ± 2.96% for the PMJ method vs. 4.02 ± 3.01% for manual spinal segment method vs. 4.46 ± 3.10% for the disc method. These differences were not statistically significant. The PMJ method was slightly more reliable than the disc-based method to compute CSA at specific spinal segments, although the difference was not statistically significant. This suggests that the PMJ can serve as a valuable alternative and reliable method for estimating CSA when a disc-based approach is challenging or not feasible, such as in cases involving fused discs in individuals with spinal cord injuries.
Collapse
Affiliation(s)
- Sandrine Bédard
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada.
| | - Maxime Bouthillier
- Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, QC, Canada
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Functional Neuroimaging Unit, CRIUGM, University of Montreal, Montreal, QC, Canada
- Mila - Quebec AI Institute, Montreal, QC, Canada
- Centre de Recherche du CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| |
Collapse
|
6
|
Hutchins J, Lagerstrand K, Stävlid E, Svensson PA, Rennerfelt K, Hebelka H, Brisby H. MRI evaluation of foraminal changes in the cervical spine with assistance of a novel compression device. Sci Rep 2023; 13:11508. [PMID: 37460649 DOI: 10.1038/s41598-023-38401-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
Standard supine Magnetic Resonance Imaging (MRI) does not acquire images in a position where most patients with intermittent arm radiculopathy have symptoms. The aim of this study was to test the feasibility of a new compression device and to evaluate image quality and foraminal properties during a Spurling test under MRI acquisition. Ten asymptomatic individuals were included in the study (6 men and 4 women; age range 27 to 55 years). First, the subjects were positioned in the cervical compression device in a 3 T MRI scanner, and a volume T2 weighted (T2w) sequence was acquired in a relaxed supine position (3 min). Thereafter, the position and compressive forces on the patient's neck (provocation position) were changed by maneuvering the device from the control room, with the aim to simulate a Spurling test, causing a mild foraminal compression, followed by a repeated image acquisition (3 min). A radiologist measured the blinded investigations evaluating cervical lordosis (C3-C7), foraminal area on oblique sagittal images and foraminal cross-distance in the axial plane. A total of three levels (C4-C7) were measured on the right side on each individual. Measurements were compared between the compressed and relaxed state. Reliability tests for inter- and intraclass correlation were performed. The device was feasible to use and well tolerated by all investigated individuals. Images of adequate quality was obtained in all patients. A significant increase (mean 9.4, p = 0.013) in the cervical lordosis and a decreased foraminal cross-distance (mean 32%, p < 0.001) was found, during the simulated Spurling test. The area change on oblique sagittal images did not reach a statistically significant change. The reliability tests on the quantitative measures demonstrated excellent intraobserver reliability and moderate to good interobserver reliability. Applying an individualized provocation test on the cervical spine, which simulates a Spurling test, during MRI acquisition was feasible with the novel device and provided images of satisfactory quality. MRI images acquired with and without compression showed changes in cervical lordosis and foraminal cross distance indicating the possibility of detecting changes of the foraminal properties. As a next step, the method is to be tested on symptomatic patients.
Collapse
Affiliation(s)
- J Hutchins
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - K Lagerstrand
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - E Stävlid
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - P-A Svensson
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - K Rennerfelt
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - H Hebelka
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - H Brisby
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
7
|
Li AY, McCarthy L, Hrabarchuk E, Spiera Z, Marayati NF, Schupper AJ, Hannah TC, Genadry L, Ali M, Quinones A, Kalagara R, Baron R, Sideras P, Naidich TP, Choudhri TF. Novel Grading Scales for Static and Flexion-Extension Magnetic Resonance Imaging in Patients with Cervical Spondylotic Myelopathy. World Neurosurg 2023; 173:e218-e227. [PMID: 36787858 DOI: 10.1016/j.wneu.2023.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Flexion-extension magnetic resonance imaging (MRI) has potential to identify cervical pathology not detectable on conventional static MRI. Our study evaluated standard quantitative and novel subjective grading scales for assessing the severity of cervical spondylotic myelopathy in dynamic sagittal MRI as well as in static axial and sagittal images. METHODS Forty-five patients underwent both conventional and flexion-extension MRI prior to anterior cervical discectomy and fusion from C4 through C7. In addition to measuring Cobb angles and cervical canal diameter, grading scales were developed for assessment of vertebral body translation, loss of disc height, change in disc contour, deformation of cord contour, and cord edema. Data were collected at all levels from C2-C3 through C7-T1. Variations in measurements between cervical levels and from flexion through neutral to extension were assessed using Mann-Whitney, Kruskal-Wallis, and two-way ANOVA tests. RESULTS Cervical canal diameter, vertebral translation, and posterior disc opening changed significantly from flexion to neutral to extension positions (P < 0.01). When comparing operative versus nonoperative cervical levels, significant differences were found when measuring sagittal cervical canal dimensions, vertebral translation, and posterior disc opening (P < 0.01). Degenerative loss of disc height, disc dehydration, deformation of ventral cord contour, and cord edema were all significantly increased at operative levels versus nonoperative levels (P < 0.01). CONCLUSIONS Flexion-extension MRI demonstrated significant changes not available from conventional MRI. Subjective scales for assessing degenerative changes were significantly more severe at levels with operative cervical spondylotic myelopathy. The utility of these scales for planning surgical intervention at specific and adjacent levels is currently under investigation.
Collapse
Affiliation(s)
- Adam Y Li
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Lily McCarthy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eugene Hrabarchuk
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zachary Spiera
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Naoum Fares Marayati
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Theodore C Hannah
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lisa Genadry
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Addison Quinones
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roshini Kalagara
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rebecca Baron
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Panagiotis Sideras
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thomas P Naidich
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tanvir F Choudhri
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
8
|
Evaluation of Dynamic Foraminal Stenosis with Positional MRI in Patients with C6 Radiculopathy-Mimicking Pain: A Prospective Radiologic Cohort Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1385387. [PMID: 35722464 PMCID: PMC9203214 DOI: 10.1155/2022/1385387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/27/2022] [Indexed: 11/17/2022]
Abstract
Objective Patients with a C6 radiculopathy-mimicking complaint are always in the gray zone if the diagnosis is not clear. The aim of the study is to make the diagnosis clear if the neck and shoulder pain is caused by a dynamic stenosis of the neural foramen at the C5-C6 level. Methods Patients with a C6 radiculopathy-mimicking complaint were included in the study. Patients had a cervical spine magnetic resonance imaging (MRI) at the normal limits, or a minimal protrusion at the C5-C6 level underwent a dynamic MRI procedure. We measured the foraminal area and spinal cord diameter (SCD) at the C5-C6 level by using the PACS system ROI irregular are determination integral embedded to PACS. Inter- and intraobserver reliability of measurements was evaluated. Results were analyzed statistically, and a p value< 0.05 was accepted as statistically meaningful. Results A total of 23 patients between January 2019 and June 2019 were included in the study. There were 10 men and 13 women, and the mean age was 41.3 (range 33-53). Foraminal area decrease at C5-C6 in extension and increase in flexion when compared with the neutral position was statistically significant (p < 0.001). Foraminal area changes between the complaint side and the opposite side was not statistically different (p > 0.05). Interobserver and intraobserver reliability of measurements were classified as in almost perfect agreement. Conclusions Our present work presented dynamic and positional foraminal changes in MRI with radiculopathy-mimicking patients. Soever, we did not find a difference between the clinical complaint side and the opposite side in radiculopathy-mimicking patients. Cervical radiculopathy pain should not be attributed only to foraminal sizes. PACS embedded irregular area measurement integral allows the easy measure of a big number of patients without additional set-up and digital work requirements.
Collapse
|
9
|
Syc-Mazurek SB, Montenegro M, Clarke MJ, Flanagan EP. MRI with neck extension to diagnose cervical spondylotic myelopathy. Pract Neurol 2021; 22:162-163. [PMID: 34836931 DOI: 10.1136/practneurol-2021-003227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2021] [Indexed: 11/04/2022]
Affiliation(s)
| | - Monique Montenegro
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Michelle J Clarke
- Department of Neurosurgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| |
Collapse
|
10
|
Singh J, Garg K, Satyarthee GD, Chandra PS, Singh M. Dynamic MRI in Cervical Myelopathy: A Useful Tool? Neurol India 2021; 69:211. [PMID: 33642307 DOI: 10.4103/0028-3886.310103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jaskaran Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - G D Satyarthee
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - P S Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
11
|
Walter WR, Alizai H, Bruno M, Portugal S, Burke CJ. Real-time dynamic 3-T MRI assessment of spine kinematics: a feasibility study utilizing three different fast pulse sequences. Acta Radiol 2021; 62:58-66. [PMID: 32233646 DOI: 10.1177/0284185120913000] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Half-Fourier acquisition single-shot turbo spin-echo (HASTE), continuous radial gradient-echo (GRE), and True FISP allow real-time dynamic assessment of the spine. PURPOSE To evaluate the feasibility of adding dynamic sequences to routine spine magnetic resonance imaging (MRI) for assessment of spondylolisthesis. MATERIAL AND METHODS Retrospective review was performed of patients referred for dynamic MRI of the cervical or lumbar spine between January 2017 and 2018 who had flexion-extension radiographs within two months of MRI. Exclusion criteria were: incomplete imaging; spinal hardware; and inability to tolerate dynamic examination. Blinded, independent review by two board-certified musculoskeletal radiologists was performed to assess for spondylolisthesis (>3 mm translation); consensus review of dynamic radiographs served as the gold standard. Cervical spinal cord effacement was assessed. Inter-reader agreement and radiographic concordance was calculated for each sequence. RESULTS Twenty-one patients were included (8 men, 13 women; mean age 47.9 ± 16.5 years). Five had MRI of the cervical spine and 16 had MRI of the lumbar spine. Mean acquisition time was 18.4 ± 1.7 min with dynamic sequences in the range of 58-77 s. HASTE and True FISP had the highest inter-reader reproducibility (κ = 0.88). Reproducibility was better for the lumbar spine (κ = 0.94) than the cervical spine (κ = 0.28). Sensitivity of sequences for spondylolisthesis was in the range of 68.8%-78.6%. All three sequences had high accuracy levels: ≥90.5% averaged across the cervical and lumbar spine. Cervical cord effacement was observed during dynamic MRI in two cases (100% agreement). CONCLUSION Real-time dynamic MRI sequences added to spine MRI protocols provide reliable and accurate assessment of cervical and lumbar spine spondylolisthesis during flexion and extension.
Collapse
Affiliation(s)
| | - Hamza Alizai
- Texas Scottish Rite Hospital for Children, Dallas, TX, USA
| | - Mary Bruno
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Salvador Portugal
- Department of Rehabilitation Medicine, NYU Langone Health, New York, NY, USA
| | | |
Collapse
|
12
|
Fiani B, Griepp DW, Lee J, Davati C, Moawad CM, Kondilis A. Weight-Bearing Magnetic Resonance Imaging as a Diagnostic Tool That Generates Biomechanical Changes in Spine Anatomy. Cureus 2020; 12:e12070. [PMID: 33489488 PMCID: PMC7805418 DOI: 10.7759/cureus.12070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Weight-bearing magnetic resonance imaging (MRI) is a unique modality in diagnostic imaging that allows for the assessment of spinal pathology in ways considered previously inaccessible or insufficient with the conventional MRI technique. Due to limitations in positioning within the MRI machine itself, difficulties would be posed in determining the underlying cause of a patient’s pain or neurological symptoms, as the traditional supine position utilized can, in many cases, alleviate the severity of presented symptoms. Weight-bearing MRI addresses this concern by allowing a clinician to position a patient (to a certain degree) into flexion, extension, rotation, or side-bending with an axial load that can mimic physiologic conditions in order to replicate the conditions the patient experiences in order to give clinicians a clearer understanding of the anatomical relationship of the spine and surrounding tissues that may lead to a particular presentation of symptoms. These findings can then guide treatment approaches that are better tailored to a patient’s needs in order to initiate treatment earlier and shorten the duration of treatment necessary for patient benefit. The goal of this review is to describe and differentiate weight-bearing MRI from conventional MRI as well as examine the advantages and disadvantages of either imaging modality. This will include assessing cost-effectiveness and improvements in clinical outcomes. Further, the advancements of weight-bearing MRI will be discussed, including potentially unique clinical applications in development.
Collapse
Affiliation(s)
- Brian Fiani
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Daniel W Griepp
- Neurosurgery, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, USA
| | - Jason Lee
- Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, USA
| | - Cyrus Davati
- Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, USA
| | - Christina M Moawad
- Neurosurgery, Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, USA
| | - Athanasios Kondilis
- Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, USA
| |
Collapse
|
13
|
Burke CJ, Samim M, Alizai H, Sanchez J, Kingsbury D, Babb JS, Walter WR. Clinical feasibility of 2D dynamic sagittal HASTE flexion-extension imaging of the cervical spine for the assessment of spondylolisthesis and cervical cord impingement. Eur J Radiol 2020; 134:109447. [PMID: 33307460 DOI: 10.1016/j.ejrad.2020.109447] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 09/19/2020] [Accepted: 11/26/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the utility of a 2D dynamic HASTE sequence in assessment of cervical spine flexion-extension, specifically (1) comparing dynamic spondylolisthesis to radiographs and (2) assessing dynamic contact upon or deformity of the cord. METHODS Patients with a dynamic flexion-extension sagittal 2D HASTE sequence in addition to routine cervical spine sequences were identified. Static and dynamic listhesis was first determined on flexion-extension radiographs reviewed in consensus. Blinded assessment of the dynamic HASTE sequence was independently performed by 2 radiologists for (1) listhesis and translation during flexion-extension and (2) dynamic spinal cord impingement (cord contact or deformity between neutral, flexion and extension). RESULTS 32 scans in 32 patients (9 males, 23 females) met inclusion criteria acquired on 1.5 T (n = 15) and 3 T (n = 17) scanners. The mean acquisition time was 51.8 s (range 20-95 seconds). Dynamic translation was seen in 14 patients on flexion-extension radiographs compared to 12 (reader 1) and 13 (reader 2) patients on HASTE, with 90.6 % agreement (K = 0.83; p = 0.789). In all cases dynamic listhesis was ≤3 mm translation with one patient showing dynamic listhesis in the range 4-6 mm. Four cases (13 %) demonstrated deformity of the cord between flexion-extension, not present in the neutral position. For cord impingement there was strong inter-reader agreement (K = 0.93) and the paired sample Wilcoxon signed rank test found no significant difference between the impingement scores of the two readers (p = 0.787). CONCLUSIONS A sagittal dynamic flexion-extension HASTE sequence provides a rapid addition to standard MRI cervical spine protocols, which may useful for assessment of dynamic spondylolisthesis and cord deformity.
Collapse
Affiliation(s)
- Christopher J Burke
- NYU Langone Orthopedic Hospital, Department of Radiology, Division of Musculoskeletal Radiology, 301 E 17th St, New York, NY, 10003, United States.
| | - Mohammad Samim
- NYU Langone Orthopedic Hospital, Department of Radiology, Division of Musculoskeletal Radiology, 301 E 17th St, New York, NY, 10003, United States
| | - Hamza Alizai
- NYU Langone Orthopedic Hospital, Department of Radiology, Division of Musculoskeletal Radiology, 301 E 17th St, New York, NY, 10003, United States
| | - Julien Sanchez
- NYU Langone Orthopedic Hospital, Department of Radiology, Division of Musculoskeletal Radiology, 301 E 17th St, New York, NY, 10003, United States
| | - Dallas Kingsbury
- Physical Medicine and Rehabilitation, NYU Langone Orthopedic Center, 333 East 38th Street, 6th Floor, New York, NY, 10016, United States
| | - James S Babb
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology Biostatistics, 660 First Avenue, New York, NY, 10016, United States
| | - William R Walter
- NYU Langone Orthopedic Hospital, Department of Radiology, Division of Musculoskeletal Radiology, 301 E 17th St, New York, NY, 10003, United States
| |
Collapse
|
14
|
Stoner KE, Abode-Iyamah KO, Magnotta VA, Howard MA, Grosland NM. Measurement of in vivo spinal cord displacement and strain fields of healthy and myelopathic cervical spinal cord. J Neurosurg Spine 2019; 31:53-59. [PMID: 30901756 DOI: 10.3171/2018.12.spine18989] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 12/05/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cervical myelopathy (CM) is a common and debilitating form of spinal cord injury caused by chronic compression; however, little is known about the in vivo mechanics of the healthy spinal cord during motion and how these mechanics are altered in CM. The authors sought to measure 3D in vivo spinal cord displacement and strain fields from MR images obtained during physiological motion of healthy individuals and cervical myelopathic patients. METHODS Nineteen study participants, 9 healthy controls and 10 CM patients, were enrolled in the study. All study participants had 3T MR images acquired of the cervical spine in neutral, flexed, and extended positions. Displacement and strain fields and corresponding principal strain were obtained from the MR images using image registration. RESULTS The healthy spinal cord displaces superiorly in flexion and inferiorly in extension. Principal strain is evenly distributed along the spinal cord. The CM spinal cord displaces less than the healthy cord and the magnitude of principal strain is higher, at the midcervical levels. CONCLUSIONS Increased spinal cord compression during cervical myelopathy limits motion of the spinal cord and increases spinal cord strain during physiological motion. Future studies are needed to investigate how treatment, such as surgical intervention, affects spinal cord mechanics.
Collapse
Affiliation(s)
- Kirsten E Stoner
- 1Department of Biomedical Engineering, The University of Iowa, and
| | | | | | | | - Nicole M Grosland
- 1Department of Biomedical Engineering, The University of Iowa, and
- 4Orthopedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa
| |
Collapse
|
15
|
Tu A, Melamed E, Krieger MD. Dynamic MRI in the Evaluation of Atlantoaxial Stability in Pediatric Down Syndrome Patients. Pediatr Neurosurg 2019; 54:12-20. [PMID: 30677764 DOI: 10.1159/000495788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 11/23/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Down syndrome is the most common inherited disorder. Some patients develop atlantoaxial instability. Existing screening guidelines were developed prior to availability of MRI. We present predictors for deficit using dynamic MRI of the craniocervical junction. METHODS A retrospective review of Down syndrome patients from 2001 to 2015 was carried out. Patients were considered symptomatic if they had clinical deficits or signal change on MRI. Measurements were taken at the atlantoaxial junction and structural abnormalities noted. Analysis was performed with SPSS. RESULTS A total of 36 patients were included. Patients averaged 93 months of age with a follow-up of 57 months. No asymptomatic patients developed myelopathy during follow-up. During dynamic imaging, symptomatic patients had greater changes in space available for the cord (SAC) (5.2 vs. 2.7 mm; p < 0.001) and atlantodental interval (ADI) (2.8 vs. 1.3 mm; p = 0.04). These patients were also more likely to have a bony anomaly (50 vs. 13%; p = 0.03). CONCLUSION This study characterizes the range of motion seen on dynamic MRI and provides parameters that can be used to distinguish patients at risk for neurologic injury. Changes greater than 3 mm in ADI or 5 mm in SAC during dynamic MRI or any bony abnormality warrants further investigation. Patients without these features may be able to avoid an unnecessary intervention.
Collapse
Affiliation(s)
- Albert Tu
- Children's Hospital of Los Angeles, Los Angeles, California, USA, .,Children's Minnesota, St. Paul, Minnesota, USA,
| | - Edward Melamed
- Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Mark D Krieger
- Children's Hospital of Los Angeles, Los Angeles, California, USA
| |
Collapse
|
16
|
A Technique for Dynamic Cervical Magnetic Resonance Imaging Applied to Cervical Spondylotic Myelopathy: A Reliability Study. Spine (Phila Pa 1976) 2019; 44:E26-E32. [PMID: 29952883 DOI: 10.1097/brs.0000000000002765] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To evaluate morphometric variations of the cervical spine in patients with cervical spondylotic myelopathy (CSM) using a standard technique of dynamic magnetic resonance imaging (MRI), to assess the inter- and intraobserver reliability of measurements of morphometric parameters based on this imaging, and to compare the resulting measurements with those previously published. SUMMARY OF BACKGROUND DATA Because dynamic factors may contribute to the etiology and severity of CSM, dynamic (flexion-extension) MRI may be useful to better evaluate for spinal stenosis and cord compromise. METHODS Dynamic cervical MRI was obtained using a standard protocol with the neck in neutral, flexion, and extension positions. The morphometric parameters considered were anterior length of the spinal cord (ALSC), posterior length of the spinal cord (PLSC), spinal canal diameter, and spinal cord width. Two observers analyzed the parameters independently, and the inter- and intraobserver reliabilities were assessed by the intraclass correlation coefficient (ICC). RESULTS A total of 18 patients were included in the study and all completed the dynamic MRI acquisition protocol. The inter- and intraobserver reliabilities demonstrated "almost perfect agreement" (ICC >0.9, P < 0.001) for ALSC and PLSC in all positions. The spinal canal diameter had inter- and intraobserver reliability classified as "almost perfect agreement" (ICC: 0.83-0.98, P < 0.001 and ICC: 0.90-0.99, P < 0.001, respectively) in all positions. The spinal cord width had inter- and intraobserver reliability classified as "substantial agreement" (ICC: 0.73-0.94, P < 0.001 and ICC: 0.79-0.96, P < 0.001, respectively) in all positions. ALSC and PLSC in neutral, flexion, and extension positions from the present study were significantly greater compared to the measurements previously published (P < 0.001). CONCLUSION The dynamic MRI protocol presented was safe and may allow a more complete evaluation of variations in the cervical spine in patients with CSM than traditional MRI protocols. The morphometric parameters based on this protocol demonstrated excellent inter- and intraobserver reliabilities. LEVEL OF EVIDENCE 4.
Collapse
|
17
|
Jha SC, Miyazaki M, Tsumura H. Kinetic change of spinal cord compression on flexion-extension magnetic resonance imaging in cervical spine. Clin Neurol Neurosurg 2018; 174:86-91. [DOI: 10.1016/j.clineuro.2018.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/28/2018] [Accepted: 09/09/2018] [Indexed: 10/28/2022]
|
18
|
Application of MR-derived cross-sectional guideline of cervical spine muscles to validate neck surface electromyography placement. J Electromyogr Kinesiol 2018; 43:127-139. [PMID: 30273920 DOI: 10.1016/j.jelekin.2018.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/10/2018] [Accepted: 09/24/2018] [Indexed: 02/03/2023] Open
Abstract
The importance of surface-EMG placement for development and interpretation of EMG-assisted biomechanical models is well established. Since MR has become a reliable noninvasive cervical spine musculoskeletal diagnostic tool, this investigation attempted to illustrate the anatomical relationships of individual cervical spine muscles with their paired surface-EMG electrodes. The secondary purpose of this investigation was to provide an MR cross-sectional pictorial and descriptive guideline of the cervical spine musculature. MR scans were performed on a healthy adult male subject from skull to manubrium of the sternum. Prior to scanning, MR safe markers were placed over neck muscles following surface EMG placement recommendations. Twenty-three neck muscles were traced manually in each of 267 scan slices. 3-D models of the neck musculoskeletal structure were constructed to aid with understanding the complex anatomy of the region as well as to identify correct EMG electrode locations and to identify muscles' curved lines-of-action. 3D models of the MR-safe markers were constructed relative to the target muscles. Based on the findings of this study, muscle palpation and bony landmarks can be used to effectively identify appropriate surface EMG electrode locations to record upper trapezius, middle trapezius, semispinalis capitis, splenius capitis, levator scapulae, scalenus, sternocleidomastoid and hyoid muscles activities.
Collapse
|
19
|
Schatlo B, Remonda L, Gruber P, Fandino J, Rohde V, Fathi AR, Berberat J. Cervical Spine Prospective Feasibility Study : Dynamic Flexion-Extension Diffusion-Tensor Weighted Magnetic Resonance Imaging. Clin Neuroradiol 2018; 29:523-532. [PMID: 29671001 DOI: 10.1007/s00062-018-0686-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/30/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Diffusion tensor imaging (DTI) in flexion-extension may serve as a diagnostic tool to improve the sensitivity for detection of myelopathy. In this study, the feasibility and reproducibility of dynamic DTI in the cervical spinal cord was assessed in healthy volunteers and patients. METHODS All subjects were examined in maximum neck flexion-extension in a 3T magnetic resonance imaging (MRI) scanner. Range of motion, space available for the spinal cord, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were measured and compared between the neck positions. RESULTS Volunteers showed no variation in ADC and FA. In patients, extension produced higher ADC in the diseased than in the control segments (p = 0.0045). The ADC of the affected segments was higher in extension than in the neutral position (p = 0.0030) or in flexion (p = 0.0002). The FA was significantly lower in extension in patients at both the control level C2/3 (p = 0.0154) and the affected segment (p = 0.0187). CONCLUSIONS Dynamic DTI of the cervical spine is feasible and ADC increased in the patient group in extension. This finding may open a previously unexplored avenue to attempt an earlier identification of myelopathy.
Collapse
Affiliation(s)
- Bawarjan Schatlo
- Department of Neuroradiology, Cantonal Hospital Aarau, Tellstraße 25, 5001, Aarau, Switzerland.,Department of Neurosurgery, Cantonal Hospital Aarau, Aarau, Switzerland.,Department of Neurosurgery, University Medicine Göttingen, Georg-August University, Göttingen, Germany
| | - Luca Remonda
- Department of Neuroradiology, Cantonal Hospital Aarau, Tellstraße 25, 5001, Aarau, Switzerland
| | - Philipp Gruber
- Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Veit Rohde
- Department of Neurosurgery, University Medicine Göttingen, Georg-August University, Göttingen, Germany
| | - Ali-Reza Fathi
- Department of Neurosurgery, Hirslanden Clinik, Aarau, Switzerland
| | - Jatta Berberat
- Department of Neuroradiology, Cantonal Hospital Aarau, Tellstraße 25, 5001, Aarau, Switzerland.
| |
Collapse
|
20
|
Martin AR, De Leener B, Cohen-Adad J, Cadotte DW, Nouri A, Wilson JR, Tetreault L, Crawley AP, Mikulis DJ, Ginsberg H, Fehlings MG. Can microstructural MRI detect subclinical tissue injury in subjects with asymptomatic cervical spinal cord compression? A prospective cohort study. BMJ Open 2018; 8:e019809. [PMID: 29654015 PMCID: PMC5905727 DOI: 10.1136/bmjopen-2017-019809] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Degenerative cervical myelopathy (DCM) involves extrinsic spinal cord compression causing tissue injury and neurological dysfunction. Asymptomatic spinal cord compression (ASCC) is more common, but its significance is poorly defined. This study investigates if: (1) ASCC can be automatically diagnosed using spinal cord shape analysis; (2) multiparametric quantitative MRI can detect similar spinal cord tissue injury as previously observed in DCM. DESIGN Prospective observational longitudinal cohort study. SETTING Single centre, tertiary care and research institution. PARTICIPANTS 40 neurologically intact subjects (19 female, 21 male) divided into groups with and without ASCC. INTERVENTIONS None. OUTCOME MEASURES Clinical assessments: modified Japanese Orthopaedic Association score and physical examination. 3T MRI assessments: automated morphometric analysis compared with consensus ratings of spinal cord compression, and measures of tissue injury: cross-sectional area, diffusion fractional anisotropy, magnetisation transfer ratio and T2*-weighted imaging white to grey matter signal intensity ratio (T2*WI WM/GM) extracted from rostral (C1-3), caudal (C6-7) and maximally compressed levels. RESULTS ASCC was present in 20/40 subjects. Diagnosis with automated shape analysis showed area under the curve >97%. Five MRI metrics showed differences suggestive of tissue injury in ASCC compared with uncompressed subjects (p<0.05), while a composite of all 10 measures (average of z scores) showed highly significant differences (p=0.002). At follow-up (median 21 months), two ASCC subjects developed DCM. CONCLUSIONS ASCC appears to be common and can be accurately and objectively diagnosed with automated morphometric analysis. Quantitative MRI appears to detect subclinical tissue injury in ASCC prior to the onset of neurological symptoms and signs. These findings require further validation, but offer the intriguing possibility of presymptomatic diagnosis and treatment of DCM and other spinal pathologies.
Collapse
Affiliation(s)
- Allan R Martin
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin De Leener
- Institute of Biomedical Engineering, École Polytechnique de Montréal, Montréal, Québec, Canada
| | - Julien Cohen-Adad
- Institute of Biomedical Engineering, École Polytechnique de Montréal, Montréal, Québec, Canada
| | - David W Cadotte
- Department of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | - Aria Nouri
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jefferson R Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Lindsay Tetreault
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University College Cork, Cork, Ireland
| | - Adrian P Crawley
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - David J Mikulis
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Howard Ginsberg
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
21
|
Martin AR, Tadokoro N, Tetreault L, Arocho-Quinones EV, Budde MD, Kurpad SN, Fehlings MG. Imaging Evaluation of Degenerative Cervical Myelopathy. Neurosurg Clin N Am 2018; 29:33-45. [DOI: 10.1016/j.nec.2017.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
22
|
White KK, Bompadre V, Goldberg MJ, Bober MB, Cho TJ, Hoover-Fong JE, Irving M, Mackenzie WG, Kamps SE, Raggio C, Redding GJ, Spencer SS, Savarirayan R, Theroux MC. Best practices in peri-operative management of patients with skeletal dysplasias. Am J Med Genet A 2017; 173:2584-2595. [DOI: 10.1002/ajmg.a.38357] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 04/20/2017] [Accepted: 06/18/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Klane K. White
- Department of Orthopedics and Sports Medicine; Seattle Children's Hospital; Seattle Washington
| | - Viviana Bompadre
- Department of Orthopedics and Sports Medicine; Seattle Children's Hospital; Seattle Washington
| | - Michael J. Goldberg
- Department of Orthopedics and Sports Medicine; Seattle Children's Hospital; Seattle Washington
| | - Michael B. Bober
- Division of Genetics; Nemour's Alfred I du Pont Hospital for Children; Wilmington Delaware
| | - Tae-Joon Cho
- Division of Pediatric Orthopaedics; Seoul National University Children's Hospital; Seoul South Korea
| | - Julie E. Hoover-Fong
- McKusick-Nathans Institute of Genetic Medicine; Johns Hopkins University; Baltimore Maryland
| | - Melita Irving
- Department of Clinical Genetics; Guy's and St Thomas NHS; London United Kingdom of Great Britain and Northern Ireland
| | - William G. Mackenzie
- Department of Orthopedic Surgery; Nemour's Alfred I du Pont Hospital for Children; Wilmington Delaware
| | - Shawn E. Kamps
- Department of Radiology; Seattle Children's Hospital; Seattle Washington
| | - Cathleen Raggio
- Department of Orthopedic Surgery; Hospital for Special Surgery; New York New York
| | - Gregory J. Redding
- Division of Pulmonary Medicine; Seattle Children's Hospital; Seattle Washington
| | - Samantha S. Spencer
- Department of Orthopedic Surgery; Boston Children's Hospital; Boston Massachusetts
| | - Ravi Savarirayan
- Victorian Clinical Genetics Services; Murdoch Children's Research Institute, University of Melbourne, Parkville; Victoria Australia
| | - Mary C. Theroux
- Department of Anesthesia; Nemour's Alfred I du Pont Hospital for Children; Wilmington Delaware
| | | |
Collapse
|
23
|
Xu N, Wang S, Yuan H, Liu X, Liu Z. Does Dynamic Supine Magnetic Resonance Imaging Improve the Diagnostic Accuracy of Cervical Spondylotic Myelopathy? A Review of the Current Evidence. World Neurosurg 2017; 100:474-479. [DOI: 10.1016/j.wneu.2017.01.047] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/10/2017] [Accepted: 01/11/2017] [Indexed: 02/04/2023]
|
24
|
Kuhn FP, Feydy A, Launay N, Lefevre-Colau MM, Poiraudeau S, Laporte S, Maier MA, Lindberg P. Kinetic DTI of the cervical spine: diffusivity changes in healthy subjects. Neuroradiology 2016; 58:929-35. [PMID: 27278377 DOI: 10.1007/s00234-016-1709-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The study aims to assess the influence of neck extension on water diffusivity within the cervical spinal cord. METHODS IRB approved the study in 22 healthy volunteers. All subjects underwent anatomical MR and diffusion tensor imaging (DTI) at 1.5 T. The cervical cord was imaged in neutral (standard) position and extension. Segmental vertebral rotations were analyzed on sagittal T2-weighted images using the SpineView® software. Spinal cord diffusivity was measured in cross-sectional regions of interests at multiple levels (C1-C5). RESULTS As a result of non-adapted coil geometry for spinal extension, 10 subjects had to be excluded. Image quality of the remaining 12 subjects was good without any deteriorating artifacts. Quantitative measurements of vertebral rotation angles and diffusion parameters showed good intra-rater reliability (ICC = 0.84-0.99). DTI during neck extension revealed significantly decreased fractional anisotropy (FA) and increased radial diffusivity (RD) at the C3 level and increased apparent diffusion coefficients (ADC) at the C3 and C4 levels (p < 0.01 Bonferroni corrected). The C3/C4 level corresponded to the maximal absolute change in segmental vertebral rotation between the two positions. The increase in RD correlated positively with the degree of global extension, i.e., the summed vertebral rotation angle between C1 and C5 (R = 0.77, p = 0.006). CONCLUSION Our preliminary results suggest that DTI can quantify changes in water diffusivity during cervical spine extension. The maximal differences in segmental vertebral rotation corresponded to the levels with significant changes in diffusivity (C3/C4). Consequently, kinetic DTI measurements may open new perspectives in the assessment of neural tissue under biomechanical constraints.
Collapse
Affiliation(s)
- Félix P Kuhn
- Service de Radiologie B, APHP, Centre Hospitalier Universitaire Cochin, Faculté de Médecine, Université Paris Descartes, 27 rue du Fbg St Jacques, 75679, Paris, France.
| | - Antoine Feydy
- Service de Radiologie B, APHP, Centre Hospitalier Universitaire Cochin, Faculté de Médecine, Université Paris Descartes, 27 rue du Fbg St Jacques, 75679, Paris, France.,INSERM, U1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Epidémiologie clinique appliquées aux maladies ostéo-articulaires (Ecamo), Université Paris Descartes, Paris, France
| | - Nathalie Launay
- Service de Radiologie B, APHP, Centre Hospitalier Universitaire Cochin, Faculté de Médecine, Université Paris Descartes, 27 rue du Fbg St Jacques, 75679, Paris, France
| | - Marie-Martine Lefevre-Colau
- INSERM, U1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Epidémiologie clinique appliquées aux maladies ostéo-articulaires (Ecamo), Université Paris Descartes, Paris, France.,Service de Médecine Physique & de Réadaptation, APHP, Centre Hospitalier Universitaire Cochin, Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Serge Poiraudeau
- INSERM, U1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Epidémiologie clinique appliquées aux maladies ostéo-articulaires (Ecamo), Université Paris Descartes, Paris, France.,Service de Médecine Physique & de Réadaptation, APHP, Centre Hospitalier Universitaire Cochin, Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Sébastien Laporte
- Laboratoire de Biomécanique, Ecole Nationale Supérieure d'Arts et Métiers, Paris, France
| | - Marc A Maier
- Centre de Psychiatrie et Neurosciences, INSERM U894, Paris, France.,FR3636 Neurosciences, CNRS, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Pavel Lindberg
- Centre de Psychiatrie et Neurosciences, INSERM U894, Paris, France.,FR3636 Neurosciences, CNRS, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| |
Collapse
|
25
|
Lee KH, Park HJ, Lee SY, Chung EC, Rho MH, Shin H, Kwon YJ. Comparison of two MR grading systems for correlation between grade of cervical neural foraminal stenosis and clinical manifestations. Br J Radiol 2016; 89:20150971. [PMID: 27007709 DOI: 10.1259/bjr.20150971] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare the reliability of two recently reported MR grading systems of cervical neural foraminal stenosis (CNFS) and their correlation with clinical manifestations. METHODS We evaluated 188 patients (male : female = 80 : 108; mean age of 41 years) who visited our institution and underwent oblique sagittal MRI of the cervical spine. Two radiologists evaluated the MRI findings for the presence and grade of CNFS at the narrowest point, with the grading systems (Park, Kim and mKim systems) suggested by Park et al and Kim et al. More than one positive neurologic sign and more than one neurologic clinical symptom was considered a positive neurologic manifestation of each foraminal stenosis. Interobserver agreement between the two readers was analyzed using kappa statistics. Non-parametric correlation analysis (Spearman's correlation) was used to evaluate the correlation coefficients (R) to assess the relationship between CNFS grade and clinical manifestations. RESULTS Both the Park and mKim systems demonstrated a relatively high correlation (R = 0.714-0.764) between the CNFS grade and clinical manifestation, while the Kim system yielded a moderate correlation (by Reader 2). The Park and mKim systems demonstrated higher correlation values at the level of C6-7 than C4-5, while the Kim system showed no difference in correlation at the cervical spine level. CONCLUSION Both the Park and mKim systems provide a reliable, reproducible CNFS diagnosis, while the Kim system has a slightly inferior reliability. The Park and mKim systems had a similar, relatively high clinical correlation. ADVANCES IN KNOWLEDGE Grades 2 and 3 of the Park system and Grade 2 in the Kim and mKim systems exhibited a similar clinical significance. Patients with a grade of 0 (using each system) consistently exhibit negative neurologic manifestation.
Collapse
Affiliation(s)
- Kyu H Lee
- 1 Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Hee J Park
- 1 Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - So Y Lee
- 1 Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Eun C Chung
- 1 Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Myung H Rho
- 1 Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Hyunchul Shin
- 2 Department of Neurosurgery, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Young J Kwon
- 2 Department of Neurosurgery, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| |
Collapse
|
26
|
Zeng C, Xiong J, Wang JC, Inoue H, Tan Y, Tian H, Aghdasi B. The Evaluation and Observation of "Hidden" Hypertrophy of Cervical Ligamentum Flavum, Cervical Canal, and Related Factors Using Kinetic Magnetic Resonance Imaging. Global Spine J 2016; 6:155-63. [PMID: 26933617 PMCID: PMC4771510 DOI: 10.1055/s-0035-1557140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 05/11/2015] [Indexed: 01/15/2023] Open
Abstract
Study Design Retrospective cohort study. Objective The objective was to measure the change of flavum ligament diameter during positional changes of the cervical spine using kinetic magnetic resonance imaging (MRI) and to examine the correlational diameter changes of the flavum ligament, disk bulging, and the spinal canal from extension to flexion positions. Methods One hundred eight-nine patients underwent kinetic MRI in neutral, extension, and flexion positions. The diameters of cervical ligamentum flavum, disk bulging, and cervical spinal canal and the disk degeneration grade and Cobb angles were measured from C2-C3 to C7-T1. Results In all, 1,134 cervical spinal segments from 189 patients were included. There was a 0.26 ± 0.85-mm average increase in the diameter of the ligamentum flavum from flexion to extension, and 62.70% of the segments had increased ligamentum flavum diameter from flexion to extension. For all segments of the 189 patients, the cervical spinal canal diameters had an average decrease at the disk level of 0.56 ± 1.21 mm from flexion to extension. For all segments with cervical spinal canal narrowing ≥1 mm from flexion to extension view, the ligamentum flavum diameters at C3-C4 to C5-C6 had significant increases compared with patients with spinal canal narrowing < 1 mm (p < 0.05). For patients with ligamentum flavum hypertrophy of ≥1 mm from the flexion to extension view, the cervical spinal canal diameters at C2-C3, C4-C5, and C5-C6 had significant decreases compared with patients with ligamentum flavum hypertrophy of <1 mm (p < 0.05). Conclusion The "hidden" hypertrophy of ligamentum flavum was significant at C4-C5 and C5-C6 and significantly contributes to the stenosis of cervical spinal canal in the extension position.
Collapse
Affiliation(s)
- Cheng Zeng
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Jian Xiong
- Department of Trauma and Orthopaedics, Peking University People's Hospital, Beijing, China,Address for correspondence Jian Xiong, MD Department of Trauma and Orthopaedics, Peking University People's Hospital11 Xizhimen South Street, Xicheng District, BeijingChina
| | - Jeffrey C. Wang
- Orthopaedic Surgery and Neurosurgery, USC Spine Center, Los Angeles, California, United States
| | - Hirokazu Inoue
- Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles, California, United States
| | - Yanlin Tan
- Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles, California, United States
| | - Haijun Tian
- Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles, California, United States
| | - Bayan Aghdasi
- Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles, California, United States
| |
Collapse
|
27
|
Bazylewicz MP, Berkowitz F, Sayah A. 3D T2 MR Imaging-Based Measurements of the Posterior Cervical Thecal Sac in Flexion and Extension for Cervical Puncture. AJNR Am J Neuroradiol 2016; 37:579-83. [PMID: 26514609 DOI: 10.3174/ajnr.a4564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/14/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The current standard technique for cervical puncture involves prone positioning with neck extension. The purpose of this study was to compare measurements of the posterior cervical thecal sac during neck flexion and extension in supine and prone positions by using high-resolution MR imaging to help determine the optimal positioning for cervical puncture. MATERIALS AND METHODS High-resolution T2-weighted MR imaging was performed of the cervical spine in 10 adult volunteers 18 years of age and older. Exclusion criteria included the following: a history of cervical spine injury/surgery, neck pain, and degenerative spondylosis. Images of sagittal 3D sampling perfection with application-optimized contrasts by using different flip angle evolutions were obtained in the following neck positions: supine extension, supine flexion, prone extension, and prone flexion. The degree of neck flexion and extension and the distance from the posterior margin of the spinal cord to the posterior aspect of the C1-C2 thecal sac were measured in each position. RESULTS The mean anteroposterior size of the posterior C1-C2 thecal sac was as follows: 4.76 mm for supine extension, 3.63 mm for supine flexion, 5.00 mm for prone extension, and 4.00 mm for prone flexion. Neck extension yielded a larger CSF space than flexion, independent of supine/prone positioning. There was no correlation with neck angle and thecal sac size. CONCLUSIONS The posterior C1-C2 thecal sac is larger with neck extension than flexion, independent of prone or supine positioning. Given that this space is the target for cervical puncture, findings suggest that extension is the ideal position for performing the procedure, and the decision for prone-versus-supine positioning can be made on the basis of operator comfort and patient preference/ability.
Collapse
Affiliation(s)
- M P Bazylewicz
- From the Division of Neuroradiology, Department of Radiology, Medstar Georgetown University Hospital, Washington, DC
| | - F Berkowitz
- From the Division of Neuroradiology, Department of Radiology, Medstar Georgetown University Hospital, Washington, DC
| | - A Sayah
- From the Division of Neuroradiology, Department of Radiology, Medstar Georgetown University Hospital, Washington, DC.
| |
Collapse
|
28
|
Ray WZ, Akbari S, Shah LM, Bisson E. Correlation of Foraminal Area and Response to Cervical Nerve Root Injections. Cureus 2015. [PMID: 26203404 PMCID: PMC4509621 DOI: 10.7759/cureus.286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: Patients with age-related degenerative changes in the cervical spine leading to cervical spondylosis may be symptomatic or asymptomatic. Older patients with radicular pain tend to have a better response to epidural steroid injections, but it is often difficult to predict which patients will have a positive response to selective nerve root block (SNRB). We analyzed whether the cervical neuroforaminal area measured on MRI predicts immediate therapeutic responses to SNRB in patients who have cervical radiculopathy. Methods: We retrospectively reviewed all patients who had cervical SNRBs treated at a single tertiary referral center. We recorded patient demographics, the neuroforaminal area of the symptomatic and contralateral sides, Visual Analog Scale (VAS) score pre- and post-injection, history of previous cervical surgery, comorbidities, and history of tobacco use. Results: Sixty-four patients with symptoms of cervical radiculopathy treated with neuroforaminal nerve root injections had appropriate imaging and VAS scores recorded. The average foraminal area of the symptomatic side before treatment was significantly smaller than the contralateral asymptomatic neuroforamen (p<0.0001). Those patients with the smallest neuroforamen had a positive response to SNRB. Diabetes and tobacco use did not influence patient response to treatment. Conclusions: Measurement of neuroforaminal areas on MRI may represent a useful pre-procedural technique to predict which patients with symptoms of cervical radiculopathy secondary to foraminal stenosis are likely to respond to selective nerve root injections. The predictive ability appears to be limited to those patients with severe stenosis and was less useful in those patients with moderate or mild stenosis.
Collapse
Affiliation(s)
- Wilson Z Ray
- Neurological Surgery, Washington University School of Medicine in St. Louis
| | - Syed Akbari
- School of Medicine, Washington University School of Medicine in St. Louis
| | | | | |
Collapse
|
29
|
Cadotte DW, Cadotte A, Cohen-Adad J, Fleet D, Livne M, Wilson JR, Mikulis D, Nugaeva N, Fehlings MG. Characterizing the location of spinal and vertebral levels in the human cervical spinal cord. AJNR Am J Neuroradiol 2014; 36:803-10. [PMID: 25523587 DOI: 10.3174/ajnr.a4192] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 10/01/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Advanced MR imaging techniques are critical to understanding the pathophysiology of conditions involving the spinal cord. We provide a novel, quantitative solution to map vertebral and spinal cord levels accounting for anatomic variability within the human spinal cord. For the first time, we report a population distribution of the segmental anatomy of the cervical spinal cord that has direct implications for the interpretation of advanced imaging studies most often conducted across groups of subjects. MATERIALS AND METHODS Twenty healthy volunteers underwent a T2-weighted, 3T MRI of the cervical spinal cord. Two experts marked the C3-C8 cervical nerve rootlets, C3-C7 vertebral bodies, and pontomedullary junction. A semiautomated algorithm was used to locate the centerline of the spinal cord and measure rostral-caudal distances from a fixed point in the brain stem, the pontomedullary junction, to each of the spinal rootlets and vertebral bodies. Distances to each location were compared across subjects. Six volunteers had 2 additional scans in neck flexion and extension to measure the effects of patient positioning in the scanner. RESULTS We demonstrated that substantial variation exists in the rostral-caudal position of spinal cord segments among individuals and that prior methods of predicting spinal segments are imprecise. We also show that neck flexion or extension has little effect on the relative location of vertebral-versus-spinal levels. CONCLUSIONS Accounting for spinal level variation is lacking in existing imaging studies. Future studies should account for this variation for accurate interpretation of the neuroanatomic origin of acquired MR signals.
Collapse
Affiliation(s)
- D W Cadotte
- From the Department of Surgery, Division of Neurosurgery (D.W.C., A.C., J.R.W., M.G.F.) Toronto Western Hospital (D.W.C., D.M., N.N., M.G.F.), University Health Network, Toronto, Ontario, Canada
| | - A Cadotte
- From the Department of Surgery, Division of Neurosurgery (D.W.C., A.C., J.R.W., M.G.F.)
| | - J Cohen-Adad
- Institute of Biomedical Engineering (J.C.-A.), Ecole Polytechnique de Montréal, Montreal, Quebec, Canada
| | - D Fleet
- Department of Computer Science (D.F., M.L.)
| | - M Livne
- Department of Computer Science (D.F., M.L.)
| | - J R Wilson
- From the Department of Surgery, Division of Neurosurgery (D.W.C., A.C., J.R.W., M.G.F.)
| | - D Mikulis
- Department of Medical Imaging, Division of Neuroradiology (D.M.), University of Toronto, Toronto, Ontario, Canada Toronto Western Hospital (D.W.C., D.M., N.N., M.G.F.), University Health Network, Toronto, Ontario, Canada
| | - N Nugaeva
- Toronto Western Hospital (D.W.C., D.M., N.N., M.G.F.), University Health Network, Toronto, Ontario, Canada
| | - M G Fehlings
- From the Department of Surgery, Division of Neurosurgery (D.W.C., A.C., J.R.W., M.G.F.) Toronto Western Hospital (D.W.C., D.M., N.N., M.G.F.), University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
30
|
Hur JW, Kim JS, Shin MH, Ryu KS. Minimally invasive posterior cervical decompression using tubular retractor: The technical note and early clinical outcome. Surg Neurol Int 2014; 5:34. [PMID: 24778922 PMCID: PMC3994691 DOI: 10.4103/2152-7806.128915] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 02/10/2014] [Indexed: 11/25/2022] Open
Abstract
Background: The aim of this work is to present a novel decompression technique that approaches cervical spine posteriorly, but through minimal invasive method using tubular retractor avoiding detachment of posterior musculature. Methods: Six patients underwent minimally invasive posterior cervical decompression using the tubular retractor system and surgical microscope. Minimally invasive access to the posterior cervical spine was performed with exposure through a paramedian muscle-splitting approach. With the assistance of a specialized tubular retraction system and deep soft tissue expansion mechanism, multilevel posterior cervical decompression could be accomplished. This approach also allows safe docking of the retractor system on the lateral mass, thus avoiding the cervical spinal canal during exposure. A standard operating microscope was used with ×10 magnification and 400 mm focal length. The hospital charts, magnetic resonance imaging studies, and follow-up records of all the patients were reviewed. Outcome was assessed by neurological status and visual analog scale (VAS) for neck and arm pain. Results: There was no significant complication related to operation. The follow-up time was 4-12 months (mean, 9 months). Muscle weakness improved in all patients; sensory deficits resolved in four patients and improved in two patients. Analysis of the mean VAS for radicular pain and VAS for neck pain showed significant improvement. Conclusions: The preliminary experiences with good clinical outcome seem to promise that this minimally invasive technique is a valid alternative option for the treatment of cervical spondylotic myelopathy.
Collapse
Affiliation(s)
- Jung-Woo Hur
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jin-Sung Kim
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Myeong-Hoon Shin
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Kyeong-Sik Ryu
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| |
Collapse
|
31
|
Bartlett RJV, Rigby AS, Joseph J, Raman A, Kunnacherry A, Hill CAR. Extension MRI is clinically useful in cervical myelopathy. Neuroradiology 2013; 55:1081-8. [PMID: 23740097 DOI: 10.1007/s00234-013-1208-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Cervical spine MRI with the neck in extension has been well described over the last 10 years, but its clinical value remains unknown. METHODS We performed extension imaging in 60 patients in whom the initial neutral study showed borderline cord compression. Images were assessed using a previously validated grading system for cord compression. Multiple linear and area measurements were also obtained. Images were scored blindly and randomly. Inter- and intra-rater variability were determined in a subset of 20 cases. Independent clinical assessment utilised the Ranwat criteria. RESULTS For most parameters inter/intra-observer variance of kappa/ICC > 0.6 was highly satisfactory. Standard MR was poor at discriminating between patients with and without myelopathy (ROC analysis, area under the curve (AUC), 0.52). This was considerably improved with extension imaging (AUC, 0.60), or by using the change in compression score between neutral and extension studies. Most measurements were not helpful; however, the ratio of cord area/CSF area at the level of maximum compression on extended images was the best discriminator (AUC, 0.71), as well as the presence of T2 change in cord substance (AUC, 0.68). CONCLUSION This is the first study to demonstrate added clinical value utilising extension MRI. In this cohort of difficult patients, when there was no T2 signal change in the cord, the presence of clinical myelopathy could only be predicted by utilising the data from extension imaging.
Collapse
|
32
|
Park HJ, Kim SS, Lee SY, Park NH, Chung EC, Rho MH, Kwon HJ, Kook SH. A practical MRI grading system for cervical foraminal stenosis based on oblique sagittal images. Br J Radiol 2013; 86:20120515. [PMID: 23410800 DOI: 10.1259/bjr.20120515] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To propose a new and practical MRI grading method for cervical neural foraminal stenosis and to evaluate its reproducibility. METHODS We evaluated 50 patients (37 males and 13 females, mean age 49 years) who visited our institution and underwent oblique sagittal MRI of the cervical spine. A total of 300 foramina and corresponding nerve roots in 50 patients were qualitatively analysed from C4-5 to C6-7. We assessed the grade of cervical foraminal stenosis at the maximal narrowing point according to the new grading system based on T2 weighted oblique sagittal images. The incidence of each of the neural foraminal stenosis grades according to the cervical level was analysed by χ(2) tests. Intra- and interobserver agreements between two radiologists were analysed using kappa statistics. Kappa value interpretations were poor (κ<0.1), slight (0.1≤κ≤0.2), fair (0.2<κ≤0.4), moderate (0.4<κ≤0.6), substantial (0.6<κ≤0.8) and almost perfect (0.8<κ≤1.0). RESULTS Significant stenoses (Grades 2 and 3) were rarely found at the C4-5 level. The incidence of Grade 3 at the C5-6 level was higher than that at other levels, a difference that was statistically significant. The overall intra-observer agreement according to the cervical level was almost perfect. The agreement at each level was almost perfect, except for only substantial agreement at the right C6-7 by Reader 2. No statistically significant differences were seen according to the cervical level. Overall kappa values of interobserver agreement according to the cervical level were almost perfect. In addition, the agreement of each level was almost perfect. Overall intra- and interobserver agreement for the presence of foraminal stenosis (Grade 0 vs Grades 1, 2 and 3) and for significant stenosis (Grades 0 and 1 vs Grades 2 and 3) showed similar results and were almost perfect. However, only substantial agreement was seen in the right C6-7. CONCLUSION A new grading system for cervical foraminal stenosis based on oblique sagittal MRI provides reliable assessment and good reproducibility. This new grading system is a useful and easy method for the objective evaluation of cervical neural foraminal stenosis by radiologists and clinicians. ADVANCES IN KNOWLEDGE The use of the new grading system for cervical foraminal stenosis based on oblique sagittal MRI can be a useful method for evaluating cervical neural foraminal stenosis.
Collapse
Affiliation(s)
- H-J Park
- Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Jongro-ku, Seoul, Republic of Korea
| | | | | | | | | | | | | | | |
Collapse
|