Novel imaging protocol enables myelography of the cervical vertebral column using computed tomography with flexion and extension comparable to x-ray.

Summary Computed tomography (CT) with CT myelography is a novel imaging modality for detailed anatomical imaging and precise diagnosis of equine cervical spine pathology. Computed tomography of the complete cervical vertebral column in live horses has not been reported previously. The objectives of this study were to describe the diagnostic utility of CT and CT myelography in horses, the technique, the type and distribution of lesions and procedure‐related complications. Medical records of horses subjected to cervical CT and CT myelography between 2013 and 2018 were reviewed for this retrospective descriptive study. The examinations were performed with horses in lateral recumbency using a large‐bore CT scanner. In total, 180 horses were included. The study population consisted of 79.4% Warmblood breed horses, 68.3% were male, the mean age was 7.1 years (range 21 days–21 years), and the bodyweight ranged from 61 to 717 kg (mean 530 kg). Pathology of the cervical vertebral column was identified in 176/180 horses (97.8%) and included osteoarthritis of the articular process joints in 83%. Impingement and compression of the spinal cord were detected using CT myelography in 125/147 horses (85%). Pathology was localised caudal to C5 in 90%. The mean ± s.d. anaesthesia time was 34 ± 19 min and 52 ± 13 min for CT examinations, excluding and including myelography, respectively. Adverse events occurred in 7.2% of the examined horses. The caudal location of the majority of lesions emphasises the importance of good‐quality imaging of the most caudal cervical vertebrae in horses with suspected cervical spinal pathology and/or spinal cord compression. Computed tomography imaging enables identification of bony and soft tissue lesions of the entire cervical vertebral column in live, large‐breed adult horses.

BackgroundThree‐dimensional computed tomographic (CT) evaluation of the cervical vertebral column enables more accurate identification of osseous and soft tissue lesions than traditional latero‐lateral radiography. However, examination of the complete cervical vertebral column has been limited by horse size, preventing evaluation of the caudal cervical vertebrae.ObjectivesTo describe a technique to enable CT myelography of the complete cervical spine and describe the findings in 51 horses.AnimalsRecords of 51 horses presented for evaluation of cervical vertebral lesions.MethodsA retrospective review of clinical records from all horses presented for CT myelography to further investigate possible cervical vertebral lesions was performed. A description of a novel approach to CT myelography in horses and retrospective review of the findings in clinical cases has been included.ResultsDegenerative joint disease was identified at 1 or more dorsal articular process joint in 50/51 horses, of which 44/51 had a site of grade 2 or greater. Spinal cord compression was observed on CT myelography in 31/51 horses, whereas attenuation of the dorsal contrast column was identified radiographically in 11/50 horses. Thirty‐three horses showed narrowing or obliteration of the intervertebral foramina at 1 or more site and osteochondral fragments were seen in 11/51 horses.Conclusions and Clinical ImportanceComputed tomography myelography is relatively safe and an easily performed technique with the correct equipment, enabling evaluation of the cervical vertebral structures of horses in all planes and volumetrically. It is possible that lesion extent might be underestimated with this diagnostic modality, hence interpretation should be complimented with flexed and extended views radiographically.

Computed tomographic myelography (CTM) is diagnostic for extradural spinal cord compression but knowledge about vertebral ratios from transverse images in flexion and normal position of unaffected horses is lacking. To compare the ratios of the cross-sectional areas (CSAs) of the spinal cord, the vertebral canal and of the contrast enhanced dural tube on transverse CTM images at C3-C4 in neutral and flexed positions in unaffected Warmbloods. CTM was performed in 13 neurologically unaffected Warmbloods in neutral and flexed cervical vertebral column positions. Ratios were calculated at intervertebral (inter1-3) and intravertebral (cranial, middle, caudal) sites. The cord canal area ratio (CCAR = CSA spinal cord / CSA vertebral canal), the dural canal area ratios (DCAR = CSA contrast enhanced dural tube / CSA vertebral canal) and the cord dural area ratios (CDAR = CSA spinal cord / CSA contrast enhanced dural tube) were calculated and compared between different cervical positions. DCAR decreased significantly (p < 0.05) in the flexed compared to the neutral position. Reductions were intravertebral at the cranial and caudal sites of C3 and C4. At the intervertebral sites, there was a significant decrease at inter1 and inter2. CDAR increased significantly (p < 0.05) at all intervertebral locations (inter 1-3) in the flexed cervical vertebral column compared to the neutral position. Flexion of the cervical vertebral column led to a decrease of the DCAR and an increase of the CDAR at the intervertebral sites in unaffected Warmbloods.

Client-owned, clinically normal Doberman Pinschers (n=20), English Foxhounds (n=17), and Doberman Pinschers with clinical signs of disk-associated cervical spondylomyelopathy (DA-CSM) (n=17) were prospectively studied. All dogs underwent magnetic resonance imaging (MRI) of the cervical vertebral column. To evaluate vertebral canal stenosis, the canal occupying ratios of the spinal cord and cerebrospinal fluid (CSF)-column were calculated from C5 to C7. To evaluate the degree of spinal cord compression and the amount of canal compromise, the compression ratio, remaining spinal cord and CSF-column area, and vertebral canal and dorsoventral vertebral canal compromise ratios were calculated at the site of most severe compression. For each canal occupying ratio, there was a significant higher value (implicating less space available for the spinal cord in the vertebral canal) at the level of C7 for clinically affected Doberman Pinschers compared with clinically normal English Foxhounds. The remaining spinal cord area was significantly smaller in dogs with clinically relevant spinal cord compression compared to dogs with clinically irrelevant spinal cord compression. Relative stenosis of the caudal cervical vertebral canal occurred more often in Doberman Pinschers with DA-CSM compared to English Foxhounds and a critical degree of spinal cord compression should be reached to result in clinical signs.

Retrospective analysis of kinematic magnetic resonance images. To provide baseline data on the segmental angular and translational motion of the degenerated cervical spine by subtype of kyphotic cervical deformity and to elucidate the relationship between motion and degree of spinal cord compression. Kyphotic deformities of the cervical spine are relatively common and are classified as either global or focal. Nevertheless, the effects of kyphotic subtype on cervical segmental motion and degree of spinal cord compression are unknown. A total of 1171 symptomatic patients (618 females, 553 males) underwent cervical kinematic magnetic resonance imaging in the neutral, flexion, and extension positions. Cervical spines demonstrating kyphosis were included and classified into 3 groups: (1) "global kyphotic deformity" (C-type) (n = 54); (2) "sigmoid deformity" (S-type) with kyphotic upper and lordotic lower cervical segments (n = 29); and (3) "reverse sigmoid deformity" (R-type) with lordotic upper and kyphotic lower cervical segments (n = 39). Translational motion, angular motion, and degree of spinal cord compression were evaluated for each cervical level along with the changes associated with flexion and extension. In the C- and R-types, angular motion with extension was increased in the upper cervical spine, where there was kyphosis; when compared with the S-type, in which there was lordosis in the upper segments. The results were opposite for flexion angular motion. R-type displayed more translational motion at C3-C4 and C5-C6. Degree of static spinal cord compression of R-type was higher than the others at C3-C4. The dynamic spinal cord compression increased in extension more than flexion in all subtypes. Cervical spine studies that aim to investigate kyphotic deformities should make efforts to discern the different subtypes of kyphotic deformities to more accurately characterize and study the effects that the sagittal alignment has on the kinematics of the spine and the degree of spinal cord compression.

Few studies have described morphological deviations in obstructive sleep apnoea (OSA) patients on two-dimensional (2D) lateral cephalograms, and the reliability of 2D radiographs has been discussed. The objective is to describe the morphology of the cervical vertebral column on cone beam CT (CBCT) in adult patients with OSA and to compare 2D lateral cephalograms with three-dimensional (3D) CBCT images. For all 57 OSA patients, the cervical vertebral column morphology was evaluated on lateral cephalograms and CBCT images and compared according to fusion anomalies and posterior arch deficiency. The CBCT assessment showed that 21.1% had fusion anomalies of the cervical column, i.e. fusion between two cervical vertebrae (10.5%), block fusions (8.8%) or occipitalization (1.8%). Posterior arch deficiency occurred in 14% as partial cleft of C1 and in 3.5% in combination with block fusions. The agreement between the occurrence of morphological deviations in the cervical vertebral column between lateral cephalograms and CBCT images showed good agreement (κ = 0.64). Prevalence and pattern in the cervical column morphology have now been confirmed on CBCT. The occurrence of morphological deviations in the cervical vertebral column showed good agreement between lateral cephalograms and CBCT images. This indicates that 2D lateral cephalograms (already available after indication in connection with, e.g. treatment planning) are sufficient for identifying morphological deviations in the cervical vertebral column. For a more accurate diagnosis and location of the deviations, CBCT is required. New 3D methods will suggest a need for new detailed characterization and division of deviations in cervical vertebral column morphology.

The orientation of the cervical vertebral column was studied by X-ray photography of the region containing the head and the neck in nine unrestrained species of vertebrates (man, monkey, cat, rabbit, guinea pig, rat, chicken, frog, lizard). In addition, the orientation of the horizontal semicircular canals was measured in four species using landmarks on the skull. In all vertebrates studied, with the exception of frog and lizard, the general orientation of the cervical vertebral column was vertical when animals were at rest, and not horizontal or oblique as suggested by the macroscopic appearance of the neck. The posture of the animal, whether lying, sitting or standing, had little effect on this general vertical orientation, although some variability was noticed depending on the species. This finding prompted the definition of a resting zone, where the cervical column can take any orientation within a narrow range around a mean position. The cervical vertebral column composes part of the S-shaped structure of the entire vertebral column, with one inflection around the cervico-thoracic (C7/Th1) junction. This feature is already noticable in the lizard. The vertical orientation of the cervical vertebral column is interpreted to provide a stable and energy saving balance of the head. Furthermore, when the head is lowered or raised, the atlanto-occipital and cervico-thoracic junctions are predominantly involved, while the entire cervical column largely preserves its intrinsic configuration. The curved configuration of the cervico-thoracic vertebral column embedded in long spring-like muscles is interpreted to function as a shock absorber. At rest, animals did not hold their heads with the horizontal canals oriented earth horizontally all the time, but often maintained them pitched up by ca. 5 deg, as has been reported for man. At other times, presumably when the vigilance level increased, the horizontal canals were brought into the earth horizontal plane. The vertical orientation of the cervical column results in a vertical positioning of the odontoid process of the axis (second cervical vertebra, C2), which thus provides the axis of rotation for yaw movements of the head. This axis corresponds to that of the horizontal semicircular canals. The vertical organization of the cervical vertebral column in birds and mammals, whether the animal is quadrupedal or bipedal, points to a common organizational principle for eye and head movement systems.(ABSTRACT TRUNCATED AT 400 WORDS)

To determine whether there is an association between the degree of transverse spinal cord compression detected by magnetic resonance imaging following thoracolumbar Hansen type 1 intervertebral disc disease in dogs and their presenting and postsurgical neurological status. Medical records of 67 dogs with surgically confirmed Hansen type 1 intervertebral disc disease (2000 to 2004) were reviewed to obtain the rate of onset of disease, duration of clinical signs and presurgical and postsurgical neurological grade. Percentage of spinal cord compression was determined on transverse T2-weighted magnetic resonance images. Linear regression was used to examine the association between spinal cord compression and each of the above variables. Chi-squared tests were used to examine associations among postsurgical outcome and presurgical variables. Eighty-five per cent (57 of 67) of dogs were chondrodystrophoid. Mean spinal cord compression was 53 per cent (sd=219.7, range 14.3 to 84.9 per cent). There was no association between the degree of spinal cord compression and the neurological grade at presentation, rate of onset of disease, duration of clinical signs or postsurgical outcome, with no difference between chondrodystrophoid and non-chondrodystrophoid dogs. The degree of spinal cord compression documented with magnetic resonance imaging in dogs with thoracolumbar Hansen type 1 intervertebral disc disease was not associated with the severity of neurological signs and was not a prognostic indicator in this study.

Predictive effect of cervical spinal cord compression and corresponding segmental paravertebral muscle degeneration on the severity of symptoms in patients with cervical spondylotic myelopathy

Cervical Vertebral Column Morphology Associated with Head Posture and Craniofacial Morphology

Reliability of CT myelography versus MRI in the assessment of spinal epidural disease

Development of a finite element model of the ligamentous cervical vertebral column of a Great Dane

The biomechanical effects on cervical vertebral columns (C1-C7) during mastication were calculated using a three-dimensional (3D) finite element method. To verify the biomechanical influences of vertical occlusal alteration to the cervical column, three finite element models (FEM) showing a normal (model A), a steep (model B), and a flat occlusal plane (model C) were constructed. The occlusal stress distribution showed various patterns for the three models; the stress extended to the anterior area as the occlusal plane became steeper. The plots of the stresses on the mid sagittal section of the cervical columns showed different patterns for the three models; the stress converged at the odontoid process in models A and B, whereas the stresses at C7 in model B tended to decrease compared with model A. Concentrated stress was observed at C5 in model C, supporting the hypothesis that vertical occlusal alteration could influence stress distribution in the cervical columns.

Cervical vertebral column morphology and head posture in preorthodontic patients with anterior open bite

Spontaneous intracranial hypotension: presentation, diagnosis, and treatment.