Cervical Magnetic Resonance Imaging Scans Research Articles

Design of a novel deep network model for spinal cord injury prediction

Degenerative cervical myelopathy must be diagnosed with magnetic resonance imaging (MRI) which predicts spinal cord injury (SCI). The growing volume of medical imaging data can be managed by deep learning models, which provide a preliminary interpretation of images taken in basic care settings. Our main goal was to create a deep-learning approach that could identify SCI using MRI data. This work concentrates on modeling a novel 2D-convolutional neural networks (2D-CNN) approach for predicting SCI. For holdouts, training, and validation, various datasets of patients were created. Two experts assigned labels to the images. The holdout dataset was used to evaluate the performance of our deep convolutional neural network (DCNN) over the image data from the available dataset. The dataset is acquired from the online resource for training and validation purpose. With the available dataset, the anticipated model attains 94% AUC, 0.1 p-value, and 92.2% accuracy. The anticipated model might make cervical spine MRI scan interpretation more accurate and reliable.

Prevalence of incidental thyroid abnormalities in patients with degenerative cervical spondylosis: a retrospective cross-sectional magnetic resonance imaging study.

Incidental thyroid abnormalities found on magnetic resonance imaging (MRI) of the neck are not uncommon. This study aimed to investigate the prevalence of incidental thyroid abnormalities in the cervical spine MRI of the degenerative cervical spondylosis (DCS) population indicated for surgery and to identify patients who require additional workup based on the recommendations of the American College of Radiology (ACR). All consecutive patients with DCS and indications for cervical spine surgery from October 2014 to May 2019 in the Affiliated Hospital of Xuzhou Medical University were reviewed. All MRI scans of the cervical spine routinely include the thyroid. Cervical spine MRI scans were retrospectively evaluated for the prevalence, size, morphologic characteristics, and location of incidental thyroid abnormalities. A total of 1,313 patients were included in the analysis, 98 (7.5%) of whom were found to have incidental thyroid abnormalities. The most frequent thyroid abnormality was thyroid nodules (5.3%), followed by goiters (1.4%). Other thyroid abnormalities included Hashimoto thyroiditis (0.4%) and thyroid cancer (0.5%). There was a statistically significant difference in age and sex between patients with DCS with and without incidental thyroid abnormalities (P=0.018 and P=0.007). Stratified by age, the results showed that the highest incidence of incidental thyroid abnormalities was found in patients aged 71 to 80 years (12.4%). Eighteen patients (1.4%) needed further ultrasound (US) and relevant workups. Incidental thyroid abnormalities are common in cervical MRI, with a prevalence of 7.5% identified in patients with DCS. Incidental thyroid abnormalities are large or have suspicious imaging features, and further evaluation with a dedicated thyroid US examination should be completed before cervical spine surgery is undertaken.

K-line tilt as a novel potential risk factor for cervical Modic change: a retrospective study

BackgroundCervical sagittal parameters are important parameters that reflect the mechanical stress in the sagittal plane of the cervical spine and are an important basis for predicting the clinical status and prognosis of patients. Although it has been confirmed that there is a significant correlation between cervical Modic changes and some sagittal parameters. However, as a newly discovered sagittal parameter, there is no report on the relationship between the K-line tilt and the Modic changes of cervical spine.MethodsA retrospective analysis was performed for 240 patients who underwent cervical magnetic resonance imaging scan for neck and shoulder pain. Among them, 120 patients with Modic changes, namely the MC(+) group, were evenly divided into three subgroups of 40 patients in each group according to different subtypes, namely MCI subgroup, MCII subgroup and MCIII subgroup. One hundred twenty patients without Modic changes were included in MC(−) group. We measured and compared the sagittal parameters of cervical spine among different groups, including K-line tilt, C2–C7 sagittal axial vertical distance (C2–C7 SVA), T1 slope and C2–7 lordosis. Logistic regression was used to analyse the risk factors of cervical Modic changes.ResultsThe K-line tilt and C2–7 lordosis were significantly different between MC(+) group and MC(−) group (P < 0.05). The K-line tilt greater than 6.72° is a risk factor for Modic changes in cervical spine (P < 0.05). At the same time, the receiver operating characteristic curve showed that this change had moderate diagnostic value when the area under the curve was 0.77.ConclusionThis study shows that the K-line tilt greater than 6.72° is a potential risk factor for Modic changes in cervical spine. When the K-line tilt is greater than 6.72°, we should be alert to the occurrence of Modic changes.Trial registration number: 2022ER023-1.

Is it possible to evaluate upper and lower cervical interdependency on supine magnetic resonance imaging?

<p>There is a significant correlation between the upper and lower cervical alignments associated with a compensatory mechanism to maintain horizontal gaze. Evaluating this correlation before cervical fusion operations is essential, particularly in the upper cervical region, to prevent the occurrence of postoperative malalignment. This study was designed to investigate whether evaluating the interdependency between the upper and lower cervical alignments on neutral supine magnetic resonance imaging (MRI) or supine MRI with neck extension is possible.&nbsp;</p>. <p>This study included 36 male and 30 female volunteers without symptoms aged between 16 and 60 years. Cervical radiographic images and supine cervical spinal MRI scans were obtained twice on the neutral supine position and on the supine position with pillows placed at 5 cm high under the shoulder. Cervical lordosis (CL) (C2&ndash;7 Cobb angle), C0&ndash;2 Cobb angle, C2&ndash;7 sagittal vertical axis (C2&ndash;7SVA), T1 slope (T1S), and T1 slope minus CL (T1S-CL (C2S)) were measured from the imaging sets from each patient, including X-ray images and two MRI scans, and the main values were obtained. The mean values of the measurements from the radiographic images were compared with those obtained from MRI scans using Student&rsquo;s t-test. The agreement between the parameters (C0&ndash;2 Cobb angle, CL Cobb angle, and T1S-CL) obtained from the radiographic images and MRI scans was evaluated using Pearson correlation analysis.</p>. <p>Pearson correlation analysis revealed significant correlations between the C0&ndash;2 and C2&ndash;7 Cobb angles in standing X-ray and neutral MRI values (r = &minus;0.425 and -0.397, respectively). In plain radiography and MR studies, the T1 slope was correlated with the C2&ndash;7 angle (r = 0.4824, 0.734, and 0.702, respectively). The C2 slope values were also significantly correlated with the C0&ndash;2 Cobb angle in standing X-ray and neutral MRI images (r = 0.5595 and 0.5719, respectively). There were significant correlations between the C2 slope and C2&ndash;7 Cobb angles in all modalities (r = &minus;0.5645, &minus;0.7917, and &minus;0.8526).</p>. <p>Negative correlations between the upper and lower cervical alignments are also present in supine MRI studies, consequently in the supine position, with statistical significance. The C2 slope is an important cervical spine parameter that is significantly correlated with both the C0&ndash;2 and CL Cobb angles. The C2 slope can be used to evaluate the interdependency of the upper and lower cervical alignments.</p>.

A Cadaver Feasibility Study of Extradural Contralateral C7 Ventral Root Transfer Technique for Treating Upper Extremity Paralysis.

A total of 6 formalin-fixed cadavers were included in the cadaver feasibility study. The aim was to ascertain the anatomical feasibility of extradural contralateral C7 ventral root transfer technique by cervical posterior. Upper limb spastic hemiplegia is a common sequela after stroke. In our previous study, the authors established a method by transferring contralateral C7 dorsal and ventral roots to the corresponding C7 dorsal and ventral roots on the affected side in the cervical posterior. In the present study, six formalin-fixed cadavers were dissected to confirm the anatomical feasibility. Experimental anastomosis in cadavers was conducted. The pertinent lengths of the extradural nerve roots were measured. The tissue structures surrounding regions between the extradural CC7 nerve roots and the vertebral artery were observed. The cervical magnetic resonance imaging scans of 60 adults were used to measure the distance between the donor and recipient nerves. Experimental anastomosis showed that the distance between the donor and recipient nerves was approximately 1cm; the short segment of the sural nerve needed bridging. The distance between both exit sites of the exit of the extradural dura mater was 33.57±1.55mm. The length of the extradural CC7 ventral root was 22.00±0.98mm. The ventral distance (vd) and the dorsal distance (dd) in males were 23.98±1.72mm and 30.85±2.22mm ( P <0.05), while those in females were 23.28±1.51mm and 30.03±2.16mm, respectively. C7 vertebral transverse process, ligaments, and other soft tissues were observed between the vertebral artery and the extradural C7 nerve root. Under the premise of less trauma, our study shows that the extradural contralateral C7 ventral root transfer technique, in theory, yields better surgical results, including better recovery of motor function and complete preservation of sensory function. 5.

Cervical facet joint effusion: A sign of instability in cervical degenerative spondylolisthesis.

Aims:The aim of this study was to trace the association between cervical facet joint effusion and cervical degenerative spondylolisthesis (CDS). CDS has not received as much attention as its lumbar counterpart. Identification of features of instability on magnetic resonance imaging (MRI) is crucial to avoid missing presence of CDS.Materials and Methods:The authors retrospectively reviewed cervical spine MRI scans and upright lateral flexion-extension radiographs of 17 consecutive patients at a single institution between January 2017 and June 2018 that revealed CDS. Presence of cervical facet joint effusion and CDS was recorded. Data were analyzed to deduce possibility of an association between cervical facet joint effusion and CDS.Results:Seventeen patients fulfilled the inclusion criteria of cervical spondylotic myelopathy associated with CDS. Out of these, 10 patients revealed facet joint effusion at C3-C4 (4 patients) and C4-C5 (6 patients) levels. The mean age of patients was 65.8 years (49–79) and M:F was 2.2:1. Amount of facet joint effusion varied and ranged from 1.6 mm to 4.7 mm on the axial images. Ten patients (58.82%) demonstrated facet joint effusion associated with mobile CDS. Seven patients (41.17%) with CDS and without facet effusion did not demonstrate mobility of more than 0.5 mm in flexion-extension radiographs.Conclusion:The current study acknowledges the association of “cervical facet effusion” and CDS. Clinically measurable facet joint effusion on MRI suggests the need for further attempts to diagnose CDS.

Study on Dangerous Acupuncture Needling Depth at Yamen (GV15) for Atlantoaxial Dislocation based on MRI and CT

Background: The depth of acupuncture at GV15 significantly changes with atlantoaxial dislocation (AAD). Magnetic resonance imaging (MRI) and computed tomography (CT) are the current methods for assessing acupuncture depth. However, the acupuncture depth in patients with AAD and the best evaluation method for acupuncture have not been thoroughly studied. Objectives: Based on MRI and 3D CT imaging measurements, dangerous needling depths for perpendicular acupuncture and oblique acupuncture in patients with AAD and normal anatomy were obtained. The application value of MRI and 3D CT in evaluating acupuncture depth is discussed. Methods: From January 2018 to December 2021, patients with AAD (120 patients) and control patients without AAD (124 patients) diagnosed and treated at the Upper Cervical Spine Research Center of the China-Japan Friendship Hospital were selected. All patients were enrolled. Both groups included patients with normal body types (BMI 18.5-23.9). The two groups of patients underwent plain cervical MRI scans and three-dimensional plain CT scans, and the dangerous needling depth of the perpendicular spur and the oblique spur were measured on sagittal images. Results: No significant differences were observed between the two measurements (MRI and CT) (P&lt;0.05). The dangerous needling depths in the AAD group were as follows: male straight stab: 45.33±5.17 mm, male oblique stab: 48.58±4.41 mm, female straight thorn: 44.17±7.80 mm, and female oblique thorn: 47.49±7.32 mm. The dangerous needling depths for the control group were as follows: male straight thorn: 47.72±5.06 mm, male oblique thorn: 42.69±5.53 mm, female straight thorn: 44.63±5.85 mm, and female oblique thorn: 39.88 ± 6.18 mm. Conclusions: Acupuncture depth at the dumb point of the AAD changed significantly. The clinical acupuncture depth should not exceed this safe depth. Both CT and MRI can be used to assess dangerous needling depth at GV15.

Pattern of cervical disc changes in patients with non-traumatic neck pain: a review of cervical MRI scan findings

Background: Neck pain is a common global health problem causing significant individual disability and socioeconomic burden on health care facilities. Many factors have been associated with neck pain but the most implicated is the cervical intervertebral disc disease. Magnetic resonance imaging (MRI) scan is considered globally as the most sensitive test for detecting degenerative disc abnormalities associated with neck pain. The objective of this study was to evaluate cervical disc changes on MRI in non-traumatic symptomatic subjects and to accumulate baseline data on the pattern of changes.Methods: A four-years retrospective review of 115 patients (age range 13 to 81 years) who had a cervical MRI scan due to non-traumatic neck and radiating shoulder pain from September 2017 to February 2021 at the Radiology Department of Jos University Teaching Hospital North Central Nigeria. All the patients were scanned using a Single Siemens (Magnetom Concerto) MRI scanner with 0.2T magnetic field strength. Sagittal T1-weighted and T2-weighted fast spin-echo images were acquired, and axial images and contrast-enhanced studies were done only when required.Results: The study included 74 (64.3%) males and 41 (35.7%) females with a mean age of 50.7±13.2 and a modal age group of 41-60 years. The normal intervertebral disc was commonest at C2/C3 followed by C6/C7 level while degenerative disc changes were most commonly seen at C4/C5 followed by C5/C6 level. The majority (93%) of patients had multilevel intervertebral disc changes and the most frequent and severe occurrences of intervertebral disc dehydration, bulge, herniation, and disc space narrowing were noted at C4/C5 (79.1%), C4/C5 (12.2%), C5/C6 (59.1%) and C4/C5 (10.4%) respectively.Conclusions: This study found all patients examined had at least one level of intervertebral disc changes with the majority having multilevel involvement (93%). The most commonly and severely affected level was C4/C5 followed by C5/C6 level. The most frequent and severe occurrences of disc desiccation, bulge, herniation (protrusion/extrusion/sequestration) and disc height reduction were noted at C4/C5 (79.1%), C4/C5 (12.2%), C5/C6 (59.1%) and C4/C5 (10.4%) respectively.

A deep learning model for detection of cervical spinal cord compression in MRI scans

Magnetic Resonance Imaging (MRI) evidence of spinal cord compression plays a central role in the diagnosis of degenerative cervical myelopathy (DCM). There is growing recognition that deep learning models may assist in addressing the increasing volume of medical imaging data and provide initial interpretation of images gathered in a primary-care setting. We aimed to develop and validate a deep learning model for detection of cervical spinal cord compression in MRI scans. Patients undergoing surgery for DCM as a part of the AO Spine CSM-NA or CSM-I prospective cohort studies were included in our study. Patients were divided into a training/validation or holdout dataset. Images were labelled by two specialist physicians. We trained a deep convolutional neural network using images from the training/validation dataset and assessed model performance on the holdout dataset. The training/validation cohort included 201 patients with 6588 images and the holdout dataset included 88 patients with 2991 images. On the holdout dataset the deep learning model achieved an overall AUC of 0.94, sensitivity of 0.88, specificity of 0.89, and f1-score of 0.82. This model could improve the efficiency and objectivity of the interpretation of cervical spine MRI scans.

Normal range of clivoaxial angle in adults using flexion and extension cervical magnetic resonance imaging scans.

An abnormally decreased clivoaxial angle (CXA) is used during the clinical evaluation for corrective skull base surgery. Published normal ranges of CXA using x-ray, computed tomography, or magnetic resonance imaging (MRI) vary dramatically, especially with neck flexion or extension. The aim of this study was to use high-resolution MRI to determine the normal range of CXA in various neck positions using a reproducible measurement technique. The CXA was measured in 10 healthy volunteers on sagittal T2 SPACE c-spine MRI in supine and prone positions and with the neck both neck and extended. CXA is strictly defined as the angle between a line along the inferior third of the dorsal clival cortex and a line from the superior/posterior cortex of the dens to the posterior/inferior corner of the C2 body. Statistical analysis was performed in all positions and included mean CXA, range, standard deviation (SD), inter-reader agreement, and group comparisons. The mean CXA overall was 156.92° (SD=4.23°; range 134-179°). The mean value for extension CXA was 169.20° (SD=5.81°), and the mean value for flexion CXA was 144.73° (SD=5.71°), the difference being statistically significant (p<0.0001) regardless of supine or prone position. Concordant correlations of reader measurements showed substantial agreement in the supine position at 0.96, with lower agreement in the prone position at 0.87. We report normal ranges for CXA in various neck positions based on 3D T2-weighted MRI, using a reproducible measurement method. There was a significant difference in the CXA values between neck extended and neck flexed positions but not between supine and prone positions.

Association between cervical disc disease and lesions of multiple sclerosis

Cervical discopathy and demyelinating lesions often co-exist in patients with multiple sclerosis (MS). Our study examines the possible association between these two pathologies. Medical records and cervical magnetic resonance imaging scans of MS patients with cervical discopathy who were seen at our MS clinic during 2018 were retrospectively reviewed. The severity of the disc disease was classified as grade I (no compression), grade II (compression of the dural sac) and grade III (cord compression). The spinal cord in each scan was divided into six segments corresponding to the intervertebral space of the spine (C1-C6). Each segment was defined as containing demyelinating lesion and disc pathology (group 1), demyelinating lesion without disc pathology (group 2), disc pathology without demyelinating lesion (group 3) and no demyelinating lesion or disc pathology (group 4). Fisher's exact test was used to test the association between demyelinating lesions and disc pathology. Thirty-four MS patients with cervical discopathy were included in the study (26 females; average age 42.9 ± 13.7 years; average disease duration 8.4 ± 5.4 years). A total of 204 spinal cord segments were evaluated. Twenty-four segments were classified as group 1, 27 segments as group 2, 52 segments as group 3 and 101 segments as group 4. There was no association between demyelinating lesions and the grade of disc disease (p = 0.1 for grade I, p = 0.3 for grade II and p = 1 for grade III disc disease). Our study did not find any association between cervical disc disease and demyelinating spinal cord lesion.

Cervical epidural hematoma after spinal manipulation therapy: a case report

BackgroundCervical spinal manipulation therapy is a common non-invasive treatment for neck pain and stiffness, and has been widely used in the population. However, most people do not pay attention to the potential risks of neck manipulation, such as ligament damage, fractures, and spinal cord injuries. Epidural hematoma is a disease in which blood accumulates in the epidural space of the vertebral body. This disease is usually caused by trauma or iatrogenic surgery, and may be associated with blood coagulopathies, neoplasms, or degenerative spinal disease. Reports of epidural hematoma caused by cervical spinal manipulation are rare.Case presentationWe present the case of a patient with tetraplegia and spinal shock after neck manipulation. A physical examination of the patient on admission found tenderness in the neck and increased muscle tension in both upper limbs. The superficial sensation of the upper limb disappeared, but the deep sensation still remained. The lower extremity had 0/5 power on both sides. The sensation below the T2 level completely disappeared. A cervical magnetic resonance imaging scan showed an acute posterior epidural hematoma from the C3–T3 vertebrae. Ultimately, the patient underwent emergency hematoma removal and showed partial improvement in symptoms of paralysis during follow-up.ConclusionsAlthough spinal manipulation is simple and neck pain is common and recurrent in the general population, the basic condition and disease history of patients should be determined before manipulation. For high-risk patients, caution should be applied for cervical spinal manipulation or it should be prohibited. For a suspected hematoma, MRI should be used at an early stage to diagnose and locate the hematoma.

Spondylotic traumatic central cord syndrome: a hidden discoligamentous injury?

PurposeTo revisit the concept of spondylotic traumatic central cord syndrome (TCCS) by assessing the frequency of discoligamentous injury and to correlate magnetic resonance imaging (MRI) and intraoperative findings.MethodsA retrospective analysis of twenty-three consecutive patients (mean age: 62.7 ± 14.8 years) with profound spondylotic TCCS after acute cervical hyperextension trauma but without signs of instability on initial CT scans who underwent anterior surgical decompression and fusion was performed. Sensitivity and specificity of MRI in the detection of anterior longitudinal ligament disruption were calculated. The topographic relations between surgically verified segmental instabilities and spinal cord signals on MRI were analyzed. The cervical MRI scans of all patients were evaluated by the radiologist on call at time of admission, re-assessed by a specialized MRI radiologist for the purpose of this study and compared with intraoperative findings.ResultsIntraoperative findings revealed 25 cervical spine segments with hyperextension instability in 22 of 23 (95.7%) patients. The radiologist on call correctly assessed segmental hyperextension instability in 15 of 25 segments (sensitivity: 0.60, specificity: 1.00), while the specialized MRI radiologist was correct in 22 segments (sensitivity: 0.88, specificity: 1.00). In 17 of 23 (73.9%) patients, the level of spinal cord signal on MRI matched the level of surgically verified segmental instability.ConclusionsOur findings challenge the traditional concept of spondylotic TCCS as an incomplete cervical spinal cord injury without discoligamentous injury and emphasize the importance of MRI as well as the radiologist’s level of experience for the assessment of segmental instability in these patients.Graphical abstractThese slides can be retrieved under Electronic Supplementary Material.

Safety of Dynamic Magnetic Resonance Imaging of the Cervical Spine in Children Performed without Neurosurgical Supervision

The need for neurosurgical supervision as well as the general safety and utility of dynamic magnetic resonance imaging (MRI) of the cervical spine in children remains controversial. We present the largest descriptive cohort study of cervical flexion-extension MRI scans in pediatric patients to help elucidate the safety and utility of this technique. We retrospectively reviewed all cervical spine MRI scans performed at Lucile Packard Children's Hospital at Stanford from 2009 to 2015. We identified 66 dynamic cervical MRI scans performed in 45 children and 2young adults for further study. General anesthesia was used in 43 scans. The neuroradiology team performed all scans with no direct supervision by the neurosurgery team. There were no adverse events. Dynamic MRI detected significant instability that was not clearly seen on dynamic radiographs (5patients) and cord compression not seen on static MRI (9 patients). One patient with asymptomatic instability found on flexion-extension radiographs had no cord compression with movement on MRI and was managed conservatively. Two neonates with significant congenital malformations of the cervical spine were cleared for operative positioning for cardiac procedures based on flexion-extension MRI. Dynamic MRI is a safe tool for evaluating the cervical spine and cervicomedullary junction in various pediatric populations and can be performed safely without direct neurosurgical supervision. We describe for the first time the use of flexion-extension MRI to clear neonates with severe congenital cervical spine abnormalities for complex operative positioning and further care in the intensive care unit.

Medial Lemniscus Tract Lesion After High Voltage Electrical Injury: A Case Report.

We present the case of a 33-year-old man who experienced a 10,000-V electrical shock when working with electrical wiring. He suffered third-degree burns on his scalp at the right occiput (entry wound) and on his left arm (exit would), and a second-degree burn on his left foot (exit wound). He presented with severe spasticity of both lower extremities, motor weakness with a Medical Research Council grade of 3, and sensory impairments below thoracic level 11 that included an inability to sense light touch and defects in proprioception. Initial magnetic resonance imaging (MRI) scans of his spine and brain showed no definite abnormalities. However, tractography obtained by diffusion tensor imaging of the brain showed absence of the right medial lemniscus tract. A cervical MRI scan 1 month later showed spinal cord swelling from cervical 1-5 levels, and signal changes in the lateral and posterior white matter in the axial view. After 6 months of rehabilitation, he recovered almost normal degree of motor function in his lower extremities and disappearance of spasticity. However, since the sensory impairments persisted, especially defects in proprioception, he was unable to walk independently.

Is there any relation between cervical cord plaques and discopathy in patients with multiple sclerosis?

IntroductionMultiple sclerosis (MS) is the most common chronic autoimmune demyelinating disease of the central nervous system. The purpose of this study is to determine the relationship between the site of the cervical discopathy and cervical spinal cord plaque in MS patients. MethodsThis retrospective study included all patients with a definite diagnosis of MS who were treated at an outpatient clinic between September 2004 and September 2011. All patients underwent cervical magnetic resonance imaging (MRI) for primary investigation of the disease. Cervical MRI scans were evaluated for detection of any evidence of cervical discopathy and cervical MS plaques. Any correlation between the site of the MS lesions and discopathy was recorded. ResultsFrom 536 patients who were involved in the study, 214 patients had both cervical discopathy and cervical cord plaques. In this group 148 (69.1% of patients) had cervical plaque at the same site of cervical discopathy. The number of patients with cervical cord plaque and discopathy at same site was significantly higher than those with plaque and discopathy at different sites (P<0.05). ConclusionThe study data suggests a possible correlation between cervical discopathy and cervical MS plaque.

Comparison of magnetic resonance imaging with standing cervical radiographs for evaluation of vertebral canal stenosis in equine cervical stenotic myelopathy

The sensitivity and specificity of lateral cervical radiographs to evaluate horses suspected of cervical stenotic myelopathy (CSM) are limited by the assessment being restricted to the sagittal plane. To determine whether magnetic resonance imaging (MRI) allows for a more accurate identification of stenosis than lateral cervical radiographs in horses with CSM. Case control study. Nineteen Thoroughbred horses with CSM (17 males, 2 females, age 6-50 months) were compared to 9 control Thoroughbreds (6 males, 3 females, age 9-67 months). Ante mortem, the subjects had neurological examinations and standing cervical radiographs with sagittal ratios calculated from C3 to C7. Intact cervical column MRI scans and histological examinations of the spinal cord were performed post mortem. Morphometric parameters were measured on the vertebral canal, spinal cord and intervertebral foramen. Radiographic cervical canal height measurements categorised by standard minimal sagittal diameter intravertebral and intervertebral ratios produced several false positive and false negative determinations of canal stenosis as defined by spinal cord histopathology. Post mortem MRI measurements of canal area and cord canal area ratio more accurately predicted sites of cord compression in CSM cases. No differences in spinal cord measurements were observed when comparing CSM to control horses, but each of the vertebral canal parameters achieved significance at multiple sites. Vertebral canal area and cord canal area ratio are better parameters to predict the location of cervical canal stenosis compared to only the sagittal plane of canal height. Additional visual planes and measurements obtained by MRI, specifically vertebral canal area and the cord canal area ratio, will provide a more accurate method to identify regions of canal stenosis than lateral cervical radiographs. The development of MRI or computed tomography equipment capable of evaluating the cervical column of mature horses may substantially enhance evaluation of CSM patients. The Summary is available in Chinese - see Supporting information.

Quadriplegia After Off-Pump Coronary Artery Bypass Surgery: Look Before You Place the Neck in an Extended Position

Quadriplegia After Off-Pump Coronary Artery Bypass Surgery: Look Before You Place the Neck in an Extended Position

Patterns of Care After Magnetic Resonance Imaging of the Spine in Primary Care

Retrospective cohort study. To examine health care services use after a magnetic resonance imaging (MRI) scan of the lumbosacral or cervical spine ordered by a primary care physician. The use of MRI of the spine in the primary care setting is increasing, yet little is known about the relationship between MRI scan findings and subsequent patterns of health care utilization. Linkage of records from an audit of outpatient MRI scans of the spine performed in Ontario, Canada, to administrative databases. Of the 647 patients who had a lumbosacral spine MRI scan ordered by a primary care physician, 288 (44.5%) were seen in consultation by an orthopedic surgeon or neurosurgeon, and 42 (6.5%) received spine surgery during 3 years of follow-up. Of the 373 patients who had a cervical spine MRI scan ordered by a primary care physician, 164 (44.0%) were seen in consultation by an orthopedic surgeon or neurosurgeon, and none had spine surgery during 3 years of follow-up. Patients with severe disc herniation (likelihood ratio, 5.62, 95% confidence interval, 2.64-12.00) or severe spinal stenosis (likelihood ratio, 2.34; 95% confidence interval, 1.13-4.85) on lumbosacral spine MRI were more likely to undergo subsequent surgery. However, many patients with these MRI abnormalities did not receive surgery, and the absence of these MRI findings did not significantly lower the likelihood of subsequent surgery. Patients receiving MRI scans of the spine in the primary care setting are frequently referred for surgical assessment and most do not receive subsequent surgery. MRI scan results do not discriminate very well between those who will and will not undergo surgery, suggesting that alternative models for the assessment of patients with spinal complaints in primary care should be explored, particularly in jurisdictions with long wait times for elective spinal surgery consultation.

A rare case of Brown-Sequard syndrome caused by cervical disc herniation: a case report.

Background and Objective: Brown-Sequard syndrome is a rare neurological disorder characterized by ipsilateral motor paralysis caused by a lesion through corticospinal tract and contralateral loss of pain and temperature sensation due to the involvement of spinothalamic tract. Cervical disc herniation has been reported to be a rare cause of Brown-Sequard's syndrome. This paper aims to report a case of Brown-Sequard syndrome that occurred in a patient suffering from CHD. In this case, using a rapid and urgent intervention we could prevent permanent neurologic deficit in the patient. Case Presentation: A 56-year-old woman complained about a sudden paresis in her right leg lasting for 4 days. Her pain was progressively worsening until she couldn’t walk without assistance. There was no history of trauma in the neck. Neurological examinations revealed right side spastic hemi-paresis as well as loss of pain and temperature sensation below T4 dermatome in the left side. The case was diagnosed as Brown-Sequard syndrome and cervical magnetic resonance imaging scan showed a disc herniation at C5/C6 and C6/C7 levels. Surgery was performed via anterior cervical microdiscectomy and fusion. After a 2-month period of follow-up, neurological assessments showed that motor and sensory functions of the patient returned to the normal condition. Conclusion: Although cervical disc herniation as a cause of Brown-Sequard syndrome is relatively rare, early diagnosis accompanied by an urgent treatment can prevent neurological complications in such cases.