Magnetic Resonance Imaging Cervical Spine Research Articles

Assessment of cervical spondylosis by dynamic MRI and its advantages over routine MRI

Background and objectives. Cervical spondylosis is an age-related condition that influences the various components of the spine. Attributed to its exceptional tissue contrast, magnetic resonance imaging (MRI) is the preferred diagnostic modality for assessing cervical spondylosis. Dynamic MRI examination adds diagnostic information obtained from imaging the patient in flexion and extension. Our study had the purpose of evaluating the flexion-extension MRI’s diagnostic utility. Materials and methods. 40 patients with cervical spondylosis joined our prospective cross-sectional study. The patients were examined by flexion and extension sagittal T2 weighted images (Dynamic MRI) in addition to static MRI cervical spine protocol. The study was carried out in our department and lasted for two years. Results. Total central spinal stenosis (TCSS) was considerably higher in extension in comparison to neutral MRI (Mean ± SD =6.1± 1.45 compared to 4.7 ± 1.29) (p<0.001) showing that extension raises the severity of the cervical spinal stenosis. TCSS was significantly decreased in flexion compared to neutral MRI (Mean ± SD = 3.2 ± 0.79 compared to 4.7 ± 1.29) (p<0.001) assuming flexion reduces the radiological severity of stenosis. Conclusion. Dynamic MRI is a valuable imaging modality. It provides useful information by highlighting more central spinal stenosis, particularly in the extension position, which enhances the treatment regimens for patients with cervical spondylosis.

Gauging the pressure: The clinical dilemma with Chiari! (P11-4.004)

<h3>Objective:</h3> N/A <h3>Background:</h3> Differentiating between Chiari Malformation I (CMI) and acquired tonsillar herniation due to spontaneous or iatrogenic intracranial hypotension (IH) can be challenging. We describe a case of IH misdiagnosed as CM1 to emphasize several distinct clinical signs that can prevent misdiagnosis. <h3>Design/Methods:</h3> <h3>Case Description:</h3> A 36-year-old multigravida female with history of multiple epidural analgesia during vaginal deliveries presented with 6 months of constant, poorly localized headaches. Fundoscopic exam revealed bilateral mild inferior disc edema without vessel obscuration. Contrasted magnetic resonance imaging (MRI) showed diffuse pachymeningeal enhancement with a 7mm downward herniation of the cerebellar tonsils but no syrinx in the upper cervical cord. The patient was thought to have CM1, and she was treated with supportive care. After 2 years, the patient again presented with severe intractable headaches and vomiting 7 weeks following epidural for vaginal delivery. Repeat MRI brain showed a 23 mm downward herniation of the cerebellar tonsils associated with severe effacement of the basilar and prepontine cisterns and diffuse sulcal effacement. MRI cervical spine showed a large cervical syrinx at this time. MRI thoracic and lumbar spine showed an epidural cerebrospinal fluid (CSF) collection extending from T1 to L3 levels with diffuse cord edema, confirming CSF leak. Given high risk of complications, blood patch was not attempted, and the patient ultimately underwent suboccipital decompressive craniotomy. <h3>Results:</h3> N/A <h3>Conclusions:</h3> This case highlights the importance of considering acquired causes of cerebellar tonsillar herniation in symptomatic adults. Headache description, chronicity, and presence/absence of syrinx cannot differentiate CMI from IH. Pachymeningeal enhancement, subdural hygromas, pituitary enlargement, distention of cerebral venous sinuses, and effacement of subarachnoid spaces along with flattening of pons are more indicative of IH. Evidence of an extradural CSF collection in the spinal cord or a CSF leak on computerized tomography myelogram are diagnostic of IH. <b>Disclosure:</b> Miss Phillips has nothing to disclose. Dr. Mannyam has nothing to disclose. Dr. Sharma has nothing to disclose.

Magnetic resonance imaging cervical spine in trauma: A retrospective single-centre audit of patient outcomes.

Magnetic resonance imaging (MRI) is often used in practice to investigate for cord or discoligamentous injury following blunt trauma and a normal computed tomography (CT). This study investigates the MRI findings and surgical outcomes of patients in this cohort. Retrospective analysis of patients following trauma with suspected cervical spine injury from 2016 to 2019. Inclusion criteria included patients receiving a normal CT of the cervical spine and subsequent MRI due to cervical spine injury symptomatology (persistent tenderness and/or neurology). Inclusion criteria included: age ≥16 years, alert and <72 h from CT to MRI. Mann-Whitney and χ2 statistical analysis techniques were employed. Two hundred and twenty-eight patients with persistent midline tenderness and/or persistent neurology following blunt trauma and negative CT report were included. One hundred and eighty-one patients received an MRI for persistent tenderness of which 35 revealed abnormal MRI findings. Twenty-one cases required no treatment, 14 cases were treated with a rigid collar with no patients requiring operative management. Forty-seven patients received an MRI for neurological symptoms following blunt trauma and negative CT, with 11 abnormal MRI findings. Management included no treatment (three cases), application of rigid collar (six cases) and operative management (two cases). No alert neurologically intact patient with 'persistent tenderness only' received operative management following a normal CT examination. While MRI is sensitive for detecting soft tissue injuries, the prevalence for detecting clinically significant cervical spine injury in blunt trauma patients in the absence of neurology is low. The utility of MRI in this cohort is questionable considering prolonged spinal immobilisation is not without harm.

Experience with Rectangular Titanium Cages in Anterior Cervical Discectomy and Fusion in a Single Unit of a Tertiary Level Hospital, Dhaka.

Background: Anterior cervical discectomy is a common procedure for treating patients for cervical disc prolapse. This study was conducted to evaluate the surgical outcome and demographic characteristics of patients who were treated for anterior cervical disc prolapse.&#x0D; Methods: Study was conducted in the Department of Neurosurgery-spine, National Institute of Neurosciences and Hospital, Dhaka. Study interval was 5 years from January, 2014 to 31st December, 2019. Total numbers of patients were 215. Males were 183 (85.1%) and females were 32 (14.9%). All the patients had undergone the procedure of anterior cervical discectomy and fusion (ACDF) with RABEA Rectangular Titanium Cages (RTC). All the patients had plain MRI cervical spine done for diagnosis of anterior cervical disc prolapse. Surgical and Clinical preoperative evaluation and surgical outcomes were evaluated using pre- and postoperative Nurick, Visual Analog Scale (VAS), Neck Disability Index (NDI), for Myelopathy, overall Odoms outcome scores, postoperative surgical complications, and fusion and subsidence rates.&#x0D; Results: Total 215 patients underwent ACDF; the mean age of these patients was 44.66 years, and their preoperative VAS and NDI, scores were 8.09 and 35.38 respectively. Sixty seven percent of patients had one level, 25.1% had two-level, and 7.9% had three-level procedures. On preoperative Magnetic Resonance Imaging(MRI), foraminal stenosis was present in 68.4% of patients, whereas medullar stenosis was present in 43.7%. The rate of complications was 2.8%: two patients had postoperative implant migration (0.93%), three patients had postoperative transient dysphagia (1.4%) and one patients had temporary hoarseness of voice. Mean postoperative follow-up time was 6.7 months; postoperative VAS and NDI scores were 1.10 and 14.4, respectively. Postoperative fusion rate was 93.5%, and subsidence rate was 5.6%.&#x0D; Conclusion: Results with Rectangular Titanium Cages are expectedly good. Symptoms resolved and fusion rate was 93.5% at 1 year follow up.&#x0D; Bang. J Neurosurgery 2021; 10(2): 137-147

Spontaneous spinal epidural hematoma in a known case of hemophilia a managed conservatively: A rare case report

Spontaneous spinal extradural hematomas are rarely attributed to hemophilia. When it occurs, magnetic resonance imaging (MRI) best establishes the diagnosis that should prompt immediate medical or surgical management. Here, we present a case with large spinal epidural hematomas (EDH) which was managed conservatively with good neurological outcome. A 12-year-old male who is a known case of hemophilia A was admitted with a complaint of neck pain, was neurologically intact on examination with no motor or sensory deficits. MRI cervical spine revealed a large spinal EDH in the cervical region compressing the cord posteriorly. The patient was managed conservatively with tranexamic acid and factor VIII replacement and observed over few days. He recovered well with interval resolution of hematoma. this case depicts the role of conservative management of spontaneous EDH in patients with Hemophilia A utilizing factor replacement therapy, steroids, and tranexamic acid and emphasizes that surgery is not always required even in such radiologically large appearing lesions.

Does preoperative magnetic resonance imaging alter the surgical plan in patients with acute traumatic cervical spinal cord injury?

Whether magnetic resonance imaging (MRI) adds value to surgical planning for patients with acute traumatic cervical spinal cord injury (ATCSCI) remains controversial. In this study, we compared surgeons' operative planning decisions with and without preoperative MRI. We had two hypotheses: (1) the surgical plan for ATCSCI would not change substantially after the MRI and (2) intersurgeon agreement on the surgical plan would also not change substantially after the MRI. We performed a vignette-based survey study that included a retrospective review of all adult trauma patients who presented to our American College of Surgeons-verified level 1 trauma center from 2010 to 2019 with signs of acute quadriplegia and underwent computed tomography (CT), MRI, and subsequent cervical spine surgery within 48 hours of admission. We abstracted patient demographics, admission physiology, and injury details. Patient clinical scenarios were presented to three spine surgeons, first with only the CT and then, a minimum of 2 weeks later, with both the CT and MRI. At each presentation, the surgeons identified their surgical plan, which included timing (none, <8, <24, >24 hours), approach (anterior, posterior, circumferential), and targeted vertebral levels. The outcomes were change in surgical plan and intersurgeon agreement. We used Fleiss' kappa (κ) to measure intersurgeon agreement. Twenty-nine patients met the criteria and were included. Ninety-three percent of the surgical plans were changed after the MRI. Intersurgeon agreement was "slight" to "fair" both before the MRI (timing, κ = 0.22; approach, κ = 0.35; levels, κ = 0.13) and after the MRI (timing, κ = 0.06; approach, κ = 0.27; levels, κ = 0.10). Surgical plans for ATCSCI changed substantially when the MRI was presented in addition to the CT; however, intersurgeon agreement regarding the surgical plan was low and not improved by the addition of the MRI. Diagnostic, level II.

Factors affecting outcome of acute cervical spine injury: A prospective study

Background:Injury to the spine and spinal cord is one of the common cause of disability and death. Several factors affect the outcome; but which are these factors (alone and in combination), are determining the outcomes are still unknown. The aim of the study was to evaluate the factors influencing the outcome following acute cervical spine injury.Materials and Methods:A prospective observational study at single-center with all patients with cervical spinal cord injury (SCI), attending our hospital within a week of injury during a period of October 2011 to July 2013 was included for analysis. Demographic factors such as age, gender, etiology of injury, preoperative American Spinal Injury Association (ASIA) grade, upper (C2-C4) versus lower (C5-C7) cervical level of injury, imageological factors on magnetic resonance imaging (MRI), and timing of intervention were studied. Change in neurological status by one or more ASIA grade from the date of admission to 6 months follow-up was taken as an improvement. Functional grading was assessed using the functional independence measure (FIM) scale at 6 months follow-up.Results:A total of 39 patients with an acute cervical spine injury, managed surgically were included in this study. Follow-up was available for 38 patients at 6 months. No improvement was noted in patients with ASIA Grade A. Maximum improvement was noted in ASIA Grade D group (83.3%). The improvement was more significant in lower cervical region injuries. Patient with cord contusion showed no improvement as opposed to those with just edema wherein; the improvement was seen in 62.5% patients. Percentage of improvement in cord edema ≤3 segments (75%) was significantly higher than edema with >3 segments (42.9%). Maximum improvement in FIM score was noted in ASIA Grade C and patients who had edema (especially ≤3 segments) in MRI cervical spine.Conclusions:Complete cervical SCI, upper-level cervical cord injury, patients showing MRI contusion, edema >3 segments group have worst improvement in neurological status at 6 months follow-up.

Spastic quadriparesis due to pathological fracture of odontoid secondary to carcinoma prostate: A rare presentation

Prostate carcinoma presenting as symptomatic metastases to atlantoaxial spine is extremely rare. Spastic quadriparesis due to pathological fracture of odontoid as the only initial manifestation without symptoms of primary malignancy is rarer still. We report a 64-year-old male who presented with progressive spastic quadriparesis along with urinary retention of 3 weeks duration. Computed tomography and magnetic resonance imaging cervical spine and craniovertebral junction showed type III pathological fracture of odontoid with anterior translation of C1 with spinal cord compression. Biopsy from an enlarged prostate showed adenocarcinoma of prostate. The patient was managed conservatively from neurological aspect as he refused for any surgical intervention.

The Current Role of Magnetic Resonance Imaging for Diagnosing Cervical Spine Injury in Blunt Trauma Patients with Negative Computed Tomography Scan

Clearance of cervical spine (CS) precautions in the neurologically altered blunt trauma patient can be difficult. Physical examination is not reliable, and although computed tomography (CT) may reveal no evidence of fracture, it is generally believed to be an inferior modality for assessing ligamentous and cord injuries. However, magnetic resonance imaging (MRI) is expensive and may be risky in critically ill patients. Conversely, prolonged rigid collar use is associated with pressure ulceration and other complications. Multidetector CT raises the possibility of clearing CS on the basis of CT alone. We performed a retrospective review at our Level I trauma center of all blunt trauma patients with Glasgow Coma Scale Score 14 or less who underwent both CT and MRI CS with negative CT. One hundred fourteen patients met inclusion criteria, of which 23 had MRI findings. Seven (6%) of these had neurologic deficits and/or a change in management on the basis of MRI findings. Although use of the single-slice scanner was significantly associated with MRI findings (odds ratio, 2.62; P=0.023), no significant clinical risk factors were identified. Patients with MRI findings were heterogeneous in terms of age, mechanism, and Injury Severity Score. We conclude that CS MRI continues play a vital role in the workup of neurologically altered patients.

Computed Tomography Alone May Clear the Cervical Spine in Obtunded Blunt Trauma Patients: A Prospective Evaluation of a Revised Protocol

Cervical spine (CS) clearance in obtunded blunt trauma patients (OBTPs) remains controversial. When computed tomography (CT) of the CS is negative for injury, debate continues over the role of magnetic resonance imaging (MRI). Use of MRI in OBTPs is costly, time-consuming, and potentially dangerous. Our study evaluated the safety of a protocol to discontinue the cervical collar in OBTPs based on CT scan alone. A prospective study was performed from October 2006 to September 2008 at a regional Level I trauma center on OBTPs with gross movement of all extremities. After a CT of the CS was read as negative for injury, the CS was cleared and the collar was removed. Patients were then followed prospectively for related complications. One hundred ninety-seven patients had their collars removed and CS cleared at a mean of 3.3 days. There were 144 males (73%), and the average age was 47.1 years. Sixty-two percent of patients were reexamined by a physician when no longer obtunded and found to have no CS signs or symptoms. Five patients (2.5%), when no longer obtunded, had persistent pain for which MRI CS was negative for injury. Coroner reports and autopsies were reviewed for missed spinal cord injuries in the 13% who died before reexamination. One of these patients had an autopsy report of an isolated CS ligamentous injury, deemed to be stable by our attending neurosurgeon. We followed up an additional 12% by phone or chart review, with no report of new onset neurologic deficit. The remaining 11% were lost to follow-up, but no patient contacted our hospital to report deterioration in function. One patient (0.5%) developed a minor CS decubitus ulceration. Removal of CS precautions in OBTPs with gross movement of all extremities is safe and efficacious if CT CS is negative for injury. Supplemental MRI CS is not needed in this patient population.

Pannus and enthesitis in the atlanto‐axial region in ankylosing spondylitis

AbstractA 30‐year‐old man with ankylosing spondylitis (AS) of 7 years duration consulted us for intractable neck pain of 2 months duration. Magnetic resonance imaging cervical spine showed inflammatory pannus around the dens and computed tomography scan showed fluffy periostitis at the attachment of the alar ligament. Cervical spine involvement in AS is reviewed.