A Simplified Algorithm for Diagnosis of Spinal Cord Lesions

Baruah, Dhiraj; Chandra, Tushar; Bajaj, Manish; Sonowal, Purabi; Klein, Andrew P.; Maheshwari, Mohit; Guleria, Saurabh

doi:10.1067/j.cpradiol.2014.12.004

Cited by 17 publications

(6 citation statements)

References 36 publications

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“…This provides a challenge in choosing the appropriate cheaper investigational modalities. Hence, MRI provides a diagnostic entry point that can guide the use of other investigative modalities for conditions like, infections, demyelination or vascular causes [7, 17]. Prioritization of MRI over CT is mainly in patients with suspected non-bone extradural lesions and intradural lesions which include the younger age groups.…”

Section: Discussionmentioning

confidence: 99%

“…Alternatively, the lesions may be classified as extradural or intradural lesions basing on the location of the lesion in relation to the dura. Intradural lesions are further classified as intramedullary versus extramedullary lesions basing on the location of the lesion in relation to the spinal cord [7]. Vascular injuries can be evaluated using CT or MR angiography [6] While CT and X-ray are limited to diagnose bony compressive lesions or extradural compressive lesions, MRI is useful in the diagnosis of all types of lesions.…”

Section: Introductionmentioning

confidence: 99%

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Epidemiology of non-traumatic spinal cord injury in Uganda: a single center, prospective study with MRI evaluation

et al. 2019

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BackgroundA few reliable national data concerning the etiology of non-traumatic spinal cord injury (SCI) in sub-Sahara Africa exists, mainly because of the limitations of diagnostic imaging. These are both expensive and mostly unavailable in several resource-limited settings. Only a few studies have employed the magnetic resonance imaging (MRI) in documenting non-traumatic SCI and most of these studies are from South Africa. We sought to describe the clinical presentation, MRI radiological patterns, and one-year survival among subjects with non-traumatic SCI in Uganda.MethodsWe enrolled a prospective cohort of 103 participants with non-traumatic SCI at Mulago National Referral Hospital Kampala, Uganda in 2013–2015. Participants received standard of care management, with surgical intervention as needed, with one-year follow up. Data were analyzed using Descriptive statistics.ResultsIn 103 participants with non-traumatic SCI, the median (IQR) age was 37 (18, 85) years and 25% of the participants were HIV-infected. Paraplegia/paraparesis was the most common clinical presentation in 70% (n = 72). Severe disease was present in 82% (n = 85) as per American Spinal Injury Association (ASIA) scale A-C. On MRI, 50% had extradural lesions. However, bone lesions accounted for only 75% of all the extradural lesions. More than 60% of the patients had lesions that could only be diagnosed on MRI. Deaths occurred in 42% (n = 44) of participants, with the highest mortality among those with extradural lesions (60%).ConclusionThe mortality following non-traumatic spinal cord injuries in Uganda is high. We demonstrated an equal distribution between extradural and intradural lesions, which differs from the historical predominance of extradural lesions. Increased utilization of MRI particularly among young age groups is needed to make a diagnosis.Electronic supplementary materialThe online version of this article (10.1186/s12883-019-1236-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Epidemiology of non-traumatic spinal cord injury in Uganda: a single center, prospective study with MRI evaluation

et al. 2019

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“…Spinal-cord magnetic resonance imaging (MRI) studies are traditionally regarded as a diagnostic modality to detect central nervous system causes of a myelopathy, and are not typically used in the evaluation of PNS disorders. [ 8 ] However, it may be underappreciated that spinal-cord lesions which affect the dorsal column can be detected in patients with sensory neuronopathies. [ 1 ] In such cases, dorsal column lesions result from the degeneration of the central afferent tracts between the dorsal root ganglia (DRG) and its synapse at the dorsal-horn.…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging of the spinal cord in the evaluation of 3 patients with sensory neuronopathies

Birnbaum¹,

Lalji

Piccione

et al. 2017

Medicine

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Rationale:Sensory neuronopathy can be a devastating peripheral nervous system disorder. Profound loss in joint position is associated with sensory ataxia, and reflects degeneration of large-sized dorsal root ganglia. Prompt recognition of sensory neuronopathies may constitute a therapeutic window to intervene before there are irreversible deficits. However, nerve-conduction studies may be unrevealing early in the disease course. In such cases, the appearance of dorsal column lesions on spinal-cord MRI can help in the diagnosis. However, most studies have not defined whether such dorsal column lesions may occur within earlier as well as chronic stages of sensory neuronopathies, and whether serial MRI studies can be used to help assess treatment efficacy. In this case-series of three sensory neuronopathy patients, we report clinical characteristics, immunological markers, nerve-conduction and skin-biopsy studies, and neuroimaging features.Patient concerns:All three patients presented with characteristic features of sensory neuronopathy with abnormal spinal-cord MRI studies. Radiographic findings included non-enhancing lesions in the dorsal columns that were longitudinally extensive (spanning ≥ 3 vertebral segments).Diagnoses:All patients had anti-Ro/SS-A and/or anti-La/SS-B antibodies, with patients one and two having Sjögren's syndrome. MRI findings were similar when performed in the earlier stages of a sensory neuronopathy (patient one, after four months) and chronic stages (patients two and three, after five and three years, respectively).Interventions:Patient one was treated with rituximab combined with intravenous immunoglobulin therapy.Outcomes:Patient one was initially wheelchair-bound and had improved ambulation after treatment. In this patient, serial MRI studies revealed partial resolution of dorsal column lesions, associated with decreased sensory ataxia and improved nerve-conduction studies.Lessons:In addition to vitamin B12 and copper deficiency, it is important to include sensory neuronopathies in the differential diagnosis of dorsal column lesions. MRI spinal-cord lesions have similar appearances in the earlier as well as chronic phases of a sensory neuronopathy, and therefore suggest that such dorsal column lesions may reflect inflammatory as well as a gliotic burden of injury. MRI may also be a useful longitudinal indicator of treatment response.

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“…[1] The incidence of primary spinal tumors has been estimated at 2.5–8.5 per 100,000 people yearly. [230] Some primary spinal tumors may not only cause a compressive effect to the cord, but also can destroy the adjacent bony structures due to its invading nature.…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional Fluoroscopy-based Navigation for the Pedicle Screw Placement in Patients with Primary Invasive Spinal Tumors

Jin

Zhao

2016

Chinese Medical Journal

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Background:Although pedicle screw placement (PSP) is a well-established technique for spine surgery, the treatment of patients with primary invasive spinal tumor (PIST) has high surgical risks secondary to destroyed pedicles. Intraoperative three-dimensional fluoroscopy-based navigation (ITFN) system permits safe and accurate instrumentation of the spine with the advantage of obtaining intraoperative real-time three-dimensional images and automatic registration. The aim of this study is to evaluate the feasibility and accuracy of PSP using ITFN system for patients afflicted with PIST in the thoracic spine.Methods:Fifty-one patients diagnosed with PISTs were retrospectively analyzed, and 157 pedicles screws were implanted in 23 patients using the free-hand technique (free-hand group) and 197 pedicle screws were implanted in 28 patients using the ITFN system (ITFN group). Modified classification of Gertzbein and Robbins was used to evaluate the accuracy of PSP, and McCormick classification was applied for assessment of neurological function. Demographic data and factors affecting accuracy of screw insertion were compared using independent t-test while comparison of accuracy of screw insertion between the two groups was analyzed with Chi-square test.Results:Of 51 patients, 39 demonstrated improved neurological status and the other 12 patients reported that symptoms remained the same. In the free-hand group, 145 screws (92.4%) were Grade I, 9 screws (5.7%) were Grade II, and 3 screws (1.9%) were Grade III. In the ITFN group, 192 screws (97.4%) were Grade I, 5 screws (2.6%) were Grade II, and no Grade III screw was detected. Statistical analysis showed that the accuracies of pedicle screws in the two groups are significantly different (χ2 = 4.981, P = 0.026).Conclusions:The treatments of PISTs include total tumor resection and reconstruction of spine stability. The ITFN system provides a high accuracy of pedicle screw placement.

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A Simplified Algorithm for Diagnosis of Spinal Cord Lesions

Cited by 17 publications

References 36 publications

Epidemiology of non-traumatic spinal cord injury in Uganda: a single center, prospective study with MRI evaluation

Epidemiology of non-traumatic spinal cord injury in Uganda: a single center, prospective study with MRI evaluation

Magnetic resonance imaging of the spinal cord in the evaluation of 3 patients with sensory neuronopathies

Three-dimensional Fluoroscopy-based Navigation for the Pedicle Screw Placement in Patients with Primary Invasive Spinal Tumors

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