Comparison of two MR grading systems for correlation between grade of cervical neural foraminal stenosis and clinical manifestations

Lee, Kyu H; Park, Hee Jin; Lee, So Yeon; Chung, Eun Chul; Rho, Myung Ho; Shin, Hyun Chang; Kwon, Young Joon

doi:10.1259/bjr.20150971

Cited by 15 publications

(8 citation statements)

References 12 publications

(37 reference statements)

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“…CFS is caused by the narrowing of cervical nerve roots at the entrance of cervical foramen and is seen commonly. Significant narrowing of the cervical foramen may present as a sharp arm or neck pain, paresthesia, numbness or tingling sensation with or without symptoms spreading to the distal portion of the upper extremities 2,5. In order to exclude the possibility of other diseases and to determine appropriate treatment, an accurate CMRI diagnosis of CFS is essential 3,16.…”

Section: Discussionmentioning

confidence: 99%

“…Compression or irritation of the cervical nerve root as it travels through a neural foramen causes cervical radiculopathy 2–4. Motor symptoms such as weakness may sometimes accompany sensory symptoms in aggravated narrowing 5–7. Cervical spine magnetic resonance imaging (CMRI) is the most sensitive technique for detecting early morphological changes in the cervical spine 3,8.…”

Section: Introductionmentioning

confidence: 99%

“…An accurate CMRI diagnosis of CFS is critical to determine appropriate treatment and to exclude the possibility of peripheral neuropathy 3,9. Clinical care of patients with CFS is determined based on neurological symptoms with CMRI studies 5. Various anatomical factors can induce CFS.…”

Section: Introductionmentioning

confidence: 99%

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<p>Best cut-off point of the cervical facet joint area as a new morphological measurement tool to predict cervical foraminal stenosis</p>

Hong

Kim

et al. 2019

JPR

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Purpose: One of the main factor of cervical foraminal stenosis (CFS) is the hypertrophic change of the cervical facet joint. In order to analyze the connection between CFS and the facet joint hypertrophy, we devised a new morphological parameter, called the cervical facet joint cross-sectional area (CFJA). The CFJA has not yet been investigated for its association with CFS. We hypothesized that the CFJA is an important morphologic parameter in the diagnosis of CFS. Patients and methods: All patients over 50 years of age were included. Data regarding the CFJA were collected from 160 subjects with CFS. A total of 162 control individuals underwent cervical spine magnetic resonance imaging (CMRI) as part of a routine medical examination. Axial T2-weighted CMRI images were acquired from all subjects. We used a picture archiving system to analyze the cross-sectional area of the bone margin of the cervical facet joint at the level of the most stenotic cervical spine in the axial plane. Results: The average CFJA was 109.07±20.91 mm 2 in the control group, and 126.75±22.59 mm 2 in the CFS group. The CFS group was found to have significantly higher levels of the CFJA ( p <0.001) than the control group. ROC curve estimation was used to verify the validity of the CFJA as a new predictor of CFS. In the CFS group, the best cut off-point was 113.14 mm 2 , with sensitivity =70.6%, specificity =68.6%, and AUC =0.72 (95% CI, 0.66–0.77). Conclusions: CFJA high values were closely associated with a possibility of CFS. We concluded CFJA is easy to use, fast, and useful new morphological parameter to predict CFS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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<p>Best cut-off point of the cervical facet joint area as a new morphological measurement tool to predict cervical foraminal stenosis</p>

Hong

Kim

et al. 2019

JPR

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“…In a previous study, Lee et al 14 demonstrated that the degree of CNFS was relatively highly correlated with clinical manifestation. However, Kim et al 6 retrospectively assessed pain intensity and treatment outcomes of CTEB based on the degree of CNFS.…”

Section: Introductionmentioning

confidence: 94%

Correlation Between Intravascular Injection Rate, Pain Intensity, and Degree of Cervical Neural Foraminal Stenosis During a Cervical Transforaminal Epidural Block

Kim¹,

Kim²,

Lee³

et al. 2021

JPR

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Purpose Cervical transforaminal epidural blocks (CTEBs) are useful for the treatment of cervical radicular pain. However, during CTEBs, inadvertent intravascular injection can introduce particulate steroids into the bloodstream, thus leading to serious complications. Moreover, the risk factors associated with intravascular injection during CTEBs have not been identified. Cervical neural foraminal stenosis (CNFS) is a form of neural foraminal narrowing and a common cause of cervical radicular pain. In this study, we aimed to identify whether there is a correlation between the incidence of intravascular injection during CTEB, pain intensity, and the degree of CNFS. Patients and Methods A total of 126 patients were recruited. The patients were classified into two subgroups (group M and group S) based on the routine cervical T2-weighted axial magnetic resonance imaging (MRI) findings. Group M (n = 63) consisted of moderate CNFS patients, while group S (n = 63) consisted of severe CNFS patients. The occurrence of intravascular injection during CTEB was established using real-time fluoroscopy. The intravascular injection was determined by the spreading of the contrast medium through the vascular channel during the injection. Additionally, pain intensity was scored using a Numeric Rating Scale (NRS) before the procedure and 1 month after the procedure. Results There was no significant difference in the incidence of intravascular injection during CTEB between group M and group S (41.3% vs 39.7%, respectively; p = 0.99) and in the NRS scores before and 1 month after CTEB. However, both groups showed a significant decrease in the NRS scores at 1 month after the procedure compared with that before the procedure. Conclusion The degree of CNFS does not affect the incidence of intravascular injection during CTEB. Regardless of whether patients have moderate or severe CNFS, caution should be exercised during CTEB procedures.

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“…Significant narrowing of the cervical foramen may present as a sharp arm or neck pain, paresthesia, numbness or tingling sensation with or without symptom spreading to the distal portion of the upper extremities. Motor symptoms such as weakness may accompany sensory symptoms in aggravated cases (8)(9)(10)(11)(12)(13)(14)(15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

Uncinate Process Area as a New Sensitive Morphological Parameter to Predict Cervical Neural Foraminal Stenosis

et al. 2019

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Background: Hypertrophy of the uncovertebral joint has been considered as a major cause of cervical neural foraminal stenosis (CNFS). The cross-sectional area of the uncinate process is a key morphologic parameter in the identification of uncovertebral joint hypertrophy. To evaluate the connection between CNFS and the uncinate process, we devised a new morphological parameter, the uncinate process area (UPA). Objective: We hypothesized that the UPA is an important morphologic parameter in the diagnosis of CNFS. Study Design: Retrospective observational study. Setting: The single center study in Incheon, Republic of Korea. Methods: UPA data were collected from 146 patients with CNFS and 197 control subjects who underwent neck computed tomography (CT) as part of a routine medical examination. Neck CT images were obtained from all subjects. The whole cross-sectional area of the bone margin of the uncinate process was measured at the C5-6 intervertebral disc level on CT scans using a picture archiving and communications system. Results: The average UPA was 15.52 mm2 in the control group and 29.97 mm2 in the CNFS group. The CNFS group displayed significantly greater UPA levels (P < 0.001). Regarding the validity of the UPA as a predictor of CNFS, the receiver operating characteristic curve analysis revealed an optimal cut-off point for the UPA of 21.15 mm2 , with 91.8% sensitivity, 93.4% specificity, and an area under the curve of 0.972 (95% CI,0.956-0.989) in the CNFS group. Limitations: Anatomically, the UP is located on the superior lateral surfaces of the C3-7 cervical vertebral bodies. However, we focused on the C5-6 uncovertebral joint level, because many previous studies revealed C6 UP has the greatest height among UP and C5-6 uncovertebral joint hypertrophy is a primary cause of CNFS. Conclusions: The newly devised UPA is a sensitive parameter for assessing CNFS. A hypertrophied UPA is associated with an increased risk of CNFS. We think that this result will be helpful for diagnostic radiology in evaluating patients with CNFS. Institutional Review Board (IRB) approval number: IS16RISI0002 Key words: Uncinate process area, cervical neural foraminal stenosis, Uncovertebral joint hypertrophy, optimal cut-off point, cross- sectional area

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Comparison of two MR grading systems for correlation between grade of cervical neural foraminal stenosis and clinical manifestations

Cited by 15 publications

References 12 publications

<p>Best cut-off point of the cervical facet joint area as a new morphological measurement tool to predict cervical foraminal stenosis</p>

<p>Best cut-off point of the cervical facet joint area as a new morphological measurement tool to predict cervical foraminal stenosis</p>

Correlation Between Intravascular Injection Rate, Pain Intensity, and Degree of Cervical Neural Foraminal Stenosis During a Cervical Transforaminal Epidural Block

Uncinate Process Area as a New Sensitive Morphological Parameter to Predict Cervical Neural Foraminal Stenosis

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