Dynamic Changes of the Spinal Canal in Patients With Cervical Spondylosis at Flexion and Extension Using Magnetic Resonance Imaging

Mühle, Claus; Weinert, D.; Falliner, Axel; Wiskirchen, Jakub; Metzner, Jörg; Baumer, Michael; Brinkmann, G.; Heller, Martin

doi:10.1097/00004424-199808000-00004

Cited by 93 publications

(67 citation statements)

References 17 publications

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“…Many techniques have been described to quantify the degree of narrowing of the subarachnoid space, or compromise of the spinal cord or exiting roots [25][26][27][28][29][30]. It is clear that no simple reliable technique exists and radiologists seem to be very poor at reliably assessing the degree of cord compression.…”

Section: Discussionmentioning

confidence: 99%

MRI of the cervical spine with neck extension: is it useful?

Bartlett¹,

Hill²,

Rigby³

et al. 2012

The British Journal of Radiology

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Objectives: Standard MRI of the cervical spine is performed in a different anatomical position to that utilised for traditional contrast myelography. Those well practised in myelography are familiar with the considerable changes in configuration of the bony and soft tissues of the cervical spine that may occur with changes in the degree of neck flexion and extension. We set out to compare the findings in a select group of patients with myeloradiculopathy who had undergone myelography and MRI in both standard and neck-extended positions. These findings were correlated with the clinical status. Methods: 29 patients underwent myelography with CT (CTM) and MRI in neutral and neck-extended positions. The imaging was assessed for the degree of cord compression and neural foraminal narrowing, quantified using a simple grading scheme suitable for routine clinical practice. The degree of neck extension was assessed using an angular measurement. Results: For both CTM and MRI, scanning with the neck extended significantly increases the severity of cord compression compared with the standard supine position, to a degree similar to that shown during conventional prone myelography. The degree of perceived cord compression is related to the degree of neck extension achieved. Correlation of standard MRI findings and the clinical level of radiculopathy is poor. This correlation improves when the neck is extended. Conclusions: The most appropriate position for routine MRI of the cervical spine in degenerative disease remains unknown, but in selected patients imaging with the neck extended may provide important additional information. With the introduction of spinal surface coil technology and gradient echo sequences in the late 1980s, MRI rapidly replaced intrathecal contrast myelography as the standard imaging method for assessment of the cervical spinal cord and nerve roots. The two investigations are performed in very different anatomical positions. Standard cervical spine MRI is performed in a coil that is designed to make the patient comfortable, to minimise movement-related artefacts. This generally results in a position of mild extension of the neck. On the other hand, the majority of images for plain cervical myelography are obtained with the patient prone and the neck hyperextended so as to retain myelographic contrast within the cervical lordosis. CT myelography (CTM) is typically performed with the patient supine and with the neck straight or mildly flexed; however, CT myelography can also be performed in the prone position with the neck extended [1].For a number of years we continued to use plain myelography, with CTM as a second-line investigation in patients with cervical myelopathy and/or radiculopathy, when the results of standard MRI were inconsistent with symptoms and signs. More recently we have also performed MRI with neck extension, predominantly in patients with myelopathic features but inconclusive supine MRI. We have been unsure how extended MRI compares with myelography and whether it is able to produce t...

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Section: Discussionmentioning

confidence: 99%

MRI of the cervical spine with neck extension: is it useful?

Bartlett¹,

Hill²,

Rigby³

et al. 2012

The British Journal of Radiology

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“…The body of the superior vertebra slides posteriorly on its inferior neighbor only when the cervical spine is extended. The relationship between these 2 vertebrae is [13][14][15] demonstrated that in healthy individuals, compared with its size in the neutral and flexed positions the cervical subarachnoid space was smallest during cervical spine extension. In patients with increasing stages of degenerative disease of the cervical spine, Muhle et al observed an increasing prevalence of functional cord impingement from the posterior aspect and from the anterior and posterior aspects (pincer effect) during cervical spine extension.…”

Section: Discussionmentioning

confidence: 99%

“…9,10,[12][13][14][15] Magnetic resonance im aging is the preferred radiological tool for diagnosing CSM because it not only anatomically depicts how the spinal cord is compressed but also reveals pathological changes in the spinal cord. However, it is difficult to make objective clinical assessments of CSM on the basis of radiological findings alone.…”

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confidence: 99%

Dynamic somatosensory evoked potentials to determine electrophysiological effects on the spinal cord during cervical spine extension

Morishita

Maeda

Ueta

et al. 2013

SPI

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Object The goal of this prospective study was to investigate somatosensory evoked potentials (SSEPs) during dynamic motion of the cervical spine and to evaluate the efficacy of analyzing dynamic SSEPs for predicting dynamic effects on the spinal cord in patients with cervical spondylotic myelopathy (CSM). Methods In total, 40 human subjects (20 CSM patients and 20 healthy volunteers as a control group) were examined prospectively using dynamic SSEPs with median nerve stimulation. The CSM patients showed cervical myelopathy due to cervical cord compression at the C4–5 segment. The SSEPs were examined with the cervical spine in a neutral position and at a 20° extension for 10 and 20 minutes. Changes in the N20 latency and amplitude were determined and analyzed. The authors defined the changes in the N20 latency and N20 amplitude between the neutral and extension positions of the cervical spine as percent latency and amplitude, respectively. Results In the CSM patients, SSEPs tended to deteriorate after cervical spine extension, and a statistically significant deterioration of the N20 amplitude after the extension was observed. Moreover, the percent latency and amplitude progressively increased during cervical spine extension in these patients. In the healthy controls, SSEPs tended to deteriorate with cervical spine extension, but these changes did not result in statistically significant differences. Moreover, in this group the percent latency and amplitude were almost identical during the extension. When the CSM patients and the healthy controls were compared, a significant difference in the percent amplitude was observed between the 2 groups during the cervical spine extension. Conclusions This study suggests the potential of dynamic SSEPs as a useful neurophysiological technique to detect the effect of dynamic factors on the pathogenesis of CSM.

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“…Disc degeneration was noted in 60% of those over the age of 40 [40]. Muhle et al [41] have shown that significant increase of spinal stenosis have been observed in extension more so than in flexion. Dynamic MRI studies have shown that patients with a congenitally narrow spinal canal [<13mm] predispose to the development of radiographic dynamic cord compression and potentially clinical myelopathy [42].…”

Section: Radiological Evidence Of Impact Of Posterior Osteophytementioning

confidence: 96%

Posterior Osteophyte Evolution and its Impact in Cervical Spondylosis: A Literature Review

Lawrence¹

2013

J Spine

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Introduction: In cervical disc disease, the exact location of the posterior osteophyte with relationship to the bodies of the adjacent cervical vertebra at each disc space level, as observed during surgery under operating microscope and correlating it with the histopathological development of the posterior osteophyte has not been documented in literature. A detailed review of literature on the development of posterior osteophytes and its impact on cervical spinal cord is also being reviewed.

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Dynamic Changes of the Spinal Canal in Patients With Cervical Spondylosis at Flexion and Extension Using Magnetic Resonance Imaging

Cited by 93 publications

References 17 publications

MRI of the cervical spine with neck extension: is it useful?

MRI of the cervical spine with neck extension: is it useful?

Dynamic somatosensory evoked potentials to determine electrophysiological effects on the spinal cord during cervical spine extension

Posterior Osteophyte Evolution and its Impact in Cervical Spondylosis: A Literature Review

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