Kinematic characteristics of patients with cervical imbalance: a weight-bearing dynamic MRI study

Tamai, Katsuto; Grisdela, Phillip; Romanu, Joshua; Paholpak, Permsak; Buser, Zorica; Wang, Jeffrey C.

doi:10.1007/s00586-018-05874-2

Cited by 3 publications

(3 citation statements)

References 26 publications

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“…A canal diameter < 10.7 mm and disk height > 7.1 mm on neutral images may predict segments with ligamentum flavum bulge apparent in extension but not in the neutral position. 12 This study highlighted the potential additional benefit of positional maneuvers in weight-bearing MRI of the cervical spine.…”

Section: Positional Maneuvers Of the Cervical Spine In A Weight-bearimentioning

confidence: 80%

Weight-bearing Magnetic Resonance Imaging of the Cervical Spine

Lee

Griffith

2019

Semin Musculoskelet Radiol

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The cervical spine is subject to the effect of gravity in the upright position. Weight-bearing upright magnetic resonance imaging (MRI) potentially allows a better diagnosis and evaluation of cervical spine pathology that may be masked or not fully appreciated in the usual non–weight-bearing supine position. Only limited studies are currently available in this area. This article summarizes the current literature on weight-bearing MRI of the cervical spine.

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Section: Positional Maneuvers Of the Cervical Spine In A Weight-bearimentioning

confidence: 80%

Weight-bearing Magnetic Resonance Imaging of the Cervical Spine

Lee

Griffith

2019

Semin Musculoskelet Radiol

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“…Patients with a lordotic alignment will not experience such benefits because their cords are already longitudinally relaxed in their neutral positions [ 1 ]. Patients with a kyphotic alignment experienced much more severe potential ligamentum flavum bulges and pincer effects upon extension [ 28 – 30 ]. which might offset the benefits of decreased longitudinal tension.…”

Section: Discussionmentioning

confidence: 99%

Patients with degenerative cervical myelopathy exhibit neurophysiological improvement upon extension and flexion: a retrospective cohort study with a minimum 1-year follow-up

Chen

Cheng

et al. 2022

BMC Neurol

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Background Cervical extension and flexion are presumably harmful to patients with degenerative cervical myelopathy (DCM) because they worsen medullary compression visible on dynamic magnetic resonance imaging (MRI). Dynamic somatosensory evoked potentials (SSEPs) are an objective tool to measure the electrophysiological function of the spinal cord at different neck positions. In contrast to previous hypotheses, a considerable proportion of patients with DCM present improved SSEPs upon extension and flexion compared to a neutral position. Methods Patients with DCM who underwent preoperative dynamic SSEP examinations and subsequent decompression surgeries between 2015 and 2019 were retrospectively evaluated. We compared extension and flexion SSEPs with neutral SSEPs in each patient and classified them into extension-improved (EI) or extension-nonimproved (EN) and flexion-improved (FI) or flexion-nonimproved (FN) groups. Preoperative clinical evaluations, decompression surgical methods and one-year follow-up clinical data were recorded. Cervical spondylolisthesis and cervical alignment types were evaluated on plain cervical lateral radiographs. The number of stenotic segments, Mühle stenosis grade and disc degeneration stage of the most severe segment, and presence of ligamentum flavum hypertrophy and intramedullary T2 weighted imaging (T2WI) hyperintensity were evaluated on lateral and axial MRI. Data were compared between the EN and EN groups or FI and FN groups with T-tests, chi-square tests or Kruskal-Wallis tests. Prediction criteria were determined with logistic regression analyses. Results Forty-nine patients were included, and 9 (18.4%) and 11 (22.4%) showed improved extension and flexion SSEPs compared to their own neutral SSEPs, respectively. Interestingly, EI or FI patients had significantly better one-year postoperative mJOA recoveries than EN or FN patients (T-test, P < 0.001). Moreover, the disease duration (T-test, P = 0.024), involved segment number (Kruskal-Wallis test, P < 0.001), and cervical alignment type (chi-square test, P = 0.005) varied significantly between the EI and EN groups. The FI group presented a significantly higher Mühle stenosis grade than the FN group (Kruskal-Wallis test, P = 0.038). Furthermore, ≤ 2 involved segments and straight or sigmoid cervical alignment were significant criteria predicting improved extension SSEPs (probability: 85.7%), while Mühle stenosis Grade 3 and disease duration ≤6 months were significant criteria predicting improved flexion SSEPs (probability: 85.7%). Conclusions Our findings provide evidence for neurophysiological improvement in patients with DCM at extension and flexion and its significance in predicting prognoses. Moreover, certain clinical and radiographic criteria may help predict neurophysiological improvement upon extension or flexion. Trial registration “[2020]151”. Retrospectively registered on April 30, 2020.

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“…Lordotic patients will not experience such bene ts because their cords are already longitudinally relaxed in their neutral positions. [2] Kyphotic patients experienced much more severe potential ligamentum avum bulges and pincer effects upon extension, [25][26][27] which could offset the bene ts of decreased longitudinal tension.…”

Section: Discussionmentioning

confidence: 99%

Clinical Factors for Predicting Neurophysiological Improvements Upon Extension and Flexion in Cervical Spondylotic Myelopathy Patients: A Retrospective Cohort Study

Yu¹,

Chen²,

Cheng³

et al. 2021

Preprint

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BackgroundCervical extension and flexion are generally thought to be harmful to CSM patients. Contrary to previous notions, a proportion of CSM patients presented DSSEP improvement upon extension and/or flexion. This study aims to determine the prediction criteria for DSSEP improvement upon extension and flexion with clinical and neutral-position imaging.MethodsCSM patients between 2015 and 2019 were retrospectively evaluated. The recorded outcomes were DSSEP changes upon extension and flexion, disease duration, modified Japanese Orthopedic Association (mJOA) score, gait impairment presence, weakness of upper limb muscles, and positive Hoffmann sign designation. The collection of MRI data included the compression ratio, the number of stenotic levels, the Mühle stenosis grade and disc degeneration stage of the most severe segment, and the presence of ligamentum flavum hypertrophy and intramedullary T2WI hyperintensity. Cervical alignment types were evaluated on plain cervical lateral radiographs.ResultsForty-nine patients were finally enrolled. Nine (18.4%) and 11 (22.4%) patients showed DSSEP improvement upon extension and flexion, respectively. Logistic regression analysis showed that an involved segment number ≤ 2 (P=0.018) and a straight/sigmoid cervical alignment (P=0.033) were significant criteria for predicting DSSEP improvement upon extension (probability: 85.7%). Mühle grade 3 (P=0.022) and disease duration ≤ 6 months (P=0.04) were significant criteria for predicting improvement upon flexion (probability: 85.7%).ConclusionsCervical extension and flexion might not necessarily cause deterioration and can even improve some CSM patients' neurological function at DSSEP examination. The involved segment number and cervical alignment were related to extension DSSEP improvement, while the stenosis grade and disease durations were related to flexion improvement. Our work suggests potential significance of educating CSM patients on maintaining individualized neck positions based on their clinical and radiographic findings.BaTrial registrationThe trial was retrospectively registered on April 30th, 2020 and the registration number is "[2020]151".

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Kinematic characteristics of patients with cervical imbalance: a weight-bearing dynamic MRI study

Cited by 3 publications

References 26 publications

Weight-bearing Magnetic Resonance Imaging of the Cervical Spine

Weight-bearing Magnetic Resonance Imaging of the Cervical Spine

Patients with degenerative cervical myelopathy exhibit neurophysiological improvement upon extension and flexion: a retrospective cohort study with a minimum 1-year follow-up

Clinical Factors for Predicting Neurophysiological Improvements Upon Extension and Flexion in Cervical Spondylotic Myelopathy Patients: A Retrospective Cohort Study

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