Magnetic resonance imaging in the prone position and the diagnosis of tethered spinal cord

Stamates, Melissa M.; Frim, David M.; Yang, Chen; Katzman, Gregory L.; Saad, Ali

doi:10.3171/2017.3.peds16596

Cited by 25 publications

(8 citation statements)

References 22 publications

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“… 65 , 66 This is now used diagnostically, for example, to identify a tethered spinal cord using MRI in the prone position. 67 , 68 Further, the material properties of the spinal cord change with normal movement of the spine. 69 , 70 This is largely in flexion, where the spinal cord lengthens, 71 , 72 and the cross-sectional area of the spinal cord reduces, 73 , 74 estimated to exhibit a strain of 12% in normal physiological conditions.…”

Section: Introductionmentioning

confidence: 99%

A New Framework for Investigating the Biological Basis of Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 5]: Mechanical Stress, Vulnerability and Time

Davies

Mowforth

Gharooni

et al. 2022

Global Spine Journal

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Study Design Literature Review (Narrative) Objective To propose a new framework, to support the investigation and understanding of the pathobiology of DCM, AO Spine RECODE-DCM research priority number 5. Methods Degenerative cervical myelopathy is a common and disabling spinal cord disorder. In this perspective, we review key knowledge gaps between the clinical phenotype and our biological models. We then propose a reappraisal of the key driving forces behind DCM and an individual’s susceptibility, including the proposal of a new framework. Results Present pathobiological and mechanistic knowledge does not adequately explain the disease phenotype; why only a subset of patients with visualized cord compression show clinical myelopathy, and the amount of cord compression only weakly correlates with disability. We propose that DCM is better represented as a function of several interacting mechanical forces, such as shear, tension and compression, alongside an individual’s vulnerability to spinal cord injury, influenced by factors such as age, genetics, their cardiovascular, gastrointestinal and nervous system status, and time. Conclusion Understanding the disease pathobiology is a fundamental research priority. We believe a framework of mechanical stress, vulnerability, and time may better represent the disease as a whole. Whilst this remains theoretical, we hope that at the very least it will inspire new avenues of research that better encapsulate the full spectrum of disease.

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Section: Introductionmentioning

confidence: 99%

A New Framework for Investigating the Biological Basis of Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 5]: Mechanical Stress, Vulnerability and Time

Davies

Mowforth

Gharooni

et al. 2022

Global Spine Journal

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show abstract

“…Although performing an MRI in the prone position is unusual and some technical difficulties would need to be overcome, some recent imaging studies reported the feasibility of performing MRIs in the prone position. 32,33 In the future, further research on performing MRIs in the prone position are needed to resolve this issue.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes Based on Preoperative Kambin's Triangular Working Zone Measurements on 3D CT/MR Fusion Imaging to Determine Optimal Approaches to Transforaminal Endoscopic Lumbar Diskectomy

Hirayama¹,

Hashimoto²,

Sakamoto³

2020

J Neurol Surg A Cent Eur Neurosurg

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Background Transforaminal endoscopic lumbar diskectomy (TELD) is a widely used minimally invasive surgical procedure to treat herniated disks. Postoperative dysesthesia (POD) is a significant complication that affects patient satisfaction. Several anatomical and magnetic resonance (MR) imaging studies of the intervertebral foramina showed that TELD should be avoided in patients with small Kambin's triangular working zones. Recently, some reports indicated the usefulness of three-dimensional (3D) computed tomography/magnetic resonance (CT/MR) fusion images. To date, no articles have been published in the English literature regarding the use of 3D CT/MR fusion images before TELD to evaluate Kambin's triangular working zone. Our objective was to examine clinical outcomes when preoperative Kambin's triangular working zone measurements from 3D CT/MR fusion images were used to determine the approach to TELD. Patients and Methods We included 31 patients who underwent TELD. We rotated the 3D CT/MR fusion images from the posteroanterior view on the approach side to the angle at which Kambin's triangular working zone appeared the largest. This was used to determine the intraoperative insertion angle for the working cannula. When the perpendicular line extending from the exiting nerve at the intervertebral disk level to the upper margin of the superior articular process (exiting nerve-superior articular process distance [ESD]) was less than or equal to 7 mm, an approach that combined foraminoplasty with an outside-in technique (F + outside-in) was used. We compared ESD and clinical outcomes, such as POD, between the approaches. Results Surgical plans were based on ESD values from 22 patients. ESD was 7 mm in 21 patients, all of whom underwent F + outside-in. The inside-out approach was used in eight of nine patients who did not have ESD measurements. Of these, five patients had retrospective ESD measurements of 7 mm. The mean ESD was 6.3 ± 1.0 mm when inside-out was used and 4.4 ± 1.6 mm when F + outside-in was used, a significant difference. Significant improvements were observed in the visual analog scale scores for low back pain, lower limb pain, and lower limb paresthesia. There were no incidences of POD or intraoperative complications. Conclusion Based on preoperative Kambin's triangular working zone measurements from 3D CT/MR fusion images, F + outside-in should be selected when the working zone is smaller than the cannula diameter. This method successfully avoided POD in our study. Preoperative Kambin's triangular working zone measurements from 3D CT/MR fusion imaging can enhance patient safety during TELD.

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“…The presence of a tight filum terminale was further evaluated by performing MRI on all patients while in prone position. A forward movement of the canal width by at least 10% was considered normal, thereby ruling out the tightness of the filum terminale [13]. The presence of cord tethering or tightness of the filum terminale was further confirmed during surgery by two skilled neurosurgeon observers for each case.…”

Section: Evaluation Of Tethered Cord Syndromementioning

confidence: 99%

Prevalence of Abnormal Urodynamic Study Results in Patients with Congenital and Idiopathic Scoliosis and Its Predictive Value for the Diagnosis of Tethered Cord Syndrome: A Single Institution Clinical Study

et al. 2021

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Study Design:A total of 110 patients with scoliosis were enrolled in this analytical cross-sectional study. Purpose: We aimed to compare the urodynamic study (UDS) results of patients with idiopathic scoliosis (ISC) and congenital scoliosis (CSC) and to evaluate the clinical significance of abnormal UDS findings in predicting underlying tethered cord syndrome (TCS). Overview of Literature: An abnormal UDS finding is commonly found in patients with CSC. However, there is no consensus regarding its prevalence in patients with ISC. Methods: Using the STROBE checklist for cross-sectional studies, 110 patients with scoliosis were selected based on our inclusion and exclusion criteria. Among the patients, 76 presented with ISC and 34 with CSC. Demographic data and other details, such as the results of spine radiography, UDS, and magnetic resonance imaging of the spine in both supine and prone positions, were recorded and analyzed. Results: Approximately 50% of patients with CSC had normal UDS findings; 8.8%, mild impairment; and 41.2%, significant abnormalities. Moreover, 67.1% of patients with ISC had normal UDS findings; 9.2%, mild impairment; and 23.7%, significant abnormalities (p=0.166). TCS was identified in 38.2% and 26.3% of patients with CSC and ISC, respectively (p=0.571). In patients with ISC, a significantly abnormal UDS finding indicated that the risk of TCS increased from 26.3% to 50% (odds ratio [OR], 4.2; p=0.009). Meanwhile, in patients with CSC, the risk was almost similar (OR, 0.8; p=0.8). Conclusions:Even with the absence of subjective urinary symptoms, subclinical urologic impairments can be observed in a significant number of patients with ISC. An abnormal UDS finding can be a sign of underlying spinal cord tethering in a patient with ISC who is a candidate for corrective spine surgery even though it is an independent variant and is not exclusive to candidates for surgery. This finding has high clinical utility for neuro-and ortho-spine surgeons who aim to correct scoliosis (OR, 4.2; p=0.009).

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Magnetic resonance imaging in the prone position and the diagnosis of tethered spinal cord

Cited by 25 publications

References 22 publications

A New Framework for Investigating the Biological Basis of Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 5]: Mechanical Stress, Vulnerability and Time

A New Framework for Investigating the Biological Basis of Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 5]: Mechanical Stress, Vulnerability and Time

Clinical Outcomes Based on Preoperative Kambin's Triangular Working Zone Measurements on 3D CT/MR Fusion Imaging to Determine Optimal Approaches to Transforaminal Endoscopic Lumbar Diskectomy

Prevalence of Abnormal Urodynamic Study Results in Patients with Congenital and Idiopathic Scoliosis and Its Predictive Value for the Diagnosis of Tethered Cord Syndrome: A Single Institution Clinical Study

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