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Chen G, Shi J. Improvement of Postoperative Quality of Life in Patients Over 80 Years Old With Thoracic Spinal Stenosis. Clin Spine Surg 2024:01933606-990000000-00300. [PMID: 38637918 DOI: 10.1097/bsd.0000000000001606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/22/2024] [Indexed: 04/20/2024]
Abstract
STUDY DESIGN A retrospective comparative study was conducted to analyze the outcome of surgical and conservative treatment for patients over 80 years old with thoracic spinal stenosis (TSS). OBJECTIVE To evaluate the safety and efficiency of posterior spinal cord decompression surgery for over 80-year-old patients with TSS. SUMMARY OF BACKGROUND DATA Concerned about the risk of surgery, over 80-year-old patients with TSS are usually treated conservatively, which often leads to a decline in quality of life. So far as we know, no study demonstrates the risk and benefit of spine surgery for these patients. METHODS Over 80 years of age who underwent dorsal decompression surgery or conservative treatment due to TSS between January 2010 and November 2020 were analyzed. Sixty-four patients who completed follow-up PROM (patient-reported outcome measure) data were collected, including the mJOA (modified Japanese Orthopedic Association score) scoring system, VAS (visual analogue scale), questionnaire-based assessment of the ODI (Oswestry disability index), BI (Barthel index), and SF-36v2 (Short Form-36v2) Health Survey. The clinical characteristics, preoperative and postoperative imaging findings, operative records, complications, and individual outcomes were analyzed. RESULTS Of the 64 patients, 38 underwent posterior decompression, pedicle screw fixation, and posterolateral fusion; another 26 chose conservative treatment. The baseline characteristics of the TSS patients in 2 groups show no significant differences. The clinical symptoms and imaging outcomes showed a significant improvement in the surgical group compared with the nonsurgical group, according to mJOA, VAS, ODI, BI, and SF-36v2. Cerebrospinal fluid leakage occurred in 6 patients, and transient neurological impairment occurred in 2 patients. CONCLUSIONS Posterior decompression surgery for over 80-year-old patients with TSS is a safe and effective treatment, it has a good clinical outcome as well as an acceptable complication rate. However, there were no obvious improvements in quality of life or pain with conservative treatment.
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Affiliation(s)
- Guozhao Chen
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou
- Department of Orthopaedics, The First People's Hospital of Zhangjiagang, Zhangjiagang, Jiangsu, China
| | - Jinhui Shi
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou
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Nagamoto K, Kawachino T, Suetsugu Y, Saruwatari H, Nihei SI, Kunugita N. Eye lens dose in spine surgeons during myelography procedures: a dosimetry study. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2023; 43:041509. [PMID: 37944177 DOI: 10.1088/1361-6498/ad0b3a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 11/09/2023] [Indexed: 11/12/2023]
Abstract
To determine the eye lens dose (3 mm dose equivalent [Hp(3)]) received by spine surgeons during myelography and evaluate the effectiveness of radiation-protective glasses and x-ray tube system positioning in reducing radiation exposure. This study included spine surgeons who performed myelography using over- or under-table x-ray tube systems. Hp(3) was measured for each examination using a radio-photoluminescence glass dosimeter (GD-352M) mounted on radiation-protective glass. This study identified significantly high Hp(3) levels, especially in the right eye lens in spinal surgeons. The median Hp(3) values in the right eye were 524 (391-719) and 58 (42-83)μSv/examination for over- and under-table x-ray tube systems, respectively. Further, Hp(3)AK, which was obtained by dividing the cumulative air kerma from Hp(3), was 8.09 (6.69-10.21) and 5.11 (4.06-6.31)μSv mGy-1for the over- and under-table x-ray tube systems, respectively. Implementing radiation-protective glasses resulted in dose reduction rates of 54% (50%-57%) and 54% (51%-60%) for the over- and under-table x-ray tube systems, respectively. The use of radiation protection glasses significantly reduced the radiation dose in the eye lens during myelography, with the most effective measures being the combination of using radiation protection glasses and an under-table x-ray tube system.
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Affiliation(s)
- Keisuke Nagamoto
- Department of Radiology, Hospital of the University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Tomonori Kawachino
- Department of Radiology, Hospital of the University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Yoshiki Suetsugu
- Department of Radiology, Hospital of the University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Hiromi Saruwatari
- Department of Radiology, Hospital of the University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Shun-Ichi Nihei
- Department of Emergency and Intensive Care Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Naoki Kunugita
- Department of Occupational and Community Health Nursing School of Health Sciences, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
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Siller S, Pannenbaecker L, Tonn JC, Zausinger S. Unilateral Approaches for Posterior Spinal Canal Decompression in Cervical Spondylotic Myelopathy—An Evaluation of Conceptual Feasibility. Oper Neurosurg (Hagerstown) 2022; 23:431-438. [DOI: 10.1227/ons.0000000000000364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/24/2022] [Indexed: 11/07/2022] Open
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Siller S, Pannenbaecker L, Tonn JC, Zausinger S. Surgery of degenerative thoracic spinal stenosis-long-term outcome with quality-of-life after posterior decompression via an uni- or bilateral approach. Acta Neurochir (Wien) 2020; 162:317-325. [PMID: 31873792 DOI: 10.1007/s00701-019-04191-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/19/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The rate of degenerative thoracic spinal stenosis (TSS) as underlying pathology for myelopathy is not precisely known, and larger case series are only available for the Asian region. We present one of the largest European series to evaluate rate and clinical outcome after dorsal decompression via a uni- or bilateral approach. METHOD We investigated patients' characteristics, imaging/surgical parameters, and outcomes with quality-of-life (QOL) in all patients who underwent surgical treatment for TSS between 2013 and 2018 in a university neurosurgical clinic. RESULTS From 645 patients with surgery for degenerative spondylotic myelopathy within 6 years, 28 patients (4.3%) suffered from TSS. Median age was 70.4 years with a slight predominance of the female sex (m:f = 1:1.3). The most frequent symptoms (mean duration 7.6 months) were ataxia (61%) and sensory changes (50%). The stenoses (median Naganawa score 3) mostly resulted from a combined osseous/ligamentous hypertrophy and disc prolapse, the majority located below Th8 (75%). Nineteen patients with lateralized compression underwent bilateral decompression via a unilateral approach (fenestration/hemilaminectomy with "undercutting" procedure), and 9 patients with circular pathology underwent bilateral-approached decompression (laminectomy). There were no significant differences of patients' characteristics, blood loss, operation time, and in-patient stay between both surgical groups. Independent from the mode of surgery, the spinal canal was significantly (p < 0.001) widened (median Naganawa score 0), and pain (p = 0.04), myelopathy (mJOA score p = 0.01), and QOL (Oswestry Disability Index, p = 0.03; SF-36-MCS, p = 0.01) were significantly improved at long-term follow-up (mean 35.1 months). CONCLUSIONS Non-tumorous myelopathy is caused in about 4% of patients by TSS and can be effectively treated by surgical decompression via both a uni- or bilateral approach.
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Affiliation(s)
- Sebastian Siller
- Neurosurgical Clinic, Clinic of the University of Munich (Ludwig Maximilians University), Campus Grosshadern, Marchioninistrasse 15, D-81377, Munich, Germany.
| | - Laura Pannenbaecker
- Neurosurgical Clinic, Clinic of the University of Munich (Ludwig Maximilians University), Campus Grosshadern, Marchioninistrasse 15, D-81377, Munich, Germany
| | - Joerg-Christian Tonn
- Neurosurgical Clinic, Clinic of the University of Munich (Ludwig Maximilians University), Campus Grosshadern, Marchioninistrasse 15, D-81377, Munich, Germany
| | - Stefan Zausinger
- Neurosurgical Clinic, Clinic of the University of Munich (Ludwig Maximilians University), Campus Grosshadern, Marchioninistrasse 15, D-81377, Munich, Germany
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Hu P, He Z, Cui J, Wan Y. Pathological changes of cervical spinal canal in cervical spondylotic myelopathy: A retrospective study on 39 cases. Clin Neurol Neurosurg 2019; 181:133-137. [DOI: 10.1016/j.clineuro.2019.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/11/2019] [Accepted: 04/14/2019] [Indexed: 10/27/2022]
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Dong F, Wu Y, Song P, Qian Y, Wang Y, Xu L, Yin M, Zhang R, Tao H, Ge P, Liu C, Zhang H, Zhu J, Shen C, Yu Y. A preliminary study of 3.0-T magnetic resonance diffusion tensor imaging in cervical spondylotic myelopathy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:1839-1845. [DOI: 10.1007/s00586-018-5579-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 03/05/2018] [Accepted: 03/30/2018] [Indexed: 10/17/2022]
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Nagel SJ, Reddy CG, Frizon LA, Chardon MK, Holland M, Machado AG, Gillies GT, Howard MA, Wilson S. Spinal dura mater: biophysical characteristics relevant to medical device development. J Med Eng Technol 2018; 42:128-139. [PMID: 29569970 PMCID: PMC7053539 DOI: 10.1080/03091902.2018.1435745] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Understanding the relevant biophysical properties of the spinal dura mater is essential to the design of medical devices that will directly interact with this membrane or influence the contents of the intradural space. We searched the literature and reviewed the pertinent characteristics for the design, construction, testing, and imaging of novel devices intended to perforate, integrate, adhere or reside within or outside of the spinal dura mater. The spinal dura mater is a thin tubular membrane composed of collagen and elastin fibres that varies in circumference along its length. Its mechanical properties have been well-described, with the longitudinal tensile strength exceeding the transverse strength. Data on the bioelectric, biomagnetic, optical and thermal characteristics of the spinal dura are limited and sometimes taken to be similar to those of water. While various modalities are available to visualise the spinal dura, magnetic resonance remains the best modality to segment its structure. The reaction of the spinal dura to imposition of a foreign body or other manipulations of it may compromise its biomechanical and immune-protective benefits. Therefore, dural sealants and replacements are of particular clinical, research and commercial interest. In conclusion, existing devices that are in clinical use for spinal cord stimulation, intrathecal access or intradural implantation largely adhere to traditional designs and their attendant limitations. However, if future devices are built with an understanding of the dura's properties incorporated more fully into the designs, there is potential for improved performance.
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Affiliation(s)
- Sean J. Nagel
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | - Chandan G. Reddy
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Leonardo A. Frizon
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | - Matthieu K. Chardon
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Marshall Holland
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Andre G. Machado
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | - George T. Gillies
- Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, USA
| | - Matthew A. Howard
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Saul Wilson
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Abstract
UNLABELLED : Imaging is important in the evaluation of patients with degenerative disease and infectious processes. There are numerous conditions that can manifest as low back pain (LBP) or neck pain in a patient, and in many cases, the cause may be multifactorial. Clinical history and physical examination are key components in the evaluation of such patients; however, physical examination has variable sensitivity and specificity. Although studies have demonstrated that uncomplicated acute LBP and/or radiculopathy are self-limited conditions that do not warrant any imaging, neuroimaging can provide clear anatomic delineation of potential causes of the patient's clinical presentation. Various professional organizations have recommendations for imaging of LBP, which generally agree that an imaging study is not indicated for patients with uncomplicated LBP or radiculopathy without a red flag (eg, neurological deficit such as major weakness or numbness in lower extremities, bowel or bladder dysfunction, saddle anesthesia, fever, history of cancer, intravenous drug use, immunosuppression, trauma, or worsening symptoms). Different imaging modalities have a complementary role in the diagnosis of pathologies affecting the spine. In this review, we discuss the standard nomenclature for lumbar disk pathology and the utility of various clinical imaging techniques in the evaluation of LBP/neck pain for potential neurosurgical management. The imaging appearance of spinal infections and potential mimics also is reviewed. Finally, we discuss advanced neuroradiological techniques that offer greater microstructural and functional information. ABBREVIATIONS ADC, apparent diffusion coefficientDTI, diffusion tensor imagingDWI, diffusion-weighted imagingDOM, diskitis-osteomyelitisLBP, low back painMRM, magnetic resonance myelographySNA, spinal neuroarthropathySPECT, single-positron emission computed tomographySTIR, short tau inversion recovery.
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Affiliation(s)
- Lubdha M Shah
- Departments of *Radiology and Imaging Sciences and ‡Neurosurgery, University of Utah, Salt Lake City, Utah; §Department of Radiology, Mayo Clinic Arizona, Scottsdale, Arizona
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Seragioli R, Simao MN, Simao GN, Herrero CFPS, Nogueira-Barbosa MH. Assessment of the cervical spine denticulate ligament using MRI volumetric sequence: Comparison between 1.5 Tesla and 3.0 Tesla. J Neuroradiol 2017; 45:147-151. [PMID: 29038025 DOI: 10.1016/j.neurad.2017.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 02/15/2017] [Accepted: 06/24/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Denticulate ligaments (DLs) are pial extensions on each side of the spinal cord, comprising about 20 to 21 pairs of fibrous structures connecting the dura mater to the spinal cord. These ligaments are significant anatomical landmarks in the surgical approach to intradural structures. To our knowledge, there is no previous study on the detection of DLs using MRI. METHODS After IRB approval, we retrospectively evaluated 116 consecutive MRI scans of the cervical spine, using the volumetric sequence 3D COSMIC, 65 and 51 studies with 1.5T and 3.0T respectively. We did not include trauma and tumor cases. Two independent radiologists assessed the detection of cervical spine DLs independently and blinded for each cervical vertebral level. We compared the frequency of detection of these ligaments in 1.5 Tesla and 3.0 Tesla MRI using Fisher exact test considering P<0.05 as significant. We evaluated interobserver agreement with Kappa coefficient. RESULTS We observed high detection frequency of the cervical spine DLs using both 1.5T (70 to 91%) and 3.0T (68 to 98%). We found no statistically significant difference in the detection frequency of ligaments between the 1.5T and 3.0T MRI in all vertebral levels. Using 3.0T, radiologists identified ligaments better in higher vertebral levels than for lower cervical levels (P=0.0003). Interobserver agreement on the identification of DL was poor both for 1.5T (k=0.3744; CI 95% 0.28-0.46) and 3.0T (k=0.3044; CI 95% 0.18-0.42) MRI. CONCLUSIONS Radiologists identified most of the cervical DLs using volumetric MRI acquisition. Our results suggest 1.5T and 3.0T MRI performed similarly in the detection of DLs.
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Affiliation(s)
- Rafael Seragioli
- University of Sao Paulo, Ribeirão Preto Medical School, 3900, Bandeirantes avenue, 14048-900, Ribeirão Preto, Sao Paulo, Brazil.
| | - Marcelo Novelino Simao
- University of Sao Paulo, Ribeirão Preto Medical School, 3900, Bandeirantes avenue, 14048-900, Ribeirão Preto, Sao Paulo, Brazil.
| | - Gustavo Novelino Simao
- University of Sao Paulo, Ribeirão Preto Medical School, 3900, Bandeirantes avenue, 14048-900, Ribeirão Preto, Sao Paulo, Brazil.
| | - Carlos Fernando P S Herrero
- University of Sao Paulo, Ribeirão Preto Medical School, 3900, Bandeirantes avenue, 14048-900, Ribeirão Preto, Sao Paulo, Brazil.
| | - Marcello H Nogueira-Barbosa
- University of Sao Paulo, Ribeirão Preto Medical School, 3900, Bandeirantes avenue, 14048-900, Ribeirão Preto, Sao Paulo, Brazil.
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Awwad W, Bourget-Murray J, Zeiadin N, Mejia JP, Steffen T, Algarni AD, Alsaleh K, Ouellet J, Weber M, Jarzem PF. Analysis of the spinal nerve roots in relation to the adjacent vertebral bodies with respect to a posterolateral vertebral body replacement procedure. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2017; 8:50-57. [PMID: 28250637 PMCID: PMC5324361 DOI: 10.4103/0974-8237.199869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aims to improve the understanding of the anatomic variations along the thoracic and lumbar spine encountered during an all-posterior vertebrectomy, and reconstruction procedure. This information will help improve our understanding of human spine anatomy and will allow better planning for a vertebral body replacement (VBR) through either a transpedicular or costotransversectomy approach. SUMMARY OF BACKGROUND DATA The major challenge to a total posterior approach vertebrectomy and VBR in the thoracolumbar spine lies in the preservation of important neural structures. METHODS This was a retrospective analysis. Hundred normal magnetic resonance imaging (MRI) spinal studies (T1-L5) on sagittal T2-weighted MRI images were studied to quantify: (1) mid-sagittal vertebral body (VB) dimensions (anterior, midline, and posterior VB height), (2) midline VB and associated intervertebral discs height, (3) mean distance between adjacent spinal nerve roots (DNN) and mean distance between the inferior endplate of the superior vertebrae to its respective spinal nerve root (DNE), and (4) posterior approach expansion ratio (PAER). RESULTS (1) The mean anterior VB height gradually increased craniocaudally from T1 to L5. The mean midline and posterior VB height showed a similar pattern up to L2. Mean posterior VB height was larger than the mean anterior VB height from T1 to L2, consistent with anterior wedging, and then measured less than the mean anterior VB height, indicating posterior wedging. (2) Midline VB and intervertebral disc height gradually increased from T1 to L4. (3) DNN and DNE were similar, whereby they gradually increased from T1 to L3. (5) Mean PAER varied between 1.69 (T12) and 2.27 (L5) depending on anatomic level. CONCLUSIONS The dimensions of the thoracic and lumbar vertebrae and discs vary greatly. Thus, any attempt at carrying out a VBR from a posterior approach should take into account the specifications at each spinal level.
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Affiliation(s)
- Waleed Awwad
- Department of Orthopedic Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Jonathan Bourget-Murray
- Division of Orthopedic Surgery, Department of Surgery, Orthopedic Research Laboratory, McGill University Health Center, McGill University, Montreal, Canada; Division of Orthopedic Surgery, Department of Surgery, Faculty of Medicine, McGill University, Montreal, Canada
| | - Nadil Zeiadin
- Division of Orthopedic Surgery, Department of Surgery, Orthopedic Research Laboratory, McGill University Health Center, McGill University, Montreal, Canada; Department of Surgery, McGill University, Montreal, Canada
| | - Juan P Mejia
- Division of Orthopedic Surgery, Department of Surgery, Orthopedic Research Laboratory, McGill University Health Center, McGill University, Montreal, Canada
| | - Thomas Steffen
- Division of Orthopedic Surgery, Department of Surgery, Orthopedic Research Laboratory, McGill University Health Center, McGill University, Montreal, Canada; Department of Surgery, McGill University, Montreal, Canada
| | | | - Khalid Alsaleh
- Department of Orthopedic Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Jean Ouellet
- Division of Orthopedic Surgery, Department of Surgery, Orthopedic Research Laboratory, McGill University Health Center, McGill University, Montreal, Canada; Department of Surgery, McGill University, Montreal, Canada
| | - Michael Weber
- Division of Orthopedic Surgery, Department of Surgery, Orthopedic Research Laboratory, McGill University Health Center, McGill University, Montreal, Canada; Department of Surgery, McGill University, Montreal, Canada
| | - Peter F Jarzem
- Division of Orthopedic Surgery, Department of Surgery, Orthopedic Research Laboratory, McGill University Health Center, McGill University, Montreal, Canada; Department of Surgery, McGill University, Montreal, Canada
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Abstract
Different radiological methods play an important role in the work-up of patients complaining of spine pain. Depending on the symptoms and the suspected underlying etiology different methods are selected. In the following presentation we briefly present the different radiological and magnetic resonance tomography methods that are at hand, give some guidance in which method to use, and present the typical imaging findings in some of the most common conditions that presents with spine pain.
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Martin-Vaquero P, da Costa RC, Drost WT. Comparison of noncontrast computed tomography and high-field magnetic resonance imaging in the evaluation of Great Danes with cervical spondylomyelopathy. Vet Radiol Ultrasound 2014; 55:496-505. [PMID: 24547789 DOI: 10.1111/vru.12148] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 12/08/2013] [Indexed: 11/28/2022] Open
Abstract
Computed tomography (CT) provides excellent bony detail, whereas magnetic resonance (MR) imaging is superior in evaluating the neural structures. The purpose of this prospective study was to assess interobserver and intermethod agreement in the evaluation of cervical vertebral column morphology and lesion severity in Great Danes with cervical spondylomyelopathy by use of noncontrast CT and high-field MR imaging. Fifteen client-owned affected Great Danes were enrolled. All dogs underwent noncontrast CT under sedation and MR imaging under general anesthesia of the cervical vertebral column. Three observers independently evaluated the images to determine the main site of spinal cord compression, direction and cause of the compression, articular process joint characteristics, and presence of foraminal stenosis. Overall intermethod agreement, intermethod agreement for each observer, overall interobserver agreement, and interobserver agreement between pairs of observers were calculated by use of kappa (κ) statistics. The highest overall intermethod agreements were obtained for the main site of compression and direction of compression with substantial agreements (κ = 0.65 and 0.62, respectively), whereas the lowest was obtained for right-sided foraminal stenosis (κ = 0.39, fair agreement). For both imaging techniques, the highest and lowest interobserver agreements were recorded for the main site of compression and degree of articular joint proliferation, respectively. While different observers frequently agree on the main site of compression using both imaging techniques, there is considerable variation between modalities and among observers when assessing articular process characteristics and foraminal stenosis. Caution should be exerted when comparing image interpretations from multiple observers.
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Affiliation(s)
- Paula Martin-Vaquero
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus, OH, 43210
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Morphometrical analysis of the thoracolumbar dural sac in sheep using computed assisted myelography. Vet Comp Orthop Traumatol 2014; 27:124-9. [PMID: 24493357 DOI: 10.3415/vcot-13-09-0116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 11/17/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Sheep are frequently used as animal models in experimental spinal injury studies. Therefore, extensive knowledge of ovine spinal dimensions is essential for experimental design and interpretation of results obtained in these trials. This study aimed to obtain quantitative morphometrical data of the thoracolumbar dural sac in sheep and determine the anatomical relationship between the dural sac and the vertebral canal. METHODS Computed assisted myelography imaging was carried out in five adult German Black-Headed Mutton sheep under general anaesthesia. Transverse images were acquired with 2 mm slice thickness from the first thoracic to the sixth lumbar vertebrae. Sagittal and transverse diameters and the cross-sectional area of the dural sac and vertebral canal were measured. To determine the anatomical relationship between the dural sac and vertebral canal, the pedicle-dural sac distance (PPSD) and the epidural space as well as the SAC (available space for the dural sac) were calculated. RESULTS Sagittal diameters of the dural sac ranged from 5.1 to 12.0 mm. Transverse diameters ranged from 5.6 to 12.2 mm. The dural sac area covered 45.9% and 49.0% of the thoracic and lumbar vertebral canal area. The PDSD in the lumbar vertebrae was up to 15.8% larger than in the thoracic ones. The dural sac area was significantly positively correlated with the transverse diameter and area of the vertebral canal. CLINICAL SIGNIFICANCE The lumbar vertebral canal contained more space for the dural sac, which seems to be safer for testing spinal implants.
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Sayit E, Daubs MD, Aghdasi B, Montgomery SR, Inoue H, Wang CJ, Wang BJ, Phan KH, Scott TP. Dynamic changes of the ligamentum flavum in the cervical spine assessed with kinetic magnetic resonance imaging. Global Spine J 2013; 3:69-74. [PMID: 24436854 PMCID: PMC3854599 DOI: 10.1055/s-0033-1337121] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 12/30/2012] [Indexed: 01/15/2023] Open
Abstract
The purpose of this article is to quantify changes in thickness of the ligamentum flavum (LF) associated with motion of the cervical spine and to compare the thickness of the LF at each cervical level using kinetic magnetic resonance imaging (kMRI). Two hundred fifty-seven symptomatic patients (129 men; 128 women) underwent kMRI in neutral, flexion, and extension positions. Midsagittal images were digitally marked and electronically analyzed by spine surgeons. Thickness of LF in the cervical region from C2-3 to C7-T1 was measured in all three positions. LF at C7-T1 was significantly thicker than C2-3 to C6-7 in neutral, flexion, and extension positions (p < 0.05). LF was significantly thicker in extension than in flexion at C3-4 to C6-7. LF thickness increases with extension and decreases with flexion. LF is uniquely thick at C6-7 and at C7-T1 in the extension position, which may predispose these levels to cord compression syndromes and associated neuropathies.
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Affiliation(s)
- E. Sayit
- Department of Orthopaedic Surgery, University of California at Los Angeles (UCLA), Los Angeles, California
| | - M. D. Daubs
- Department of Orthopaedic Surgery, University of California at Los Angeles (UCLA), Los Angeles, California,Address for correspondence Michael Daubs, MD Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA1250 16th Street, Suite 3145-ESanta Monica, CA 90404
| | - B. Aghdasi
- Department of Orthopaedic Surgery, University of California at Los Angeles (UCLA), Los Angeles, California
| | - S. R. Montgomery
- Department of Orthopaedic Surgery, University of California at Los Angeles (UCLA), Los Angeles, California
| | - H. Inoue
- Department of Orthopaedic Surgery, University of California at Los Angeles (UCLA), Los Angeles, California
| | - C. J. Wang
- Department of Orthopaedic Surgery, University of California at Los Angeles (UCLA), Los Angeles, California
| | - B. J. Wang
- Department of Orthopaedic Surgery, University of California at Los Angeles (UCLA), Los Angeles, California
| | - K. H. Phan
- Department of Orthopaedic Surgery, University of California at Los Angeles (UCLA), Los Angeles, California
| | - T. P. Scott
- Department of Orthopaedic Surgery, University of California at Los Angeles (UCLA), Los Angeles, California
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Abstract
The differential of cervical spondylotic myelopathy (CSM) is broad and includes multiple conditions that can cause and mimic myelopathy. In adults older than 55 years of age, CSM is the most common cause of myelopathy. This article summarizes the pathophysiology, clinical presentation, differential diagnosis, diagnostic evaluation, and natural history of CSM. Available treatment options and their complications are reviewed.
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Affiliation(s)
- Michel Toledano
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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17
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Dong F, Shen C, Jiang S, Zhang R, Song P, Yu Y, Wang S, Li X, Zhao G, Ding C. Measurement of volume-occupying rate of cervical spinal canal and its role in cervical spondylotic myelopathy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:1152-7. [PMID: 23291855 DOI: 10.1007/s00586-012-2622-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 11/24/2012] [Accepted: 12/08/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare volume-occupying rate of cervical spinal canal between patients with cervical spondylotic myelopathy (CSM) and normal subjects, and to investigate its significance in cervical spine disease. METHODS Spiral computed tomography (CT) scan (C4-C6 cervical spine unit) was performed in 20 normal subjects and 36 cases of CSM at a neutral position, and data were transferred to the Advantage Workstation Version 4.2 for assessment. Bony canal area and fibrous canal area in each cross section, and sagittal diameters of cervical spinal canal and cervical spinal body were measured. Volume-occupying rate of cervical spinal canal was calculated using MATLAB. Cervical spinal canal ratio and effective cervical spinal canal ratio were calculated, and Japanese Orthopaedic Association score was used to assess cervical spinal cord function. RESULTS Volume-occupying rate of cervical spinal canal at a neutral position was significantly higher in CSM patients as compared to normal subjects (P < 0.01). There was no correlation between cervical spinal canal ratio and JOA score in CSM patients, with a Pearson's correlation coefficient of 0.171 (P > 0.05). However, sagittal diameter of secondary cervical spinal canal, effective cervical spinal canal ratio and volume-occupying rate of cervical spinal canal were significantly associated to JOA score, with Pearson's coefficient correlations of 0.439 (P < 0.05), 0.491 (P < 0.05) and -0.613 (P < 0.01), respectively. CONCLUSIONS Volume-occupying rate of cervical spinal canal is an objective reflection of compression on cervical spine and spinal cord, and it is associated with cervical spinal cord function. These suggest that it may play a significant role in predicting the development of CSM.
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Affiliation(s)
- Fulong Dong
- Orthopedics Department, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
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18
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Maus TP. Imaging of spinal stenosis: neurogenic intermittent claudication and cervical spondylotic myelopathy. Radiol Clin North Am 2012; 50:651-79. [PMID: 22643390 DOI: 10.1016/j.rcl.2012.04.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Spinal stenosis in either the cervical or lumbar spinal segments is one of the most common indications for spine imaging and intervention, particularly among the elderly. This article examines the pathophysiology and imaging of the corresponding clinical syndromes, cervical spondylotic myelopathy or neurogenic intermittent claudication. The specificity fault of spine imaging is readily evident in evaluation of spinal stenosis, as many patients with anatomic cervical or lumbar central canal narrowing are asymptomatic. Imaging also may be insensitive to dynamic lesions. Those imaging features that identify symptomatic patients, or predict response to interventions, are emphasized.
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Affiliation(s)
- Timothy P Maus
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA.
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19
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da Costa RC, Echandi RL, Beauchamp D. Computed tomography myelographic findings in dogs with cervical spondylomyelopathy. Vet Radiol Ultrasound 2012; 53:64-70. [PMID: 22093094 DOI: 10.1111/j.1740-8261.2011.01869.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Computed tomography (CT) myelography is used occasionally in the diagnosis of cervical spondylomyelopathy, but the type of lesion found in large- versus giant-breed dogs using this modality has not been characterized. Our purpose was to report the frequency of compressive lesions in large- and giant-breed dogs with cervical spondylomyelopathy and imaged using CT myelography. Fifty-eight dogs were retrospectively studied, 23 large-breed and 35 giant-breed dogs. Multiple sites of compression were found in 12 large-breed dogs (52.2%) compared to 30 (85.8%) giant-breed dogs. The main site of compression was at C5-6 and C6-7 in both large-breed (91.3%) and giant-breed (72.4%) dogs. The main cause and direction of compression was disc-associated and ventral in 19 (82.6%) of the large-breed dogs while osseous changes were the primary cause of compression in 27 (77.2%) of the giant-breed dogs, with most compressions being lateral (51.4%), followed by dorsolateral (14.2%). Osseous compression was observed at C7-T1 in eight giant-breed dogs (22.8%), and at T1-T2 or T2 only in five dogs (14.3%). Four of 23 large-breed dogs (17.4%), and seven (20%) of 35 giant-breed dogs had spinal cord atrophy. Therefore, giant-breed dogs often have multiple compressions, usually caused by osseous changes causing lateralized compressions. In large-breed dogs most compressions are disc-associated and located ventrally. Considering the number of giant-breed dogs with compressions at C7-T1, T1-2, and T2, it is important to include the cranial thoracic region when imaging dogs suspected of having cervical spondylomyelopathy.
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Affiliation(s)
- Ronaldo C da Costa
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210, USA.
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Myelography in the Age of MRI: Why We Do It, and How We Do It. Radiol Res Pract 2011; 2011:329017. [PMID: 22091378 PMCID: PMC3197073 DOI: 10.1155/2011/329017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 01/17/2011] [Indexed: 12/19/2022] Open
Abstract
Myelography is a nearly ninety-year-old method that has undergone a steady development from the introduction of water-soluble contrast agents to CT myelography. Since the introduction of magnetic resonance imaging into clinical routine in the mid-1980s, the role of myelography seemed to be constantly less important in spinal diagnostics, but it remains a method that is probably even superior to MRI for special clinical issues.
This paper briefly summarizes the historical development of myelography, describes the technique, and discusses current indications like the detection of CSF leaks or cervical root avulsion.
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