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Zhao E, Hirase T, Kim AG, Du JY, Amen TB, Araghi K, Subramanian T, Kamil R, Shahi P, Fourman MS, Asada T, Simon CZ, Singh N, Korsun M, Tuma OC, Zhang J, Lu AZ, Mai E, Kim AYE, Allen MRJ, Kwas C, Dowdell JE, Sheha ED, Qureshi SA, Iyer S. The Impact of Posterior Intervertebral Osteophytes on Patient-Reported Outcome Measures After L5-S1 Anterior Lumbar Interbody Fusion and Transforaminal Lumbar Interbody Fusion. Spine (Phila Pa 1976) 2024; 49:652-660. [PMID: 38193931 DOI: 10.1097/brs.0000000000004904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/11/2023] [Indexed: 01/10/2024]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE (1) To develop a reliable grading system to assess the severity of posterior intervertebral osteophytes and (2) to investigate the impact of posterior intervertebral osteophytes on clinical outcomes after L5-S1 decompression and fusion through anterior lumbar interbody fusion (ALIF) and minimally-invasive transforaminal lumbar interbody fusion (MIS-TLIF). BACKGROUND There is limited evidence regarding the clinical implications of posterior lumbar vertebral body osteophytes for ALIF and MIS-TLIF surgeries and there are no established grading systems that define the severity of these posterior lumbar intervertebral osteophytes. PATIENTS AND METHODS A retrospective analysis of patients undergoing L5-S1 ALIF or MIS-TLIF was performed. Preoperative and postoperative patient-reported outcome measures of the Oswestry Disability Index (ODI) and leg Visual Analog Scale (VAS) at 2-week, 6-week, 12-week, and 6-month follow-up time points were assessed. Minimal clinically important difference (MCID) for ODI of 14.9 and VAS leg of 2.8 were utilized. Osteophyte grade was based on the ratio of osteophyte length to foraminal width. "High-grade" osteophytes were defined as a maximal osteophyte length >50% of the total foraminal width. RESULTS A total of 70 consecutive patients (32 ALIF and 38 MIS-TLIF) were included in the study. There were no significant differences between the two cohorts in patient-reported outcome measures or achievement of MCID for Leg VAS or ODI preoperatively or at any follow-ups. On multivariate analysis, neither the surgical approach nor the presence of high-grade foraminal osteophytes was associated with leg VAS or ODI scores at any follow-up time point. In addition, neither the surgical approach nor the presence of high-grade foraminal osteophytes was associated with the achievement of MCID for leg VAS or ODI at 6 months. CONCLUSION ALIF and MIS-TLIF are both valid options for treating degenerative spine conditions and lumbar radiculopathy, even in the presence of high-grade osteophytes that significantly occupy the intervertebral foramen. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Eric Zhao
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Spine Surgery, Weill Cornell Medicine, New York, NY
| | - Takashi Hirase
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Andrew G Kim
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Jerry Y Du
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Troy B Amen
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Kasra Araghi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Tejas Subramanian
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Spine Surgery, Weill Cornell Medicine, New York, NY
| | - Robert Kamil
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Pratyush Shahi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | | | - Tomoyuki Asada
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Chad Z Simon
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Nishtha Singh
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Maximilian Korsun
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Olivia C Tuma
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Joshua Zhang
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Amy Z Lu
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Spine Surgery, Weill Cornell Medicine, New York, NY
| | - Eric Mai
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Spine Surgery, Weill Cornell Medicine, New York, NY
| | - Ashley Yeo Eun Kim
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Spine Surgery, Weill Cornell Medicine, New York, NY
| | - Myles R J Allen
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Cole Kwas
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - James E Dowdell
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Evan D Sheha
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Sheeraz A Qureshi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Sravisht Iyer
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
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Seo J, Lee JW. Magnetic Resonance Imaging Grading Systems for Central Canal and Neural Foraminal Stenoses of the Lumbar and Cervical Spines With a Focus on the Lee Grading System. Korean J Radiol 2023; 24:224-234. [PMID: 36788771 PMCID: PMC9971835 DOI: 10.3348/kjr.2022.0351] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 11/30/2022] [Accepted: 12/19/2022] [Indexed: 02/16/2023] Open
Abstract
Magnetic resonance imaging (MRI) is a standard imaging modality for diagnosing spinal stenosis, which is a common degenerative disorder in the elderly population. Standardized interpretation of spinal MRI for diagnosing and grading the severity of spinal stenosis is necessary to ensure correct communication with clinicians and to conduct clinical research. In this review, we revisit the Lee grading system for central canal and neural foraminal stenosis of the cervical and lumbar spine, which are based on the pathophysiology and radiologic findings of spinal stenosis.
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Affiliation(s)
- Jiwoon Seo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
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Dimensional Changes of the Neuroforamen After Anterior Decompression of the Cervical Spine: An In Vitro Micro-Computed Tomography Investigation. World Neurosurg 2022; 165:e423-e431. [PMID: 35738534 DOI: 10.1016/j.wneu.2022.06.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this preliminary cadaveric study was to quantify the dimensional changes of the neuroforamen and area available for the cord (AAC) after implantation of various interbody devices with and without posterior longitudinal ligament (PLL) removal. METHODS Eight cervical spines (C3-T1) underwent micro-computed tomography (micro-CT) scanning of the intact spine, followed by discectomy and reconstruction at 3 contiguous levels (C4-C7). Under conditions of intact and resected PLL, the following interbody device configurations were evaluated: 1) parallel, 2) lordotic, and 3) optimal lordotic. Neuroforaminal measurements were calculated from an oblique angle and the AAC was calculated by quantifying the empty space compared with the total space available for the cord. Posterior disc height and operative range lordosis were measured and compared between groups. RESULTS Neuroforaminal height and area significantly increased for all reconstruction groups compared with intact. The increase in neuroforaminal height and area was greatest after PLL resection and placement of parallel (27.1% and 43.6%, respectively) and optimal lordotic (30.5% and 41.5%, respectively) implants. The AAC increased as a function of implant placement compared with intact and increased further after resection of the PLL (P < 0.05). There were no significant differences in operative range lordosis between parallel and lordotic implants. CONCLUSIONS Similar to the lumbar spine, segmental distraction via placement of an interbody device produces indirect decompression of the cervical neuroforamen. Results indicate that a 34% increase in neuroforaminal area and a 51% increase in AAC are achievable with appropriately sized interbody devices and adequate distraction at the posterior aspect of the vertebral body.
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Barnaure I, Galley J, Fritz B, Sutter R. Magnetic resonance imaging in the evaluation of cervical foraminal stenosis: comparison of 3D T2 SPACE with sagittal oblique 2D T2 TSE. Skeletal Radiol 2022; 51:1453-1462. [PMID: 35006279 PMCID: PMC9098590 DOI: 10.1007/s00256-022-03988-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/30/2021] [Accepted: 01/02/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The oblique orientation of the cervical neural foramina challenges the implementation of a short MRI protocol with concurrent excellent visualization of the spine. While sagittal oblique T2-weighted sequences permit good evaluation of the cervical neuroforamina, all segments may not be equally well depicted on a single sequence and conspicuity of foraminal stenosis may be limited. 3D T2-weighted sequences can be reformatted in arbitrary planes, including the sagittal oblique. We set out to compare 3D T2w SPACE sequences with sagittal oblique reformations and sagittal oblique 2D T2w TSE sequences for the evaluation of cervical foraminal visibility and stenosis. MATERIALS AND METHODS Sixty consecutive patients who underwent MRI of the cervical spine with sagittal oblique 2D T2w TSE and 3D T2w SPACE sequences were included. Image homogeneity of the sequences was evaluated. Imaging sets were assessed for structure visibility and foraminal stenosis by two independent readers. Results of the sequences were compared by Wilcoxon matched-pairs tests. Interreader agreement was evaluated by weighted κ. RESULTS Visibility of most structures was rated good to excellent on both sequences (mean visibility scores ≥ 4.5 of 5), though neuroforaminal contents were better seen on sagittal oblique T2w TSE (mean scores 4.1-4.6 vs. 3.1-4.1 on 3D T2w SPACE, p < 0.01). Stenosis grades were comparable between sequences (mean 1.1-2.6 of 4), with slightly higher values for 3D T2w SPACE at some levels (difference ≤ 0.3 points). CONCLUSION 3D T2w SPACE is comparable with sagittal oblique 2D T2w TSE in the evaluation of cervical neural foramina.
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Affiliation(s)
- I Barnaure
- Department of Radiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - J Galley
- Department of Radiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - B Fritz
- Department of Radiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - R Sutter
- Department of Radiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
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Kang KC, Lee HS, Lee JH. Cervical Radiculopathy Focus on Characteristics and Differential Diagnosis. Asian Spine J 2020; 14:921-930. [PMID: 33373515 PMCID: PMC7788378 DOI: 10.31616/asj.2020.0647] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 12/14/2022] Open
Abstract
Cervical radiculopathy is characterized by neurological dysfunction caused by compression and inflammation of the spinal nerves or nerve roots of the cervical spine. It mainly presents with neck and arm pain, sensory loss, motor dysfunction, and reflex changes according to the dermatomal distribution. The most common causes of cervical radiculopathy are cervical disc herniation and cervical spondylosis. It is important to find the exact symptomatic segment and distinguish between conditions that may mimic certain cervical radicular compression syndromes through meticulous physical examinations and precise reading of radiographs. Non-surgical treatments are recommended as an initial management. Surgery is applicable to patients with intractable or persistent pain despite sufficient conservative management or with severe or progressive neurological deficits. Cervical radiculopathy is treated surgically by anterior and/or posterior approaches. The appropriate choice of surgical treatment should be individualized, considering the patient’s main pathophysiology, specific clinical symptoms and radiographic findings thoroughly.
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Affiliation(s)
- Kyung-Chung Kang
- Department of Orthopedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hee Sung Lee
- Department of Orthopedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jung-Hee Lee
- Department of Orthopedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
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Engel G, Bender YY, Adams LC, Boker SM, Fahlenkamp UL, Wagner M, Diederichs G, Hamm B, Makowski MR. Evaluation of osseous cervical foraminal stenosis in spinal radiculopathy using susceptibility-weighted magnetic resonance imaging. Eur Radiol 2018; 29:1855-1862. [DOI: 10.1007/s00330-018-5769-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/23/2018] [Accepted: 09/14/2018] [Indexed: 02/04/2023]
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Kim W, Ahn KS, Kang CH, Kang WY, Yang KS. Comparison of MRI grading for cervical neural foraminal stenosis based on axial and oblique sagittal images: Concordance and reliability study. Clin Imaging 2017; 43:165-169. [DOI: 10.1016/j.clinimag.2017.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/27/2017] [Accepted: 03/10/2017] [Indexed: 10/20/2022]
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Mao H, Driscoll SJ, Li JS, Li G, Wood KB, Cha TD. Dimensional changes of the neuroforamina in subaxial cervical spine during in vivo dynamic flexion-extension. Spine J 2016; 16:540-6. [PMID: 26681352 PMCID: PMC4866915 DOI: 10.1016/j.spinee.2015.11.052] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/10/2015] [Accepted: 11/23/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Neuroforaminal stenosis is one of the key factors causing clinical symptoms in patients with cervical radiculopathy. Previous quantitative studies on the neuroforaminal dimensions have focused on measurements in a static position. Little is known about dimensional changes of the neuroforamina in the cervical spine during functional dynamic neck motion under physiological loading conditions. PURPOSE This study aimed to investigate the in vivo dimensional changes of the neuroforamina in human cervical spine (C3-C7) during dynamic flexion-extension neck motion. STUDY DESIGN A case-control study was carried out. METHODS Ten asymptomatic subjects were recruited for this study. The cervical spine of each subject underwent magnetic resonance image scanning for construction of three-dimensional (3-D) vertebrae models from C3 to C7. The cervical spine was then imaged using a dual fluoroscopic system while the subject performed a dynamic flexion-extension neck motion in a sitting position. The 3-D vertebral models and the fluoroscopic images were used to reproduce the in vivo vertebral motion. The dimensions (area, height, and width) were measured for each cervical neuroforamen (C3/C4, C4/C5, C5/C6, and C6/C7) in the following functional positions: neutral position, maximal flexion, and maximal extension. Repeated measures analysis of variance and post hoc analysis were used to examine the differences between levels and positions. RESULTS Compared with the neutral position, almost all dimensional parameters (area, height, and width) of the subaxial cervical neuroforamina decreased in extension and increased in flexion, except the neuroforaminal area at C5/C6 (p=.07), and the neuroforaminal height at C6/C7 (p=.05) remained relatively constant from neutral to extension. When comparisons of the overall change fromextension to flexion were made between segments, the overall changes of the neuroforaminal area and height revealed no significant differences between segments, and the width overall change of the upper levels (C3/C4 and C4/C5) was significantly greater than the lower levels (C5/C6 and C6/C7) (p<.01). CONCLUSIONS The dimensional changes of the cervical neuroforamina showed segment-dependent characteristics during the dynamic flexion-extension. These data may have implications for diagnosis and treatment of patients with cervical radiculopathy.
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Affiliation(s)
- Haiqing Mao
- Bioengineering Laboratory, Department of Orthopedic Surgery, Harvard Medical School / Massachusetts General Hospital, Boston, MA,Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Sean J Driscoll
- Bioengineering Laboratory, Department of Orthopedic Surgery, Harvard Medical School / Massachusetts General Hospital, Boston, MA
| | - Jing-Sheng Li
- Bioengineering Laboratory, Department of Orthopedic Surgery, Harvard Medical School / Massachusetts General Hospital, Boston, MA
| | - Guoan Li
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Harvard Medical School/Massachusetts General Hospital, 55 Fruit St-GRJ 1215, Boston 02114, MA, USA.
| | - Kirkham B Wood
- Bioengineering Laboratory, Department of Orthopedic Surgery, Harvard Medical School / Massachusetts General Hospital, Boston, MA
| | - Thomas D Cha
- Bioengineering Laboratory, Department of Orthopedic Surgery, Harvard Medical School / Massachusetts General Hospital, Boston, MA
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Cervical cages placed bilaterally in the facet joints from a posterior approach significantly increase foraminal area. 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 2016; 25:2279-85. [PMID: 26869077 DOI: 10.1007/s00586-016-4430-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 01/09/2016] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Foraminal stenosis is a common cause of cervical radiculopathy. Posterior cervical cages can indirectly increase foraminal area and decompress the nerve root. The aim of this study was to assess the influence of bilateral posterior cervical cages on the surface area and shape of the neural foramen. METHODS Radiographic analysis was performed on 43 subjects enrolled in a prospective, multi-center study. CT scans were obtained at baseline and 6- and 12-months after cervical fusion using bilateral posterior cervical cages. The following measurements were performed on CT scan: foraminal area (A), theoretical area (TA), height (H), superior diagonal (DSI), inferior diagonal (DIS), and inferior diagonal without implant (DISI). Comparisons were performed using R-ANOVA with a significance of α < 0.05. RESULTS Foraminal area, height, TA and DISI were significantly greater following placement of the implant. The mean (SD) A increased from 4.01 (1.09) mm(2) before surgery to 4.24 (1.00) mm(2) at 6 months, and 4.18 (1.05) mm(2) at 12 months after surgery (p < 0.0001). Foraminal height (H) increased from mean (SD) 9.20 (1.08) mm at baseline to 9.65 (1.06) mm and 9.55 (1.14) mm at 6- and 12-months post-operatively, respectively (p < 0.0001). The mean DIS did not change significantly. There was a significant decrease in DSI: 6.18 (1.59) mm pre-operatively, 5.95 (1.47) mm and 5.73 (1.46) mm at 6- and 12-months (p < 0.0001). CONCLUSIONS Implantation of bilateral posterior cervical cages can increase foraminal area and may indirectly decompress the nerve roots. Correlation between increase in foraminal area and clinical outcomes needs further investigation.
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Levi DS, Horn S, Collado A. Reliability and Accuracy of MRI Laminar Angle Measurements to Determine Intra-Procedural Contralateral Oblique View Angle for Cervical or Thoracic Interlaminar Epidural Steroid Injections. PAIN MEDICINE 2016; 17:1628-33. [PMID: 26814309 DOI: 10.1093/pm/pnv075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 10/30/2015] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND OBJECTIVE Contralateral oblique (CLO) angle view has been a useful addition to standard views in fluoroscopically guided interlaminar epidural injections. Determination of the appropriate CLO angle is paramount in the usefulness of this technique. Using MRI laminar angle measurements as a pre-procedural guide for the intra-procedural fluoroscopic CLO angle has been proposed. The purpose of this study was to help determine if using axial MRI laminar measurements prior to a cervical or thoracic epidural steroid injection would be useful in predicting the appropriate fluoroscopic CLO angle. STUDY DESIGN A retrospective review was performed for patients who underwent cervical or thoracic interlaminar injections. In the performance of interlaminar injections, the authors had routinely determined the true fluoroscopic contra-lateral oblique angle after epidural access was confirmed, for use during any potential future injections. The fluoroscopic CLO angle measurements were obtained from a chart review and compared blindly to each patient's MRI axial laminar angle measurements. RESULTS 34 injections were included. Inter-rater reliability comparing the two authors' MRI angle measurements was considered fair, ICC = 0.395. Accuracy was only 57% comparing MRI laminar angle measurements to within five degrees of the true fluoroscopic CLO angle as determined during the injection procedure. Accuracy by ICC showed only fair agreement, 0.47 and 0.22, for the two authors. CONCLUSIONS The findings of this study indicate fair inter-rater reliability in manual measurements of laminar angle on axial MRI images. MRI laminar angle measurements do not appear to be highly accurate in determining the appropriate fluoroscopic CLO angle.
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Affiliation(s)
- David S Levi
- *APM Spine and Sports Physicians, Virginia Beach, Virginia, USA
| | - Scott Horn
- *APM Spine and Sports Physicians, Virginia Beach, Virginia, USA
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Diagnostic value of oblique magnetic resonance images for evaluating cervical foraminal stenosis. Spine J 2015; 15:607-11. [PMID: 25452016 DOI: 10.1016/j.spinee.2014.10.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 10/02/2014] [Accepted: 10/19/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The benefits of oblique magnetic resonance imaging (MRI) reformations to assess cervical neural foramina have been reported previously in clinical and cadaveric studies. But there is a paucity of literature investigating intra- and interobserver variabilities for assessing cervical foraminal stenosis using oblique MRI views. PURPOSE To determine the value of oblique MRI views compared with axial and sagittal views for assessing foraminal stenosis of the cervical spine using intra- and interobserver variabilities. STUDY DESIGN A retrospective study. PATIENT SAMPLE Twenty-six patients were included. OUTCOME MEASURES Two independent reviewers blindly identified the presence of foraminal stenosis as definite or indeterminate on the sagittal, axial, and oblique views. The assessments using the different views were compared using an independent t test. Intra- and interobserver variabilities were assessed using Kappa analysis. METHODS We evaluated the cervical spine MRIs of patients with varying degrees of foraminal stenosis. The mean age of the patients was 60.8 years (range 50-86 years). Male to female ratio was 16:10. The oblique images were obtained by reformatting the scans perpendicular to the long axis of the right and left neural foramina, respectively. RESULTS The oblique or axial views had significantly greater confidence rates for determining the presence of foraminal stenosis than the sagittal views (92.3%, 88.1% vs. 58.0%, respectively, p=.000). The oblique view had significantly better intraobserver agreement than the sagittal and axial images. Both the axial and oblique views had significantly better interobserver agreement than the sagittal images. CONCLUSIONS Oblique MRI views of the cervical spine significantly reduce the degree of intra- and interobserver variabilities and increase observer confidence in the assessment of foraminal stenosis. Our results suggest that routine use of oblique cervical MRI views might be useful for evaluating cervical foraminal stenosis.
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Gill JS, Aner M, Nagda JV, Jyotsna N, Keel JC, Simopoulos TT. Contralateral oblique view is superior to lateral view for interlaminar cervical and cervicothoracic epidural access. PAIN MEDICINE 2014; 16:68-80. [PMID: 25220833 DOI: 10.1111/pme.12557] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the reliability of the lateral fluoroscopic view and several contralateral oblique (CLO) views at different angles in visualizing and accurately predicting the position of the needle tip at the point of access in the posterior cervical and cervicothoracic epidural space. DESIGN After the epidural space was accessed but before confirmation with contrast fluoroscopy, we prospectively obtained fluoroscopic images at eight different angles. Subsequent contrast injection confirmed epidural spread. Needle tip visualization and location of needle relative to bony landmarks were analyzed. RESULTS The needle tip was clearly visualized in all CLO projections in all 24 subjects. CLO view at 50 degrees and at obliquity measured on magnetic resonance imaging (MRI) images provided the most consistent needle tip location. In these views, the epidural space was accessed at or just beyond the ventral laminar margin at the ventral interlaminar line or within the proximal half of the predefined CLO area in all patients. The needle tip was poorly visualized in the lateral view and the location of the needle tip was less well defined and independent of the needle location in the anteroposterior (AP) view. CONCLUSIONS This study provides evidence that during cervical and cervicothoracic epidural access, the CLO view at 50 degrees and at MRI-measured obliquity is superior to the lateral view for the purpose of needle tip visualization and in providing a consistent landmark for accessing the epidural space. This article also introduces the concept of zones to describe needle position in the cervical and cervicothoracic spine in AP, lateral, and oblique views.
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Affiliation(s)
- Jatinder S Gill
- Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Sato T, Masui K. Morphologic Differences in Intervertebral Foramina: A Radiographic Study of Cervical Spine Positions in Asymptomatic Men. J Manipulative Physiol Ther 2013; 36:327-32. [DOI: 10.1016/j.jmpt.2013.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 09/23/2012] [Accepted: 10/07/2012] [Indexed: 01/12/2023]
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