A meta-analysis of the role of diffusion tensor imaging in cervical spinal cord compression

Diffusion Imaging of the Spinal Cord: Clinical Applications

Spinal cord pathologic condition often presents as a neurologic emergency where timely and accurate diagnosis is critical to expedite appropriate treatment and minimize severe morbidity and even mortality. MR imaging is the gold standard imaging technique for diagnosing patients with suspected spinal cord pathologic condition. This review will focus on the basic principles of diffusion imaging and how spinal anatomy presents technical challenges to its application. Both the promises and shortcomings of spinal diffusion imaging will then be explored in the context of several clinical spinal cord pathologies for which diffusion has been evaluated.

Management of Cervical Spinal Cord Injury without Major Bone Injury in Adults

The incidence of cervical spinal cord injury (CSCI) without major bone injury is increasing, possibly because older people typically have pre-existing cervical spinal canal stenosis. The demographics, neurological injury, treatment, and prognosis of this type of CSCI differ from those of CSCI with bone or central cord injury. Spine surgeons worldwide are debating on the optimal management of CSCI without major bone injury. Therefore, this narrative review aimed to address unresolved clinical questions related to CSCI without major bone injury and discuss treatment strategies based on current findings. The greatest divide among spine surgeons worldwide hinges on whether surgery is necessary for patients with CSCI without major bone injury. Certain studies have recommended early surgery within 24 h after injury; however, evidence regarding its superiority over conservative treatment remains limited. Delayed MRI may be beneficial; nevertheless, reliable factors and imaging findings that predict functional prognosis during the acute phase and ascertain the necessity of surgery should be identified to determine whether surgery/early surgery is better than conservative therapy/delayed surgery. Quality-of-life assessments, including neuropathic pain, spasticity, manual dexterity, and motor function, should be performed to examine the superiority of surgery/early surgery to conservative therapy/delayed surgery.