Myelographic cervical nerve root deformities

Comparison of Myelography, CT Myelography and Magnetic Resonance Imaging in Cervical Spondylosis and Disk Herniation

Twenty-six patients with cervical radiculopathy and/or myelopathy caused by spondylosis or disk herniation were examined with myelography, CT myelography and MR. Fourteen of the patients were operated upon and 11 of them underwent postoperative MR and CT. The three radiologic methods provided comparable information about narrowing of the subarachnoid space and compression of the spinal cord. It was more difficult to distinguish bone from soft tissue with MR only, but the combination of MR and conventional radiography gave sufficient information for this differentiation. When radiologic nerve root sheath deformity was compared with clinical radiculopathy, myelography, CT myelography and MR had similar sensitivity and accuracy. Postoperative MR could reveal remaining indentation on the thecal sac and the cord but CT without contrast medium was useful as a complement to determine the aetiology of the indentation. Because MR has several practical advantages, it is well suited as the primary imaging modality, together with conventional radiography, for the preoperative radiologic evaluation of patients with cervical radiculopathy and/or myelopathy. Postoperative MR is useful in patients with persistent or new symptoms.

Simultaneous cervical and lumbar surgery for combined symptomatic cervical and lumbar spinal stenoses

Spinal stenosis may rarely involve both cervical and lumbar spines. An alternative surgical strategy used for the treatment of combined cervical and lumbar spinal stenosis is presented. Two cases with symptomatic combined stenosis of the cervical and lumbar spinal canal are described. Simultaneous surgery was performed in both cases. The combined stenosis of the cervical and lumbar spinal canal dictates careful neurologic and neuroradiologic examinations. Simultaneous surgery is an alternative approach for patients with symptomatic multilevel spinal stenoses, whose general conditions necessitate a one-session and short-lasting surgery.

Imaging of the cervical spine

The emergence of multiplanar spiral computed tomography and high-resolution magnetic resonance imaging has resulted in the ability to see cervical spine anatomy and pathologic conditions in detail. Appropriately chosen and performed, these imaging studies can provide an anatomic basis for a clinical diagnosis and a therapeutic plan. In the evaluation of cervical spondylosis, magnetic resonance imaging is more commonly performed than computed tomography because of its superior depiction of soft tissue anatomy, including intervertebral discs and spinal cord disease. However, computed tomography still has a role, particularly in the assessment of osseous neural foraminal stenosis. In cervical spine trauma, routine radiography remains the procedure of choice. Computed tomography is performed in patients who have abnormal plain radiographs or in patients in whom there is a strong clinical suspicion of fracture with inconclusive radiographs. In the neurologically compromised patient, magnetic resonance imaging is useful in the diagnosis of cord and nerve root injury. Magnetic resonance imaging is the most sensitive and specific imaging study in the assessment of spinal infection, including osteomyelitis, discitis, and epidural abscess. Magnetic resonance imaging has also supplanted all other imaging methods in the evaluation of primary and secondary tumors of the spinal cord and spinal column. Despite the precise depiction of cervical spine anatomy provided by these imaging methods, the role of the clinician in determining the true cause of a patient's symptoms is in no way diminished. The presence of an imaging study abnormality does not automatically imply causality.

Cervical and lumbar MRI in asymptomatic older male lifelong athletes: frequency of degenerative findings

OBJECTIVE

The athletic activity of the adult U.S. population has increased markedly in the last 20 years. To evaluate the possible long-term effects of such activity on the cervical and lumbar spine, we studied a group of asymptomatic currently very active lifelong male athletes over age 40 (41-69 years old, av. age 53).

MATERIALS AND METHODS

Nineteen active, lifelong male athletes were studied with MRI and the results compared with previous imaging studies of other populations. An athletic history and a spine history were also taken.

RESULTS

Evidence of asymptomatic degenerative spine disease was similar to that seen in published series of other populations. Degenerative changes including disk protrusion and herniation, spondylosis, and spinal stenosis were present and increased in incidence with increasing patient age. In this group, all MRI findings proved to be asymptomatic and did not limit athletic activity.

CONCLUSION

The incidence of lumbar degenerative changes in our study population of older male athletes was similar to those seen in other populations.

Cervical intervertebral foramen narrowing and myelographic nerve root sleeve deformities

Intervertebral foramen narrowing on plain radiographs of the cervical spine was graded from 0 (normal) to 3 according to its severity; myelographic nerve root sleeve deformity was graded from 1 to 3 in 99 consecutive patients with cervical radiculopathy. We thus examined 1118 foramina and root sleeves. Plain radiographs of 684 foramina were normal, changes of one grade were seen in 243, of two grades in 145 and of three grades in 46. Grading of myelographic root sleeves' was normal in 789, changes of one grade in 157, of two grades in 129, and of three grades in 43. The correlations between the foraminal and root sleeve changes were: full correlation in 63.9%, a difference of one grade in 27.4%, a difference of two grades in 7.4% and a difference of three grades in 1.3%. The positive predictive value of the plain radiographs for myelographic root sleeve deformities was 55.5% and the negative value 87.1%.

MRI in cervical disk herniation

Eleven operated herniated disks in 10 patients were evaluated preoperatively with plain films, myelography and magnetic resonance imaging. Plain X-ray was a valuable supplement to MRI for studying the bony changes. Myelography showed 7 of 11 herniated disks while MRI gave correct diagnosis in all. It is concluded that MRI can replace myelography and computerized tomography in the preoperative evaluation of cervical herniated disk. The other examinations may be supplementary in some cases.

The correlation of myelographic root sleeve deformity, uncovertebral spondylosis and radiculopathy

Myelographic root sleeve deformities, uncovertebral spondylosis and myelopathy were correlated in 56 patients. Good correlation between root sleeve deformities and uncovertebral spondylosis was found. However, in some cases with spinal canal stenosis root sleeve deformities were found without corresponding bone changes. The correlation of radiculopathy to root sleeve deformity and uncovertebral spondylosis was 61 and 67%, respectively. Radiologic changes at an adjacent root level were often seen in patients without clinically correlated radiculopathy. The myelographic changes were verified at operation in all the 46 patients operated upon.

Surgical treatment of 63 cases of conjoined nerve roots

The operative results of 63 cases of lumbar disc disease with surgically confirmed conjoined nerve roots are reviewed. The first 55 patients were treated by standard hemilaminectomy and discectomy, with only 30% reporting a good result. Of the last eight patients treated by hemilaminectomy, pediculectomy, and discectomy, seven patients returned to work. Te rationale for and the technique of pediculectomy are discussed in detail. Clinical, radiological, and surgical clues indicating the presence of the conjoined nerve root anomaly are reviewed.