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Shao H, Liu Q, Saeed A, Liu C, Liu WV, Zhang Q, Huang S, Zhang G, Li L, Zhang J, Zhu W, Tang X. Feasibility of diffusion tensor imaging in cervical spondylotic myelopathy using MUSE sequence. Spine J 2024; 24:1352-1360. [PMID: 38556218 DOI: 10.1016/j.spinee.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/03/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND CONTEXT The most frequent type of spinal cord injury is cervical spondylotic myelopathy (CSM). Conventional structural magnetic resonance imaging (MRI) is the gold diagnosis standard for CSM. Diffusion tensor imaging (DTI) could reflect microstructural changes in the spinal cord by tracing water molecular diffusion in early stages of CSM. However, due to the complex local anatomical structure and small field of view of the spinal cord, the imaging effect of traditional DTI imaging on the spinal cord is limited. MUSE (MUltiplexed Sensitivity-Encoding) -DTI is a novel diffusion-weighted imaging (DWI) sequence that achieves higher signal intensity through multiple excitation acquisition. MUSE sequence may improve the quality of spinal cord DTI imaging. STUDY DESIGN Prospective study. PURPOSE This study aimed to investigate the clinical diagnosis value of a novel protocol of MUSE-DTI in patients with cervical spondylotic myelopathy (CSM). PATIENT SAMPLE From August 2021 to March 2022, a total of 60 subjects (22-71 years) were enrolled, including 51 CSM patients (22 males, 29 females) and 9 healthy subjects (4 males and 5 females). Each subject underwent a MUSE-DTI examination and a clinical Japanese Orthopedic Association (JOA) scale. OUTCOME MEASURES We measured values of FA (Fractional Anisotropy), MD (Mean Diffusivity), AD (Axial Diffusivity), and RD (Radial Diffusivity), and collected the clinical JOA scores of each subject before the MR examination. METHODS A 3.0T MR scanner (Signa Architect, GE Healthcare) performed the MUSE-DTI sequence on each subject. The cervical canal stenosis of subjects was classified from grade 0 to grade Ⅲ according to the method of an MRI grading system. FA, MD, AD, and RD maps were generated by postprocessing MUSE-DTI data on the GE workstation. Regions of interest (ROIs) were manually drawn at the C2 vertebral body level and C2/3-C6/7 intervertebral disc levels by covering the whole spinal cord. The clinical severity of myelopathy of subjects was assessed by the clinical Japanese Orthopedic Association scale (JOA). RESULTS MUSE-DTI can acquire a high-resolution diffusion image compared to traditional DTI. The FAMCL values showed a decreasing trend from grade 0 to grade Ⅲ, while the MDMCL, ADMCL, and RDMCL values showed an overall increasing trend. Significant differences in MDMCL, ADMCL, and RDMCL values were found between adjacent groups among grades Ⅰ-Ⅲ (p<.05). The ADC2 values in CSM patients (grade I-Ⅲ) were significantly lower than in healthy individuals (grade 0) (p=.019). The clinical JOA score has a significant correlation with FAMCL (p=.035), MDMCL (p<.001), ADMCL (p<.001), and RDMCL (p<.001) values. CONCLUSIONS MUSE-DTI displayed a better image quality compared to traditional DTI. MUSE-DTI parameters displayed a grade-dependent trend. All the MUSE-DTI parameters at MCL were correlated with the clinical JOA scores. The ADC2 values can reflect the secondary damage of distal spinal cord. Therefore, MUSE-DTI could be a reliable biomarker for clinical auxiliary diagnosis of spinal cord injury severity in cervical spondylotic myelopathy.
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Affiliation(s)
- Haoyue Shao
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiufeng Liu
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Azzam Saeed
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chaoxu Liu
- Department of Orthopedics, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Qiya Zhang
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuting Huang
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guiling Zhang
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Li
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaxuan Zhang
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangyu Tang
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Jo J, Anesi TJ, Vance EH, Sills AK, Zuckerman SL, Bonfield CM. Retrospective Case Series of Spinal Cord Neurapraxia in Male Adolescent Athletes: Can These Athletes Return-to-Play? Neurosurgery 2024; 95:339-346. [PMID: 38358270 DOI: 10.1227/neu.0000000000002884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 01/02/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVES While spinal cord neurapraxia (SCN) is a documented pathology in athletes, guidance for neurosurgeons evaluating these patients is sparse. Therefore, in a cohort of adolescent athletes with SCN, we sought to (1) review their presentation and management and (2) describe outcomes and return-to-play (RTP). METHODS A single-center, retrospective case series was conducted to examine adolescent athletes diagnosed with SCN from 2017 to 2022. SCN was defined as an episode of bilateral upper and/or lower extremity weakness/numbness after an impact during sport. Collected variables included demographics, presentation, management, outcomes, and RTP. RESULTS Six patients were included (mean age = 14.5 ± 2.1 years, 100.0% male). Three American football players sustained tackle injuries, 1 ice hockey and 1 basketball player fell and landed on their head/neck, and 1 weight lifter sustained an axial load of weights to his neck. Motor symptoms ranged from quadriplegia to partial weakness. Full symptom resolution was seen in 6/6 patients: in <1 day for 3 patients, 2-3 days for 2 patients, and 1-2 months for 1 patient. All 6/6 patients received computed tomography of head/cervical spine and MRI of cervical spine, half of whom received computed tomography and MRI of thoracic/lumbar spine. No patient had congenital stenosis or abnormal T2 signal on MRI. Specific RTP recommendations varied. All 6 patients/parents were contacted at a mean of 16.6 ± 2.6 months from the injury. All patients returned to play at a mean of 5.7 ± 3.3 months. All 6 patients returned to their previous sports. Across all patients, no recurrence or neurological sequelae was endorsed in the follow-up period. CONCLUSION Six athletes with SCN with no imaging abnormalities and full symptom resolution were able to RTP to their previous sport without future consequence. Symptom duration may not be clinically useful in determining the feasibility of RTP. Follow-up studies are warranted in this patient cohort to standardize RTP recommendations.
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Affiliation(s)
- Jacob Jo
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville , Tennessee , USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
- Vanderbilt University School of Medicine, Nashville , Tennessee , USA
| | - Trevor J Anesi
- Vanderbilt University School of Medicine, Nashville , Tennessee , USA
| | - E Haley Vance
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville , Tennessee , USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | - Allen K Sills
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville , Tennessee , USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | - Scott L Zuckerman
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville , Tennessee , USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | - Christopher M Bonfield
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville , Tennessee , USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
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Tao Q, Wang K, Wen B, Kang Y, Dang J, Sun J, Niu X, Zhang M, Liu Z, Wang W, Zhang Y, Cheng J. Assessment of image quality and diagnostic accuracy for cervical spondylosis using T2w-STIR sequence with a deep learning-based reconstruction approach. 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 2024; 33:2982-2996. [PMID: 39007984 DOI: 10.1007/s00586-024-08409-0] [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: 10/20/2023] [Revised: 03/05/2024] [Accepted: 07/09/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVES To investigate potential of enhancing image quality, maintaining interobserver consensus, and elevating disease diagnostic efficacy through the implementation of deep learning-based reconstruction (DLR) processing in 3.0 T cervical spine fast magnetic resonance imaging (MRI) images, compared with conventional images. METHODS The 3.0 T cervical spine MRI images of 71 volunteers were categorized into two groups: sagittal T2-weighted short T1 inversion recovery without DLR (Sag T2w-STIR) and with DLR (Sag T2w-STIR-DLR). The assessment covered artifacts, perceptual signal-to-noise ratio, clearness of tissue interfaces, fat suppression, overall image quality, and the delineation of spinal cord, vertebrae, discs, dopamine, and joints. Spanning canal stenosis, neural foraminal stenosis, herniated discs, annular fissures, hypertrophy of the ligamentum flavum or vertebral facet joints, and intervertebral disc degeneration were evaluated by three impartial readers. RESULTS Sag T2w-STIR-DLR images exhibited markedly superior performance across quality indicators (median = 4 or 5) compared to Sag T2w-STIR sequences (median = 3 or 4) (p < 0.001). No statistically significant differences were observed between the two sequences in terms of diagnosis and grading (p > 0.05). The interobserver agreement for Sag T2w-STIR-DLR images (0.604-0.931) was higher than the other (0.545-0.853), Sag T2w-STIR-DLR (0.747-1.000) demonstrated increased concordance between reader 1 and reader 3 in comparison to Sag T2w-STIR (0.508-1.000). Acquisition time diminished from 364 to 197 s through the DLR scheme. CONCLUSIONS Our investigation establishes that 3.0 T fast MRI images subjected to DLR processing present heightened image quality, bolstered diagnostic performance, and reduced scanning durations for cervical spine MRI compared with conventional sequences.
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Affiliation(s)
- Qiuying Tao
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe Dong Road, ErQi District, Zhengzhou, Henan, China
| | - Kaiyu Wang
- MR Research China, GE Healthcare, Beijing, China
| | - Baohong Wen
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe Dong Road, ErQi District, Zhengzhou, Henan, China
| | - Yimeng Kang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe Dong Road, ErQi District, Zhengzhou, Henan, China
| | - Jinghan Dang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe Dong Road, ErQi District, Zhengzhou, Henan, China
| | - Jieping Sun
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe Dong Road, ErQi District, Zhengzhou, Henan, China
| | - Xiaoyu Niu
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe Dong Road, ErQi District, Zhengzhou, Henan, China
| | - Mengzhe Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe Dong Road, ErQi District, Zhengzhou, Henan, China
| | - Zijun Liu
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe Dong Road, ErQi District, Zhengzhou, Henan, China
| | - Weijian Wang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe Dong Road, ErQi District, Zhengzhou, Henan, China
| | - Yong Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe Dong Road, ErQi District, Zhengzhou, Henan, China.
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe Dong Road, ErQi District, Zhengzhou, Henan, China.
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Begrich D, Jäger M. [Cervical stenosis-Diagnostics and treatment of symptomatic spinal canal stenosis and neuroforaminal stenosis]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:617-628. [PMID: 38976023 DOI: 10.1007/s00132-024-04526-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 07/09/2024]
Abstract
Cervical stenosis is a clinical picture that is regularly encountered by both hospital physicians and orthopedic surgeons in the daily clinical practice. While advanced cervical spinal canal stenosis may lead to myelopathic symptoms in cases of sufficient manifestation and spinal cord injury, neuroforaminal stenosis leads to radicular symptoms due to compression of the nerve roots. The clinical examination can provide initial clues as to the suspected cause of the patient's symptoms; however, reliable diagnostics are based only on sectional imaging of the cervical spine. Depending on the extent of the symptoms, the treatment options vary between nonsurgical treatment for moderate symptoms without neurological deficits and surgical decompression of the spinal cord or nerve roots. The surgical treatment can be performed from anterior or posterior depending on the findings. Surgery can lead to an improvement of the neurological symptoms; however, the primary aim of surgical treatment is to avoid deterioration of the neurological deficits.
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Affiliation(s)
- Daniel Begrich
- Wirbelsäulenzentrum, St. Marien Hospital Mülheim a.d.R., Kaiserstr. 50, 45468, Mülheim, Deutschland.
| | - Marcus Jäger
- Lehrstuhl für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Deutschland
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, St. Marien Hospital Mülheim a.d.R., Kaiserstr. 50, 45468, Mülheim, Deutschland
- Klinik für Orthopädie, Unfall & Wiederherstellungschirurgie, Katholisches Klinikum Essen Philippusstift, Hülsmannstrasse 17, 45355, Essen, Deutschland
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Kitab SA, AbdulKareem SB, Wakefield AE, Benzel EC. Three-dimensional Spinal Canal Morphometric Analysis and Relevant Spinal Cord Occupational Ratios in Congenital Cervical Spinal Stenosis: A Classification Algorithm of the Stenosis Phenotypes and Data-driven Decompression Approach. World Neurosurg 2024; 187:e982-e996. [PMID: 38750891 DOI: 10.1016/j.wneu.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/21/2024] [Accepted: 05/06/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVES No standardized magnetic resonance imaging (MRI) parameters have defined the 3-dimensional morphoanatomy and relevant spinal cord occupation ratios (occupation of spinal cord dimensions/similar dimensions within the spinal canal) in congenital cervical stenosis (CCS). METHODS A retrospective, comparative analysis was conducted on 200 patients >18 years of age with myelopathy and CCS (mean age, 52.4 years) and 200 age-matched controls with no myelopathy or radiculopathy. The variables assessed from high resolution MRI included sagittal and axial spinal canal dimensions (MRI Torg-Pavlov ratios) from C3 to C7. Morphometric dimensions from the sagittal retrodiscal and retrovertebral regions as well as axial MRI dimensions were compared. Sagittal and axial spinal cord occupation ratios were defined and correlated with spinal canal dimensions. RESULTS Multivariate analyses indicated reduced sagittal and axial anteroposterior (AP) spinal canal dimensions and a large reduction in transverse spinal canal dimensions at all spinal levels. There was a small significant correlation between AP sagittal spinal canal dimensions and axial transverse spinal canal dimensions at C3-C5, but not at C5-C6. Small correlations were noted between AP sagittal spinal canal dimensions and AP axial spinal cord and axial cross-sectional area occupation ratios at C3-C6, but there was no correlation with axial mediolateral spinal cord occupation ratios. CONCLUSIONS The stenosis effect can involve any dimension, including the transverse spinal canal dimension, independent of other dimensions. Owing to the varied observed morphoanatomies, a classification algorithm that defines CCS specific phenotypes was formulated. Objectivizing the stenosis morphoanatomy may allow for data-driven patient-focused decompression approaches in the future.
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Affiliation(s)
- Sameer A Kitab
- Department of Spine Fellowship, University of Al-Qadisiyah, Baghdad, Iraq.
| | - Salam B AbdulKareem
- Department of Spine Fellowship, Scientific Council of Orthopedics, Baghdad, Iraq
| | - Andrew E Wakefield
- Department of Neurosurgery, Hartford Hospital, Hartford, Connecticut, USA; Department of Surgery, Connecticut University School of Medicine, Farmington, Connecticut, USA
| | - Edward C Benzel
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA
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Hohenhaus M, Klingler JH, Scholz C, Watzlawick R, Hubbe U, Beck J, Reisert M, Würtemberger U, Kremers N, Wolf K. Quantification of cervical spinal stenosis by automated 3D MRI segmentation of spinal cord and cerebrospinal fluid space. Spinal Cord 2024; 62:371-377. [PMID: 38627568 PMCID: PMC11230899 DOI: 10.1038/s41393-024-00993-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 07/10/2024]
Abstract
DESIGN Prospective diagnostic study. OBJECTIVES Anatomical evaluation and graduation of the severity of spinal stenosis is essential in degenerative cervical spine disease. In clinical practice, this is subjectively categorized on cervical MRI lacking an objective and reliable classification. We implemented a fully-automated quantification of spinal canal compromise through 3D T2-weighted MRI segmentation. SETTING Medical Center - University of Freiburg, Germany. METHODS Evaluation of 202 participants receiving 3D T2-weighted MRI of the cervical spine. Segments C2/3 to C6/7 were analyzed for spinal cord and cerebrospinal fluid space volume through a fully-automated segmentation based on a trained deep convolutional neural network. Spinal canal narrowing was characterized by relative values, across sever segments as adapted Maximal Canal Compromise (aMCC), and within the index segment as adapted Spinal Cord Occupation Ratio (aSCOR). Additionally, all segments were subjectively categorized by three observers as "no", "relative" or "absolute" stenosis. Computed scores were applied on the subjective categorization. RESULTS 798 (79.0%) segments were subjectively categorized as "no" stenosis, 85 (8.4%) as "relative" stenosis, and 127 (12.6%) as "absolute" stenosis. The calculated scores revealed significant differences between each category (p ≤ 0.001). Youden's Index analysis of ROC curves revealed optimal cut-offs to distinguish between "no" and "relative" stenosis for aMCC = 1.18 and aSCOR = 36.9%, and between "relative" and "absolute" stenosis for aMCC = 1.54 and aSCOR = 49.3%. CONCLUSION The presented fully-automated segmentation algorithm provides high diagnostic accuracy and objective classification of cervical spinal stenosis. The calculated cut-offs can be used for convenient radiological quantification of the severity of spinal canal compromise in clinical routine.
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Affiliation(s)
- Marc Hohenhaus
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany.
| | - Jan-Helge Klingler
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - Christoph Scholz
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - Ralf Watzlawick
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - Ulrich Hubbe
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - Marco Reisert
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstraße 5a, 79106, Freiburg, Germany
| | - Urs Würtemberger
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - Nico Kremers
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - Katharina Wolf
- Department of Neurology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
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Zhang JK, Javeed S, Greenberg JK, Yakdan S, Kaleem MI, Botterbush KS, Benedict B, Dibble CF, Sun P, Sherrod B, Dailey AT, Bisson EF, Mahan M, Mazur M, Song SK, Ray WZ. Diffusion MRI Metrics Characterize Postoperative Clinical Outcomes After Surgery for Cervical Spondylotic Myelopathy. Neurosurgery 2024:00006123-990000000-01226. [PMID: 38904404 DOI: 10.1227/neu.0000000000003037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 04/16/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Advanced diffusion-weighted MRI (DWI) modeling, such as diffusion tensor imaging (DTI) and diffusion basis spectrum imaging (DBSI), may help guide rehabilitation strategies after surgical decompression for cervical spondylotic myelopathy (CSM). Currently, however, postoperative DWI is difficult to interpret, owing to signal distortions from spinal instrumentation. Therefore, we examined the relationship between postoperative DTI/DBSI-extracted from the rostral C3 spinal level-and clinical outcome measures at 2-year follow-up after decompressive surgery for CSM. METHODS Fifty patients with CSM underwent complete clinical and DWI evaluation-followed by DTI/DBSI analysis-at baseline and 2-year follow-up. Clinical outcomes included the modified Japanese Orthopedic Association score and comprehensive patient-reported outcomes. DTI metrics included apparent diffusion coefficient, fractional anisotropy, axial diffusivity, and radial diffusivity. DBSI metrics evaluated white matter tracts through fractional anisotropy, fiber fraction, axial diffusivity, and radial diffusivity as well as extra-axonal pathology through restricted and nonrestricted fraction. Cross-sectional Spearman's correlations were used to compare postoperative DTI/DBSI metrics with clinical outcomes. RESULTS Twenty-seven patients with CSM, including 15, 7, and 5 with mild, moderate, and severe disease, respectively, possessed complete baseline and postoperative DWI scans. At 2-year follow-up, there were 10 significant correlations among postoperative DBSI metrics and postoperative clinical outcomes compared with 3 among postoperative DTI metrics. Of the 13 significant correlations, 7 involved the neck disability index (NDI). The strongest relationships were between DBSI axial diffusivity and NDI (r = 0.60, P < .001), DBSI fiber fraction and NDI (rs = -0.58, P < .001), and DBSI restricted fraction and NDI (rs = 0.56, P < .001). The weakest correlation was between DTI apparent diffusion coefficient and NDI (r = 0.35, P = .02). CONCLUSION Quantitative measures of spinal cord microstructure after surgery correlate with postoperative neurofunctional status, quality of life, and pain/disability at 2 years after decompressive surgery for CSM. In particular, DBSI metrics may serve as meaningful biomarkers for postoperative disease severity for patients with CSM.
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Affiliation(s)
- Justin K Zhang
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
- Department of Neurological Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Saad Javeed
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Jacob K Greenberg
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Salim Yakdan
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Muhammad I Kaleem
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Kathleen S Botterbush
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Braeden Benedict
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Christopher F Dibble
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Peng Sun
- Department of Imaging Physics, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Brandon Sherrod
- Department of Neurological Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Andrew T Dailey
- Department of Neurological Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Erica F Bisson
- Department of Neurological Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Mark Mahan
- Department of Neurological Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Marcus Mazur
- Department of Neurological Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Sheng-Kwei Song
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Wilson Z Ray
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
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Al-Shawwa A, Craig M, Ost K, Anderson D, Jacobs WB, Evaniew N, Tripathy S, Bouchard J, Casha S, Cho R, du Plessis S, Lewkonia P, Nicholls F, Salo PT, Soroceanu A, Swamy G, Thomas KC, Yang MMH, Cadotte DW. Focal compression of the cervical spinal cord alone does not indicate high risk of neurological deterioration in patients with a diagnosis of mild degenerative cervical myelopathy. J Neurol Sci 2024; 461:123042. [PMID: 38788286 DOI: 10.1016/j.jns.2024.123042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024]
Abstract
Degenerative Cervical Myelopathy (DCM) is the functional derangement of the spinal cord resulting from vertebral column spondylotic degeneration. Typical neurological symptoms of DCM include gait imbalance, hand/arm numbness, and upper extremity dexterity loss. Greater spinal cord compression is believed to lead to a higher rate of neurological deterioration, although clinical experience suggests a more complex mechanism involving spinal canal diameter (SCD). In this study, we utilized machine learning clustering to understand the relationship between SCD and different patterns of cord compression (i.e. compression at one disc level, two disc levels, etc.) to identify patient groups at risk of neurological deterioration. 124 MRI scans from 51 non-operative DCM patients were assessed through manual scoring of cord compression and SCD measurements. Dimensionality reduction techniques and k-means clustering established patient groups that were then defined with their unique risk criteria. We found that the compression pattern is unimportant at SCD extremes (≤14.5 mm or > 15.75 mm). Otherwise, severe spinal cord compression at two disc levels increases deterioration likelihood. Notably, if SCD is normal and cord compression is not severe at multiple levels, deterioration likelihood is relatively reduced, even if the spinal cord is experiencing compression. We elucidated five patient groups with their associated risks of deterioration, according to both SCD range and cord compression pattern. Overall, SCD and focal cord compression alone do not reliably predict an increased risk of neurological deterioration. Instead, the specific combination of narrow SCD with multi-level focal cord compression increases the likelihood of neurological deterioration in mild DCM patients.
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Affiliation(s)
- Abdul Al-Shawwa
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Mike Craig
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Kalum Ost
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - David Anderson
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - W Bradley Jacobs
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, Calgary, AB T2N 2T9, Canada; Department of Clinical Neurosciences, Section of Neurosurgery, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Nathan Evaniew
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, Calgary, AB T2N 2T9, Canada; Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Saswati Tripathy
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Jacques Bouchard
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, Calgary, AB T2N 2T9, Canada; Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Steve Casha
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, Calgary, AB T2N 2T9, Canada; Department of Clinical Neurosciences, Section of Neurosurgery, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Roger Cho
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, Calgary, AB T2N 2T9, Canada; Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Stephen du Plessis
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, Calgary, AB T2N 2T9, Canada; Department of Clinical Neurosciences, Section of Neurosurgery, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Peter Lewkonia
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, Calgary, AB T2N 2T9, Canada; Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Fred Nicholls
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, Calgary, AB T2N 2T9, Canada; Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Paul T Salo
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, Calgary, AB T2N 2T9, Canada; Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Alex Soroceanu
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, Calgary, AB T2N 2T9, Canada; Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Ganesh Swamy
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, Calgary, AB T2N 2T9, Canada; Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Kenneth C Thomas
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, Calgary, AB T2N 2T9, Canada; Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Michael M H Yang
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, Calgary, AB T2N 2T9, Canada; Department of Clinical Neurosciences, Section of Neurosurgery, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - David W Cadotte
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada; Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, Calgary, AB T2N 2T9, Canada; Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada; Department of Clinical Neurosciences, Section of Neurosurgery, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2T9, Canada.
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9
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Lee S, Jung JY, Chung H, Lee HS, Nickel D, Lee J, Lee SY. Comparative analysis of image quality and interchangeability between standard and deep learning-reconstructed T2-weighted spine MRI. Magn Reson Imaging 2024; 109:211-220. [PMID: 38513791 DOI: 10.1016/j.mri.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/28/2024] [Accepted: 03/16/2024] [Indexed: 03/23/2024]
Abstract
RATIONALE AND OBJECTIVES MRI reconstruction of undersampled data using a deep learning (DL) network has been recently performed as part of accelerated imaging. Herein, we compared DL-reconstructed T2-weighted image (T2-WI) to conventional T2-WI regarding image quality and degenerative lesion detection. MATERIALS AND METHODS Sixty-two patients underwent C-spine (n = 27) or L-spine (n = 35) MRIs, including conventional and DL-reconstructed T2-WI. Image quality was assessed with non-uniformity measurement and 4-scale grading of structural visibility. Three readers (R1, R2, R3) independently assessed the presence and types of degenerative lesions. Student t-test was used to compare non-uniformity measurements. Interprotocol and interobserver agreement of structural visibility was analyzed with Wilcoxon signed-rank test and weighted-κ values, respectively. The diagnostic equivalence of degenerative lesion detection between two protocols was assessed with interchangeability test. RESULTS The acquisition time of DL-reconstructed images was reduced to about 21-58% compared to conventional images. Non-uniformity measurement was insignificantly different between the two images (p-value = 0.17). All readers rated DL-reconstructed images as showing the same or superior structural visibility compared to conventional images. Significantly improved visibility was observed at disk margin of C-spine (R1, p < 0.001; R2, p = 0.04) and dorsal root ganglia (R1, p = 0.03; R3, p = 0.02) and facet joint (R1, p = 0.04; R2, p < 0.001; R3, p = 0.03) of L-spine. Interobserver agreements of image quality were variable in each structure. Clinical interchangeability between two protocols for degenerative lesion detection was verified showing <5% in the upper bounds of 95% confidence intervals of agreement rate differences. CONCLUSIONS DL-reconstructed T2-WI demonstrates comparable image quality and diagnostic performance with conventional T2-WI in spine imaging, with reduced acquisition time.
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Affiliation(s)
- Seungeun Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Joon-Yong Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
| | - Heeyoung Chung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hyun-Soo Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; Siemens Healthineers, Seoul 06620, Republic of Korea.
| | - Dominik Nickel
- Siemens Healthcare GmbH, Allee am Roethelheimpark, Erlangen 91052, Germany.
| | - Jooyeon Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX 77030, USA.
| | - So-Yeon Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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10
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Rahyussalim AJ, Putra MNS, Nasser MK, Kusuma BW, Kurniawati T, Canintika AF. Cervical tuberculosis treated with closed system abscess evacuation, and percutaneous laser disc decompression combined with secretome derived from umbilical cord mesenchymal stem cells: A case report. Int J Surg Case Rep 2024; 119:109764. [PMID: 38776822 PMCID: PMC11141440 DOI: 10.1016/j.ijscr.2024.109764] [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: 02/18/2024] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Minimal invasive surgery is preferred as it offers the same benefit with less tissue damage, especially in the cervical area where a lot of critical structure resides. Mesenchymal stem cells (MSCs) and its secretome provide a promising regenerative intervention to damaged tissue. We report a cervical spinal tuberculosis case with hemiparesis treated with minimally invasive surgery combined with a regenerative approach. CASE PRESENTATION A 13-year-old boy presented with weakness in his left arm and left leg, accompanied by hemiparesthesia. The patient was unable to get up from bed, run, and jumpRadiology examination showed compression fracture, intervertebral disc retropulsion, spinal cord compression, and paravertebral cold abscess. The patient was treated with a single minimal invasive surgery consisting of closed system abscess evacuation, and percutaneous laser disc decompression combined with umbilical cord-derived mesenchymal stem cells. CLINICAL DISCUSSION The pain, weakness, and numbness were gone two days after surgery. The patient could carry out normal activities, even doing sports such as mini soccer and badminton. This clinical improvement was obtained as he carried out some procedures. The cold abscess aspiration removed infection focus which prevents further vertebra destruction, PLDD which decompresses the retropulsed discs, and implantation of MSCs and secretomes which regenerate and strengthen the destructed bone and surrounding tissue. CONCLUSION Closed system abscess evacuation, and percutaneous laser disc degeneration combined with secretome derived from UC-MSC are minimally-invasive strategies with promising results. Further studies are required to investigate its efficacy.
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Affiliation(s)
- Ahmad Jabir Rahyussalim
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo National General Hospital and Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia; Stem Cells and Tissue Engineering Research Cluster, Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Muhammad Nadhil Sunaryo Putra
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo National General Hospital and Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Mochammad Kamal Nasser
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo National General Hospital and Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Bagus Wijaya Kusuma
- Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Tri Kurniawati
- Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia; Stem Cells and Tissue Engineering Research Cluster, Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Anissa Feby Canintika
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo National General Hospital and Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
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11
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Guntin J, Regalado L, Serhal A, Omar IM, Hsu WK, Garg A. Safety outcomes and improvement in pain scores after radiologist-performed fluoroscopy-guided interlaminar cervical epidural steroid injection. Skeletal Radiol 2024; 53:1145-1152. [PMID: 38110779 DOI: 10.1007/s00256-023-04548-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Image-guided spine injections are an important tool in the management of patients with a variety of spinal pathologies. Our practice offers radiologist-performed fluoroscopy-guided interlaminar cervical epidural steroid injection (ESI) routinely performed in the outpatient setting. The purpose of this study was to evaluate clinical outcomes and improvement in pain scores after radiologist-performed cervical ESI. METHODS An institutional database was used to retrospectively identify cervical injections performed between October 2016 and October 2022. All injections were performed at the C7-T1 level utilizing 1.0 mL of 10 mg/mL dexamethasone without epidural anesthetic. The Numerical Rating Scale (NRS) was used to assess pain improvement. Cervical MRI was reviewed to assess pre-injection cervical disease severity. Patient charts were reviewed for any post-injection complications. RESULTS A total of 251 cervical injections in 186 patients met our inclusion criteria with mean clinical follow up of 28.5 months (range 0.2 - 73.0 months). No patients experienced any major complications after injection. Post-injection pain scores were available for 218 of 251 injections (86.9%) with mean follow-up of 11.8 days (range 6 - 57 days). There was a significant improvement in pain scores from a mean pre-injection NRS score of 5.2/10 to 3.0/10 (p < .0001). 117 patients (53.7%) reported ≥ 50% improvement after injection. Patients who had prior injection were more likely to report ≥ 50% pain improvement after subsequent injection (p = .012). CONCLUSION Radiologist-performed fluoroscopy-guided interlaminar cervical ESI at the C7-T1 level is a safe and effective tool in the management of patients with cervical pathology.
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Affiliation(s)
- Jonathan Guntin
- Northwestern Memorial Hospital, Northwestern University, 676 N St Clair St, Suite 800, Chicago, IL, 60611, USA.
| | - Luis Regalado
- Northwestern Memorial Hospital, Northwestern University, 676 N St Clair St, Suite 800, Chicago, IL, 60611, USA
| | - Ali Serhal
- Northwestern Memorial Hospital, Northwestern University, 676 N St Clair St, Suite 800, Chicago, IL, 60611, USA
| | - Imran M Omar
- Northwestern Memorial Hospital, Northwestern University, 676 N St Clair St, Suite 800, Chicago, IL, 60611, USA
| | - Wellington K Hsu
- Northwestern Memorial Hospital, Northwestern University, 676 N St Clair St, Suite 800, Chicago, IL, 60611, USA
| | - Ankur Garg
- Northwestern Memorial Hospital, Northwestern University, 676 N St Clair St, Suite 800, Chicago, IL, 60611, USA
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12
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Yao H, Jia B, Pan X, Sun J. Validation and Feasibility of Ultrafast Cervical Spine MRI Using a Deep Learning-Assisted 3D Iterative Image Enhancement System. J Multidiscip Healthc 2024; 17:2499-2509. [PMID: 38799011 PMCID: PMC11128255 DOI: 10.2147/jmdh.s465002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024] Open
Abstract
Purpose This study aimed to evaluate the feasibility of ultrafast (2 min) cervical spine MRI protocol using a deep learning-assisted 3D iterative image enhancement (DL-3DIIE) system, compared to a conventional MRI protocol (6 min 14s). Patients and Methods Fifty-one patients were recruited and underwent cervical spine MRI using conventional and ultrafast protocols. A DL-3DIIE system was applied to the ultrafast protocol to compensate for the spatial resolution and signal-to-noise ratio (SNR) of images. Two radiologists independently assessed and graded the quality of images from the dimensions of artifacts, boundary sharpness, visibility of lesions and overall image quality. We recorded the presence or absence of different pathologies. Moreover, we examined the interchangeability of the two protocols by computing the 95% confidence interval of the individual equivalence index, and also evaluated the inter-protocol intra-observer agreement using Cohen's weighted kappa. Results Ultrafast-DL-3DIIE images were significantly better than conventional ones for artifacts and equivalent for other qualitative features. The number of cases with different kinds of pathologies was indistinguishable based on the MR images from ultrafast-DL-3DIIE and conventional protocols. With the exception of disc degeneration, the 95% confidence interval for the individual equivalence index across all variables did not surpass 5%, suggesting that the two protocols are interchangeable. The kappa values of these evaluations by the two radiologists ranged from 0.65 to 0.88, indicating good-to-excellent agreement. Conclusion The DL-3DIIE system enables 67% spine MRI scan time reduction while obtaining at least equivalent image quality and diagnostic results compared to the conventional protocol, suggesting its potential for clinical utility.
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Affiliation(s)
- Hui Yao
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Bangsheng Jia
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Xuelin Pan
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Jiayu Sun
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, People’s Republic of China
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13
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Tran CV, Yang HR, Ahmad ZY, Utukuri PS, Quarterman P, Fung M, Lignelli A, Wong TT. Utility of Zero-Echo time sequence as an adjunct for MR evaluation of degenerative disease in the cervical spine. Skeletal Radiol 2024; 53:899-908. [PMID: 37945769 DOI: 10.1007/s00256-023-04507-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Determine the utility of ZTE as an adjunct to routine MR for assessing degenerative disease in the cervical spine. METHODS Retrospective study on 42 patients with cervical MR performed with ZTE from 1/1/2022 to 4/30/22. Fellowship trained radiologists evaluated each cervical disc level for neural foraminal (NF) narrowing, canal stenosis (CS), facet arthritis (FA), and presence of ossification of the posterior longitudinal ligament (OPLL). When NF narrowing and CS were present, the relative contributions of bone and soft disc were determined and a confidence level for doing so was assigned. Comparisons were made between assessments on routine MR without and with ZTE. RESULTS With ZTE added, bone contribution as a cause of NF narrowing increased in 47% (n = 110) of neural foramina and decreased in 12% (n = 29) (p = < 0.001). Bone contribution as a cause of CS increased in 25% (n = 33) of disc levels and decreased in 10% (n = 13) (p = 0.013). Confidence increased in identifying the cause of NF narrowing (p = < 0.001)) and CS (p = 0.009) with ZTE. The cause of NF narrowing (p = 0.007) and CS (p = 0.041) changed more frequently after ZTE was added when initial confidence in making the determination was low. There was no change in detection of FA or presence of OPLL with ZTE. CONCLUSION Addition of ZTE to a routine cervical spine MR changes the assessment of the degree of bone involvement in degenerative cervical spine pathology.
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Affiliation(s)
- Clement Vinh Tran
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
| | - Hye Ryung Yang
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
| | - Zohaib Y Ahmad
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
| | - Pallavi S Utukuri
- Department of Radiology, Division of Neuroradiology, NewYork-Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
| | | | - Maggie Fung
- New York, NY General Electric (GE) Healthcare, New York, NY, USA
| | - Angela Lignelli
- Department of Radiology, Division of Neuroradiology, NewYork-Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
| | - Tony T Wong
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA.
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14
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Kuang C, Zha Y. Neurodegeneration within the rostral spinal cord is associated with brain gray matter volume atrophy in the early stage of cervical spondylotic myelopathy. Spinal Cord 2024; 62:214-220. [PMID: 38454066 DOI: 10.1038/s41393-024-00971-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
STUDY DESIGN Case-control study. OBJECTIVES Investigating the association between neurodegeneration within rostral spinal cord and brain gray matter volume (GMV) and assessing the relationship between remote neurodegenerative changes and clinical outcomes at the early phase of Cervical Spondylotic Myelopathy (CSM). SETTING University/hospital. METHODS Using Spinal Cord Toolbox, spinal cord morphometrics (cross-sectional area [CSA], gray matter area [GMA], white matter area [WMA]) of 40 patients with CSM and 28 healthy controls (HCs) were computed and compared using two-sample t test. Brain GMV of the two groups was analyzed using voxel-based morphometry approach. Pearson's correlation between spinal cord morphometrics and altered brain GMV and Spearman's relationship between remote neurodegenerations and clinical outcomes were conducted in CSM group. RESULTS Compared to HCs, CSA and WMA at C2/3 and GMV in right postcentral gyrus (PoCG.R) and left supplementary motor area (SMA.L) were significantly decreased in patients with CSM. CSA and WMA at C2/3 were associated with GMV in SMA.L and MCG.R in patients with CSM. CSA at C2/3 and GMV in PoCG.R were related to modified Japanese Orthopedic Association score in patients with CSM. CONCLUSIONS The associations between CSA and WMA at C2/3 and GMV in SMA.L and MCG.R suggest a concordant change pattern and adaptive mechanisms for neuronal plasticity underlying remote neurodegeneration in early CSM. The atrophy of CSA at C2/3 and GMV loss in PoCG.R can serve as potential neuroimaging biomarkers of early structural changes within spinal cord and brain preceding marked clinical disabilities in patients with CSM.
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Affiliation(s)
- Cuili Kuang
- Department of Radiological, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yunfei Zha
- Department of Radiological, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
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15
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Kang KC, Lee JH, Lee KY, Jang TS. Surgical Outcomes of Extensive Dome-Like Laminoplasty Using En Bloc Resection of C2 Inner Lamina for Patients With Severe Cord Compression Behind C2 Body. Clin Spine Surg 2024; 37:115-123. [PMID: 38637931 DOI: 10.1097/bsd.0000000000001610] [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: 01/19/2024] [Accepted: 02/28/2024] [Indexed: 04/20/2024]
Abstract
STUDY DESIGN A retrospective, single-center study. OBJECTIVE The aim of this study is to evaluate the efficacy and safety of a newly developed extensive dome-like laminoplasty using en bloc resection of the C2 inner lamina in patients with severe cord compression behind the C2 body. SUMMARY OF BACKGROUND DATA A surgery for severe cord compression behind C2 body is challenging for spinal surgeons. To date, there has been no established solution for severe cord compression behind the C2 body. MATERIALS AND METHODS Patients with severe cord compression behind the C2 body who underwent posterior surgery consecutively were enrolled. Extensive dome-like laminoplasty that was newly developed was performed to remove en bloc removal of the C2 inner lamina were performed. Preoperative and postoperative canal diameters behind the C2 and mean removed area of the C2 inner lamina were measured using MRI and CT scan. Clinical and radiographic parameters were assessed preoperative and postoperative periods. In addition, perioperative complications were analyzed. RESULTS A total of 36 patients underwent extensive dome-like laminoplasty and their diagnoses were ossification of the posterior longitudinal ligament (OPLL, 66.7%) and congenital stenosis with spondylosis (33.3%). The mean canal diameter behind the C2 increased from 9.85 (2.28) mm preoperatively to 19.91 (3.93) mm at the last follow-up ( P <0.001). Clinically, neck and arm visual analog scale, Japanese Orthopaedic Association score, and neck disability index significantly improved at postoperative 1 month ( P <0.05), and the scores were maintained until the last follow-up. No meaningful radiographic changes occurred after the surgeries. During the procedures, there were no particular complications, but one patient showed deteriorated myelopathic symptoms and underwent additional C1-C2 decompressive surgery. CONCLUSIONS After extensive dome-like laminoplasty, surgical outcomes are satisfactory, and complications are rare. This technique may be a viable option for patients with severe cord compression behind the C2 body. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Kyung-Chung Kang
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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16
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Stefanie M, Antonia G, Leah Shyela V, Sabine H, Peter D, Jens F, Daniel B, Christian B, Veit R, Mathias B, Jan L, Ilko L M. T1 mapping in patients with cervical spinal canal stenosis with and without decompressive surgery: A longitudinal study. J Neuroimaging 2024; 34:329-338. [PMID: 38403747 DOI: 10.1111/jon.13195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND AND PURPOSE Cervical spinal canal stenosis (cSCS) is a common cause of spinal impairment in the elderly. With conventional magnetic resonance imaging (MRI) suffering from various limitations, high-resolution single-shot T1 mapping has been proposed as a novel MRI technique in cSCS diagnosis. In this study, we investigated the effect of conservative and surgical treatment on spinal cord T1 relaxation times in cSCS. METHODS T1-mapping was performed in 54 patients with cSCS at 3 Tesla MRI at the maximum-, above and below the stenosis. Subsequently, intraindividual T1-differences (ΔT1) intrastenosis were calculated. Twenty-four patients received follow-up scans after 6 months. RESULTS Surgically treated patients showed higher ΔT1 at baseline (154.9 ± 81.6 vs. 95.3 ± 60.7), while absolute T1-values within the stenosis were comparable between groups (863.7 ± 89.3 milliseconds vs. 855.1 ± 62.2 milliseconds). In surgically treated patients, ΔT1 decreased inverse to stenosis severity. After 6 months, ΔT1 significantly decreased in the surgical group (154.9 ± 81.6 milliseconds to 85.7 ± 108.9 milliseconds, p = .021) and remained unchanged in conservatively treated patients. Both groups showed clinical improvement at the 6-month follow-up. CONCLUSIONS Baseline difference of T1 relaxation time (ΔT1) might serve as a supporting marker for treatment decision and change of T1 relaxation time might reflect relief of spinal cord narrowing indicating regenerative processes. Quantitative T1-mapping represents a promising additional imaging method to indicate a surgical treatment plan and to validate treatment success.
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Affiliation(s)
- Meyer Stefanie
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Geiger Antonia
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Volnhals Leah Shyela
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Hofer Sabine
- Biomedical NMR, Max-Planck-Institute for Multidisciplinary Sciences, Göttingen, Germany
| | - Dechent Peter
- Department of Cognitive Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Frahm Jens
- Biomedical NMR, Max-Planck-Institute for Multidisciplinary Sciences, Göttingen, Germany
| | - Behme Daniel
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
- Department of Neuroradiology, University Medical Center Magdeburg, Göttingen, Germany
| | - Brelie Christian
- Department of Neurosurgery, Johanniter-Clinics Bonn, Göttingen, Germany
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Rohde Veit
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Bähr Mathias
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Liman Jan
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- Department of Neurology, Paracelsus Medical School, Nürnberg, Germany
| | - Maier Ilko L
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
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Yoganandan N, Harinathan B, Vedantam A. Cervical Column and Cord and Column Responses in Whiplash With Stenosis: A Finite Element Modeling Study. JOURNAL OF ENGINEERING AND SCIENCE IN MEDICAL DIAGNOSTICS AND THERAPY 2024; 7:021003. [PMID: 37860790 PMCID: PMC10583276 DOI: 10.1115/1.4063250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/18/2023] [Indexed: 10/21/2023]
Abstract
Spine degeneration is a normal aging process. It may lead to stenotic spines that may have implications for pain and quality of life. The diagnosis is based on clinical symptomatology and imaging. Magnetic resonance images often reveal the nature and degree of stenosis of the spine. Stenosis is concerning to clinicians and patients because of the decreased space in the spinal canal and potential for elevated risk of cord and/or osteoligamentous spinal column injuries. Numerous finite element models of the cervical spine have been developed to study the biomechanics of the osteoligamentous column such as range of motion and vertebral stress; however, spinal cord modeling is often ignored. The objective of this study was to determine the external column and internal cord and disc responses of stenotic spines using finite element modeling. A validated model of the subaxial spinal column was used. The osteoligamentous column was modified to include the spinal cord. Mild, moderate, and severe degrees of stenosis commonly identified in civilian populations were simulated at C5-C6. The column-cord model was subjected to postero-anterior acceleration at T1. The range of motion, disc pressure, and cord stress-strain were obtained at the index and superior and inferior adjacent levels of the stenosis. The external metric representing the segmental motion was insensitive while the intrinsic disc and cord variables were more sensitive, and the index level was more affected by stenosis. These findings may influence surgical planning and patient education in personalized medicine.
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Affiliation(s)
- Narayan Yoganandan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226; Department of Veterans Affairs Medical Center, Milwaukee, WI 53295
| | - Balaji Harinathan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226; School of Mechanical Engineering, Vellore Institute of Technology, Chennai, Tamilnadu 632014, India
| | - Aditya Vedantam
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226; Department of Veterans Affairs Medical Center, Milwaukee, WI 53295
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Kim UH, Kim HJ, Seo J, Chai JW, Oh J, Choi YH, Kim DH. Cerebrospinal fluid flow artifact reduction with deep learning to optimize the evaluation of spinal canal stenosis on spine MRI. Skeletal Radiol 2024; 53:957-965. [PMID: 37996559 DOI: 10.1007/s00256-023-04501-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/18/2023] [Accepted: 10/28/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE The aim of study was to employ the Cycle Generative Adversarial Network (CycleGAN) deep learning model to diminish the cerebrospinal fluid (CSF) flow artifacts in cervical spine MRI. We also evaluate the agreement in quantifying spinal canal stenosis. METHODS For training model, we collected 9633 axial MR image pairs from 399 subjects. Then, additional 104 image pairs from 19 subjects were gathered for the test set. The deep learning model was developed using CycleGAN to reduce CSF flow artifacts, where T2 TSE images served as input, and T2 FFE images, known for fewer CSF flow artifacts. Post training, CycleGAN-generated images were subjected to both quantitative and qualitative evaluations for CSF artifacts. For assessing the agreement of spinal canal stenosis, four raters utilized an additional 104 pairs of original and CycleGAN-generated images, with inter-rater agreement evaluated using a weighted kappa value. RESULTS CSF flow artifacts were reduced in the CycleGAN-generated images compared to the T2 TSE and FFE images in both quantitative and qualitative analysis. All raters concordantly displayed satisfactory estimation results when assessing spinal canal stenosis using the CycleGAN-generated images with T2 TSE images (kappa = 0.61-0.75) compared to the original FFE with T2 TSE images (kappa = 0.48-0.71). CONCLUSIONS CycleGAN demonstrated the capability to produce images with diminished CSF flow artifacts. When paired with T2 TSE images, the CycleGAN-generated images allowed for more consistent assessment of spinal canal stenosis and exhibited agreement levels that were comparable to the combination of T2 TSE and FFE images.
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Affiliation(s)
- Ue-Hwan Kim
- AI Graduate School, Gwangju Institute of Science and Technology (GIST), Gwangju, Republic of Korea
| | - Hyo Jin Kim
- Department of Radiology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Jiwoon Seo
- Department of Radiology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Jee Won Chai
- Department of Radiology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Jiseon Oh
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoon-Hee Choi
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
| | - Dong Hyun Kim
- Department of Radiology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea.
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Xu ML, Yang YT, Zeng HZ, Cao YT, Zheng LD, Jin C, Zhu SJ, Zhu R. Finite element modeling and analysis of effect of preexisting cervical degenerative disease on the spinal cord during flexion and extension. Med Biol Eng Comput 2024; 62:1089-1104. [PMID: 38148413 DOI: 10.1007/s11517-023-02993-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 12/07/2023] [Indexed: 12/28/2023]
Abstract
Recent studies have emphasized the importance of dynamic activity in the development of myelopathy. However, current knowledge of how degenerative factors affect the spinal cord during motion is still limited. This study aimed to investigate the effect of various types of preexisting herniated cervical disc and the ligamentum flavum ossification on the spinal cord during cervical flexion and extension. A detailed dynamic fluid-structure interaction finite element model of the cervical spine with the spinal cord was developed and validated. The changes of von Mises stress and maximum principal strain within the spinal cord in the period of normal, hyperflexion, and hyperextension were investigated, considering various types and grades of disc herniation and ossification of the ligamentum flavum. The flexion and extension of the cervical spine with spinal canal encroachment induced high stress and strain inside the spinal cord, and this effect was also amplified by increased canal encroachments and cervical hypermobility. The spinal cord might evade lateral encroachment, leading to a reduction in the maximum stress and principal strain within the spinal cord in local-type herniation. Although the impact was limited in the case of diffuse type, the maximum stress tended to appear in the white matter near the encroachment site while compression from both ventral and dorsal was essential to make maximum stress appear in the grey matter. The existence of canal encroachment can reduce the safe range for spinal cord activities, and hypermobility activities may induce spinal cord injury. Besides, the ligamentum flavum plays an important role in the development of central canal syndrome.Significance. This model will enable researchers to have a better understanding of the influence of cervical degenerative diseases on the spinal cord during extension and flexion.
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Affiliation(s)
- Meng-Lei Xu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Yi-Ting Yang
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China
| | - Hui-Zi Zeng
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China
| | - Yu-Ting Cao
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China
| | - Liang-Dong Zheng
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China
| | - Chen Jin
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Shi-Jie Zhu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China
| | - Rui Zhu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China.
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China.
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Yamahata H, Ijiri K, Tanabe F, Murasumi K, Nagano Y, Makino R, Higa N, Hanaya R. Radiological Analysis of Cerebrospinal Fluid Dynamics at the Craniovertebral Junction Using Time-Spatial Labeling Inversion Pulse Magnetic Resonance Imaging in Patients with Cervical Spinal Canal Stenosis. World Neurosurg 2024; 184:e731-e736. [PMID: 38340799 DOI: 10.1016/j.wneu.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Spondylotic changes in the cervical spine cause degeneration, leading to cervical spinal canal stenosis. This stenotic change can affect cerebrospinal fluid (CSF) dynamics by compressing the dural sac and reducing space in the subarachnoid space. We examined CSF dynamics at the craniovertebral junction (CVJ) using time-spatial labeling inversion pulse magnetic resonance imaging (Time-SLIP MRI) in patients with cervical spinal canal stenosis. METHODS The maximum longitudinal movement of the CSF at the CVJ was measured as length of motion (LOM) in the Time-SLIP MRI of 56 patients. The sum of ventral and dorsal LOM was defined as the total LOM. Patients were classified into 3 groups depending on their spinal sagittal magnetic resonance imaging findings: control (n = 27, Kang classification grades 0 and 1), stenosis (n = 14, Kang classification grade 2), and severe stenosis (n = 15, Kang classification grade 3). RESULTS Time-SLIP MRI revealed pulsatile movement of the CSF at the CVJ. The mean total, ventral, and dorsal LOM was 14.2 ± 9, 8.1 ± 5.7, and 3.8 ± 2.9 mm, respectively. The ventral LOM was significantly larger than the dorsal LOM. The total LOM was significantly smaller in the severe stenosis group (6.1 ± 3.4 mm) than in the control (16.0 ± 8.4 mm) or stenosis (11 ± 5.4 mm) groups (P < 0.001, Kruskal-Wallis H-test). In 5 patients, postoperative total LOM was improved after adequate decompression surgery. CONCLUSIONS This study demonstrates that CSF dynamics at the CVJ are influenced by cervical spinal canal stenosis. Time-SLIP MRI is useful for evaluating CSF dynamics at the CVJ in patients with spinal canal stenosis.
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Affiliation(s)
- Hitoshi Yamahata
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
| | | | | | | | - Yushi Nagano
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Ryutaro Makino
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Nayuta Higa
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Ryosuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Mahdavi A, Rasti S. Dynamic Flexion-Extension Magnetic Resonance Imaging of the Cervical Spine: An Evolutionary Tool for Diagnosis and Management of Cervical Spondylotic Myelopathy. World Neurosurg 2024; 184:138-147. [PMID: 38246532 DOI: 10.1016/j.wneu.2024.01.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 01/23/2024]
Abstract
Dynamic problems need dynamic solutions. High motility of the cervical spine causes a common age-related degenerative condition called cervical spondylotic myelopathy (CSM), manifested by neurological impairments. An accurate and reliable diagnosis of CSM is crucial for determining appropriate management strategies. Traditional static magnetic resonance imaging (MRI) has been the gold standard for imaging CSM; however, it may not fully capture dynamic changes during neck movement. Dynamic flexion-extension (DFE) MRI is an innovative imaging technique that allows for real-time visualization of cervical spine motion. This review article aims to scrutinize the role of DFE MRI in assessing CSM, its added value to clinical implementations, and its limitations. Finally, by addressing the knowledge gaps, this survey sheds light on the road ahead to incorporate DFE MRI into a standard version of the practice.
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Affiliation(s)
- Ali Mahdavi
- Department of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Rasti
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
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Hong JJ, Kim S, Lee GY, Chung BM. Demonstration of transverse ligament on 3D SPACE MRI in whiplash-associated disorder and nontraumatic conditions. 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 2024; 33:1171-1178. [PMID: 38141107 DOI: 10.1007/s00586-023-08079-4] [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: 09/17/2023] [Revised: 11/16/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE This study aims to delineate the three-dimensional (3D) SPACE MRI findings of the transverse ligament (TL) in whiplash-associated disorder (WAD) patients, and to compare them with those from a nontraumatic group. METHODS A retrospective analysis was performed on cervical spine MRI scans obtained from 46 patients with WAD and 62 nontraumatic individuals. Clinical features, including the WAD grade and stage, were recorded. The TL's morphological grade and the symmetricity of the lateral atlantodental interval was assessed using axial 3D T2-SPACE images. The morphological grading was evaluated using a four-point scale: 0 = homogeneously low signal intensity with normal thickness, 1 = high signal intensity with normal thickness, 2 = reduced thickness, 3 = full-thickness rupture or indistinguishable from surrounding structures. Additionally, the number of cervical levels exhibiting degeneration was documented. RESULTS When comparing the WAD and nontraumatic groups, a significant difference was observed in the proportion of high-grade TL changes (grade 2 or 3) and the number of degenerated cervical levels. Logistic regression analysis revealed that high-grade TL changes and a lower number of degenerative levels independently predicted the presence of WAD. Within the WAD group, the subset of patients with high-grade TL changes demonstrated a significantly higher mean age than the low-grade group (grade 0 or 1). CONCLUSION High-grade morphological changes in the TL can be detected in patients with WAD through the use of 3D SPACE sequences. Clinical relevance statement 3D SPACE MRI could serve as an instrumental tool in the assessment of TL among patients with WAD. Integrating MRI findings with patient history and symptomology could facilitate the identification of potential ligament damage, and may help treatment and follow-up planning.
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Affiliation(s)
- Jung Joo Hong
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Republic of Korea
| | - Sujin Kim
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Republic of Korea
| | - Guen Young Lee
- Department of Radiology, Chung-Ang University Gwangmyeong Hospital, 110, Deokan‑ro, Gwangmyeong‑si, Gyeonggi‑do, Republic of Korea
| | - Bo Mi Chung
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Republic of Korea.
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Iwamae M, Tamai K, Suzuki A, Terai H, Hoshino M, Kato M, Toyoda H, Takahashi S, Yabu A, Sawada Y, Nakamura H. Degeneration of Cervical Multifidus Muscles Negatively Affects Physical Activity-related Quality of Life After Laminoplasty for Degenerative Cervical Myelopathy. Clin Spine Surg 2024:01933606-990000000-00261. [PMID: 38366328 DOI: 10.1097/bsd.0000000000001585] [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: 08/17/2023] [Accepted: 01/22/2024] [Indexed: 02/18/2024]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE The study aimed to investigate the related factors affecting physical activity-related quality of life (QOL) after 2 years of cervical laminoplasty for degenerative cervical myelopathy (DCM), focusing on the degree of preoperative degeneration of the cervical multifidus muscles. SUMMARY OF BACKGROUND DATA The association between paraspinal muscle degeneration and clinical outcomes after spinal surgery is being investigated. The effect of preoperative degeneration of the cervical multifidus muscles in patients undergoing cervical laminoplasty is ambiguous. METHODS Patients who underwent laminoplasty for DCM and followed up for more than 2 years were reviewed. To evaluate physical QOL, the physical component summary (PCS) of the 36-Item Short-Form Health Survey (SF-36) was recorded at 2 years postoperatively. The degree of preoperative degeneration in the multifidus muscles at the C4 and C7 levels on axial T2-weighted magnetic resonance imaging (MRI) was categorized according to the Goutallier grading system. The correlation between 2-year postoperative PCS and each preoperative clinical outcome, radiographic parameter, and MRI finding, including Goutallier classification, was analyzed. Variables with a P value <0.10 in univariate analysis were included in multiple linear regression analysis. RESULTS In total, 106 consecutive patients were included. The 2-year postoperative PCS demonstrated significant correlation with age (R=-0.358, P=0.002), preoperative JOA score (R=0.286, P=0.021), preoperative PCS (R=0.603, P<0.001), C2-C7 lordotic angle (R=-0.284, P=0.017), stenosis severity (R=-0.271, P=0.019), and Goutallier classification at the C7 level (R=-0.268, P=0.021). In multiple linear regression analysis, sex (β=-0.334, P=0.002), age (β=-0.299, P=0.013), preoperative PCS (β=0.356, P=0.009), and Goutallier classification at the C7 level (β=-0.280, P=0.018) were significantly related to 2-year postoperative PCS. CONCLUSIONS Increased degeneration of the multifidus muscle at the C7 level negatively affected physical activity-related QOL postoperatively. These results may guide spine surgeons in predicting physical activity-related QOL in patients with DCM after laminoplasty. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Masayoshi Iwamae
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Koji Tamai
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Akinobu Suzuki
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Hidetomi Terai
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Masatoshi Hoshino
- Department of Orthopedic Surgery, Osaka City General Hospital, Osaka
| | - Minori Kato
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Hiromitsu Toyoda
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Shinji Takahashi
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Akito Yabu
- Department of Orthopedic Surgery, Eniwa Hospital, Hokkaido, Japan
| | - Yuta Sawada
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
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Payne DL, Xu X, Faraji F, John K, Pradas KF, Bernard VV, Bangiyev L, Prasanna P. Automated Detection of Cervical Spinal Stenosis and Cord Compression via Vision Transformer and Rules-Based Classification. AJNR Am J Neuroradiol 2024; 45:ajnr.A8141. [PMID: 38360785 PMCID: PMC11288556 DOI: 10.3174/ajnr.a8141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/15/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND AND PURPOSE Cervical spinal cord compression, defined as spinal cord deformity and severe narrowing of the spinal canal in the cervical region, can lead to severe clinical consequences, including intractable pain, sensory disturbance, paralysis, and even death, and may require emergent intervention to prevent negative outcomes. Despite the critical nature of cord compression, no automated tool is available to alert clinical radiologists to the presence of such findings. This study aims to demonstrate the ability of a vision transformer (ViT) model for the accurate detection of cervical cord compression. MATERIALS AND METHODS A clinically diverse cohort of 142 cervical spine MRIs was identified, 34% of which were normal or had mild stenosis, 31% with moderate stenosis, and 35% with cord compression. Utilizing gradient-echo images, slices were labeled as no cord compression/mild stenosis, moderate stenosis, or severe stenosis/cord compression. Segmentation of the spinal canal was performed and confirmed by neuroradiology faculty. A pretrained ViT model was fine-tuned to predict section-level severity by using a train:validation:test split of 60:20:20. Each examination was assigned an overall severity based on the highest level of section severity, with an examination labeled as positive for cord compression if ≥1 section was predicted in the severe category. Additionally, 2 convolutional neural network (CNN) models (ResNet50, DenseNet121) were tested in the same manner. RESULTS The ViT model outperformed both CNN models at the section level, achieving section-level accuracy of 82%, compared with 72% and 78% for ResNet and DenseNet121, respectively. ViT patient-level classification achieved accuracy of 93%, sensitivity of 0.90, positive predictive value of 0.90, specificity of 0.95, and negative predictive value of 0.95. Receiver operating characteristic area under the curve was greater for ViT than either CNN. CONCLUSIONS This classification approach using a ViT model and rules-based classification accurately detects the presence of cervical spinal cord compression at the patient level. In this study, the ViT model outperformed both conventional CNN approaches at the section and patient levels. If implemented into the clinical setting, such a tool may streamline neuroradiology workflow, improving efficiency and consistency.
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Affiliation(s)
- David L Payne
- From the Department of Radiology (D.L.P., F.F., K.J., K.F.P., V.V.B., L.B.), Stony Brook University Hospital, Stony Brook, New York
- Department of Biomedical Informatics (D.L.P., X.X., F.F., K.J., P.P.), Stony Brook University, Stony Brook, New York
| | - Xuan Xu
- Department of Biomedical Informatics (D.L.P., X.X., F.F., K.J., P.P.), Stony Brook University, Stony Brook, New York
| | - Farshid Faraji
- From the Department of Radiology (D.L.P., F.F., K.J., K.F.P., V.V.B., L.B.), Stony Brook University Hospital, Stony Brook, New York
- Department of Biomedical Informatics (D.L.P., X.X., F.F., K.J., P.P.), Stony Brook University, Stony Brook, New York
| | - Kevin John
- From the Department of Radiology (D.L.P., F.F., K.J., K.F.P., V.V.B., L.B.), Stony Brook University Hospital, Stony Brook, New York
- Department of Biomedical Informatics (D.L.P., X.X., F.F., K.J., P.P.), Stony Brook University, Stony Brook, New York
| | - Katherine Ferra Pradas
- From the Department of Radiology (D.L.P., F.F., K.J., K.F.P., V.V.B., L.B.), Stony Brook University Hospital, Stony Brook, New York
| | - Vahni Vishala Bernard
- From the Department of Radiology (D.L.P., F.F., K.J., K.F.P., V.V.B., L.B.), Stony Brook University Hospital, Stony Brook, New York
| | - Lev Bangiyev
- From the Department of Radiology (D.L.P., F.F., K.J., K.F.P., V.V.B., L.B.), Stony Brook University Hospital, Stony Brook, New York
| | - Prateek Prasanna
- Department of Biomedical Informatics (D.L.P., X.X., F.F., K.J., P.P.), Stony Brook University, Stony Brook, New York
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Muhammad F, Smith ZA. A Diagnostic Biomarker for Cervical Myelopathy Based on Dynamic Magnetic Resonance Imaging. Spine (Phila Pa 1976) 2023; 48:E420-E421. [PMID: 37294831 DOI: 10.1097/brs.0000000000004744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/11/2023]
Affiliation(s)
- Fauziyya Muhammad
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Lambrechts MJ, Issa TZ, Lee Y, Tran KS, Heard J, Purtill C, Fried TB, Oh S, Kim E, Mangan JJ, Canseco JA, Kaye ID, Rihn JA, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD. How Does the Severity of Neuroforaminal Compression in Cervical Radiculopathy Affect Outcomes of Anterior Cervical Discectomy and Fusion. Asian Spine J 2023; 17:1051-1058. [PMID: 37946340 PMCID: PMC10764125 DOI: 10.31616/asj.2023.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/07/2023] [Accepted: 05/09/2023] [Indexed: 11/12/2023] Open
Abstract
STUDY DESIGN This study is a retrospective cohort study. PURPOSE This study aims to determine whether preoperative neuroforaminal stenosis (FS) severity is associated with motor function patient-reported outcome measures (PROMs) following anterior cervical discectomy and fusion (ACDF). OVERVIEW OF LITERATURE Cervical FS can significantly contribute to patient symptoms. While magnetic resonance imaging (MRI) has been used to classify FS, there has been limited research into the impact of FS severity on patient outcomes. METHODS Patients undergoing primary, elective 1-3 level ACDF for radiculopathy at a single academic center between 2015 and 2021 were identified retrospectively. Cervical FS was evaluated using axial T2-weighted MRI images via a validated grading scale. The maximum degree of stenosis was used for multilevel disease. Motor symptoms were classified using encounters at their final preoperative and first postoperative visits, with examinations ≤3/5 indicating weakness. PROMs were obtained preoperatively and at 1-year follow-up. Bivariate analysis was used to compare outcomes based on stenosis severity, followed by multivariable analysis. RESULTS This study included 354 patients, 157 with moderate stenosis and 197 with severe stenosis. Overall, 58 patients (16.4%) presented with upper extremity weakness ≤3/5. A similar number of patients in both groups presented with baseline motor weakness (13.5% vs. 16.55, p =0.431). Postoperatively, 97.1% and 87.0% of patients with severe and moderate FS, respectively, experienced full motor recovery (p =0.134). At 1-year, patients with severe neuroforaminal stenosis presented with significantly worse 12-item Short Form Survey Physical Component Score (PCS-12) (33.3 vs. 37.3, p =0.049) but demonstrated a greater magnitude of improvement (Δ PCS-12: 5.43 vs. 0.87, p =0.048). Worse stenosis was independently associated with greater ΔPCS-12 at 1-year (β =5.59, p =0.022). CONCLUSIONS Patients with severe FS presented with worse preoperative physical health. While ACDF improved outcomes and conferred similar motor recovery in all patients, those with severe FS reported much better improvement in physical function.
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Affiliation(s)
- Mark J. Lambrechts
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA,
USA
| | - Tariq Z. Issa
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA,
USA
| | - Yunsoo Lee
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA,
USA
| | - Khoa S. Tran
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA,
USA
| | - Jeremy Heard
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA,
USA
| | - Caroline Purtill
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA,
USA
| | - Tristan B. Fried
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA,
USA
| | - Samuel Oh
- Icahn School of Medicine at Mount Sinai, New York, NY,
USA
| | - Erin Kim
- Boston University School of Medicine, Boston University, Boston, MA,
USA
| | - John J. Mangan
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA,
USA
| | - Jose A. Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA,
USA
| | - I. David Kaye
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA,
USA
| | - Jeffrey A. Rihn
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA,
USA
| | - Alan S. Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA,
USA
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA,
USA
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA,
USA
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA,
USA
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27
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Hesni S, Baxter D, Saifuddin A. The imaging of cervical spondylotic myeloradiculopathy. Skeletal Radiol 2023; 52:2341-2365. [PMID: 37071191 DOI: 10.1007/s00256-023-04329-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/12/2023] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
This review provides a detailed description of the imaging features of cervical spondylotic myelopathy and radiculopathy, with a focus on MRI. Where relevant, we will outline grading systems of vertebral central canal and foraminal stenosis. Whilst post-operative appearances of the cervical spine are outside the scope of this paper, we will touch on imaging features recognised as predictors of clinical outcome and neurological recovery. This paper will serve as a reference for both radiologists and clinicians involved in the care of patients with cervical spondylotic myeloradiculopathy.
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Affiliation(s)
- Susan Hesni
- Department of Radiology, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK.
| | - David Baxter
- Department of Surgery, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK
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28
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Seo G, Lee SJ, Park DH, Paeng SH, Koerzdoerfer G, Nickel MD, Sung J. Image quality and lesion detectability of deep learning-accelerated T2-weighted Dixon imaging of the cervical spine. Skeletal Radiol 2023; 52:2451-2459. [PMID: 37233758 DOI: 10.1007/s00256-023-04364-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To validate the subjective image quality and lesion detectability of deep learning-accelerated Dixon (DL-Dixon) imaging of the cervical spine compared with routine Dixon imaging. MATERIALS AND METHODS A total of 50 patients underwent sagittal routine Dixon and DL-Dixon imaging of the cervical spine. Acquisition parameters were compared and non-uniformity (NU) values were calculated. Two radiologists independently assessed the two imaging methods for subjective image quality and lesion detectability. Interreader and intermethod agreements were estimated with weighted kappa values. RESULTS Compared with the routine Dixon imaging, the DL-Dixon imaging reduced the acquisition time by 23.76%. The NU value is slightly higher in DL-Dixon imaging (p value: 0.015). DL-Dixon imaging showed superior visibility of all four anatomical structures (spinal cord, disc margin, dorsal root ganglion, and facet joint) for both readers (p value: < 0.001 ~ 0.002). The motion artifact scores were slightly higher in the DL-Dixon images than in routine Dixon images (p value = 0.785). Intermethod agreements were almost perfect for disc herniation, facet osteoarthritis, uncovertebral arthritis, central canal stenosis (κ range: 0.830 ~ 0.980, all p values < 0.001) and substantial to almost perfect for foraminal stenosis (κ = 0.955, 0.705 for each reader). There was an improvement in the interreader agreement of foraminal stenosis by DL-Dixon images, from moderate to substantial agreement. CONCLUSION The DLR sequence can substantially decrease the acquisition time of the Dixon sequence with subjective image quality at least as good as the conventional sequence. And no significant differences in lesion detectability were observed between the two sequence types.
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Affiliation(s)
- Geojeong Seo
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Sun Joo Lee
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
| | - Dae Hyun Park
- Department of Orthopaedic Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Sung Hwa Paeng
- Department of Neurosurgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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29
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Ohtake Y, Yasaka K, Hamada A, Fujita N, Abe O. Effect of Deep Learning Reconstruction on Evaluating Cervical Spinal Canal Stenosis With Computed Tomography. J Comput Assist Tomogr 2023; 47:996-1001. [PMID: 37948377 DOI: 10.1097/rct.0000000000001490] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) is commonly used to evaluate cervical spinal canal stenosis; however, some patients are ineligible for MRI. We aimed to assess the effect of deep learning reconstruction (DLR) in evaluating cervical spinal canal stenosis using computed tomography (CT) compared with hybrid iterative reconstruction (hybrid IR). METHODS This retrospective study included 33 patients (16 male patients; mean age, 57.7 ± 18.4 years) who underwent cervical spine CT. Images were reconstructed using DLR and hybrid IR. In the quantitative analyses, noise was recorded by placing the regions of interest on the trapezius muscle. In the qualitative analyses, 2 radiologists evaluated the depiction of structures, image noise, overall image quality, and degree of cervical canal stenosis. We additionally evaluated the agreement between MRI and CT in 15 patients for whom preoperative cervical MRI was available. RESULTS Image noise was less with DLR than hybrid IR in the quantitative ( P ≤ 0.0395) and subjective analyses ( P ≤ 0.0023), and the depiction of most structures was improved ( P ≤ 0.0052), which resulted in better overall quality ( P ≤ 0.0118). Interobserver agreement in the assessment of spinal canal stenosis with DLR (0.7390; 95% confidence interval [CI], 0.7189-0.7592) was superior to that with hybrid IR (0.7038; 96% CI, 0.6846-0.7229). As for the agreement between MRI and CT, significant improvement was observed for 1 reader with DLR (0.7910; 96% CI, 0.7762-0.8057) than hybrid IR (0.7536; 96% CI, 0.7383-0.7688). CONCLUSIONS Deep learning reconstruction provided better quality cervical spine CT images in the evaluation of cervical spinal stenosis than hybrid IR.
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Affiliation(s)
- Yuta Ohtake
- From the Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
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30
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Costello JE, Shah LM, Peckham ME, Stilwill SE, Safazadeh G, Hutchins TA. Time for change? Radiologists highly concordant assessing change in stenoses on follow-up cervical spine MRI. Neuroradiol J 2023; 36:588-592. [PMID: 37042077 PMCID: PMC10569186 DOI: 10.1177/19714009231163562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVE There is considerable variability among radiologists when grading spinal canal and foraminal stenosis on MRI. However, to date, studies have not evaluated radiologists' agreement when assessing interval change in cervical spine stenoses. The purpose of this study was to evaluate radiologists' concordance for change in cervical spine stenoses on follow-up MRIs, a major indication for these exams. METHODS Initial and follow-up cervical MRIs were retrospectively reviewed by three blinded radiologists. Spinal canal and foramina from C1 through T1 were rated for interval change and concordance between the blinded raters was calculated. The original MRI reports were also reviewed for specific language assessing interval change on the follow-up exams. RESULTS 40 cervical MRI exams and 40 corresponding MRI follow-ups were assessed. Agreement for interval change in spinal canal and foraminal stenosis was near perfect amongst all readers (kappa values of 0.78-0.94). 97% of the original MRI reports used the standard severity scale. 68% of follow-up MRI reports specifically assessed for change. DISCUSSION Blinded radiologists had high agreement when assessing for change in spinal canal and foraminal stenosis on follow-up cervical spine MRIs. Because of inter-rater variability in stenosis grading, reports that do not emphasize change assessment, may imply change that is not truly present. For clarity and consistency in reporting of cervical spine stenoses, change assessment should be emphasized and added to structured reporting templates.
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Affiliation(s)
- Justin E Costello
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
- Walter Reed National Military Medical Center, Department of Neuroradiology, Bethesda, MD, United States
| | - Lubdha M Shah
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
| | - Miriam E Peckham
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
| | - Sarah E Stilwill
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
| | - Ghazaleh Safazadeh
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
| | - Troy A Hutchins
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
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Hohenhaus M, Klingler JH, Scholz C, Volz F, Hubbe U, Beck J, Reisert M, Würtemberger U, Kremers N, Wolf K. Automated signal intensity analysis of the spinal cord for detection of degenerative cervical myelopathy - a matched-pair MRI study. Neuroradiology 2023; 65:1545-1554. [PMID: 37386202 PMCID: PMC10497437 DOI: 10.1007/s00234-023-03187-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/16/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE Detection of T2 hyperintensities in suspected degenerative cervical myelopathy (DCM) is done subjectively in clinical practice. To gain objective quantification for dedicated treatment, signal intensity analysis of the spinal cord is purposeful. We investigated fully automated quantification of the T2 signal intensity (T2-SI) of the spinal cord using a high-resolution MRI segmentation. METHODS Matched-pair analysis of prospective acquired cervical 3D T2-weighted sequences of 114 symptomatic patients and 88 healthy volunteers. Cervical spinal cord was segmented automatically through a trained convolutional neuronal network with subsequent T2-SI registration slice-by-slice. Received T2-SI curves were subdivided for each cervical level from C2 to C7. Additionally, all levels were subjectively classified concerning a present T2 hyperintensity. For T2-positive levels, corresponding T2-SI curves were compared to curves of age-matched volunteers at the identical level. RESULTS Forty-nine patients showed subjective T2 hyperintensities at any level. The corresponding T2-SI curves showed higher signal variabilities reflected by standard deviation (18.51 vs. 7.47 a.u.; p < 0.001) and range (56.09 vs. 24.34 a.u.; p < 0.001) compared to matched controls. Percentage of the range from the mean absolute T2-SI per cervical level, introduced as "T2 myelopathy index" (T2-MI), was correspondingly significantly higher in T2-positive segments (23.99% vs. 10.85%; p < 0.001). ROC analysis indicated excellent differentiation for all three parameters (AUC 0.865-0.920). CONCLUSION This fully automated T2-SI quantification of the spinal cord revealed significantly increased signal variability for DCM patients compared to healthy volunteers. This innovative procedure and the applied parameters showed sufficient diagnostic accuracy, potentially diagnosing radiological DCM more objective to optimize treatment recommendation. TRIAL REGISTRATION DRKS00012962 (17.01.2018) and DRKS00017351 (28.05.2019).
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Affiliation(s)
- Marc Hohenhaus
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Jan-Helge Klingler
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Scholz
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Florian Volz
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ulrich Hubbe
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marco Reisert
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Urs Würtemberger
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nico Kremers
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Wolf
- Department of Neurology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Lin CH, Yen YS, Wu CY. Ultrasound-guided nerve hydrodissection of cervical nerve roots for cervical radicular pain in patients with mild and moderate to severe stenosis: a retrospective cohort study. Sci Rep 2023; 13:13817. [PMID: 37620404 PMCID: PMC10449834 DOI: 10.1038/s41598-023-40376-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
Because fascial entrapment neuropathy can occur in multiple locations, ultrasound-guided nerve hydrodissection has become a key component of the treatment of cervical radicular pain. In this paper, we propose a combination of injectates used for nerve hydrodissection of the cervical nerve roots and compare the clinical outcomes of this treatment among patients with different severities of stenosis. This is a retrospective cohort study designed to compare outcomes between patients with mild stenosis and moderate to severe stenosis. Forty-four patients with mild cervical stenosis and 30 patients with moderate to severe cervical stenosis were consecutively enrolled into two groups. A 10-mL mixture in a single level consisting of 5% in Dextrose, 0.2% lidocaine (Xylocaine), and 4 mg betamethasone (Rinderon) was used for nerve roots hydrodissection. The two groups were compared with regard to their numeric rating scales (NRS) of pain, proportion of patients who exhibited a favorable outcome (a reduction of pain ≥ 50%), duration of patient exhibited a favorable outcome, and occurrence of serious complications and minor side effects. The follow-up period ranged from 3 to 20 months. The NRS of both groups improved significantly by 1 week, 1 month, 3 months, and final follow-up after the initial injection. Differences in the groups' NRS, proportion of patients who exhibited a favorable outcome, duration of patient exhibited a favorable outcome, and occurrence of serious complications and minor side effects were nonsignificant. There were 4 patients (5.4%) experienced dizziness in that resolved without further treatment. Ultrasound-guided nerve hydrodissection of cervical nerve roots is a safe procedure that reduces pain associated with cervical radicular pain, even in patients with moderate to severe stenosis.
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Affiliation(s)
- Chang-Hao Lin
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Yun-Shan Yen
- Department of Rehabilitation Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Cheng-Yi Wu
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.
- Department of Nursing, Chung Jen Junior College of Nursing, Health Science and Management, Chiayi, Taiwan.
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Ogholoh OD, Bemigho-Odonmeta AP, Orhrohoro OI, Ikubor JE, Idowu BM, Tsebi BH, Kogha N, Nwafor NN, Ogbeide AO. Association of Cervical Spine Magnetic Resonance Imaging Abnormalities with Chronic Neck Pain in Southern Nigeria. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2023; 13:48-55. [PMID: 37538219 PMCID: PMC10395864 DOI: 10.4103/jwas.jwas_11_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/12/2023] [Indexed: 08/05/2023]
Abstract
Objective This study was done to evaluate the relationship between cervical spine magnetic resonance imaging (MRI) findings and clinical features in adults with chronic neck pain (NP) at our tertiary hospital. Materials and Methods This was a prospective cross-sectional study of the cervical spine MRI of 90 adult patients with chronic NP. The clinical history, biodata, and cervical spine MRI findings were analysed. Statistical tests were considered significant at P ≤ 0.05. Results The mean age of the participants was 54.72 (13.51) years (range = 28-79 years). There were 52 (58%) males and 38 (42%) females. Cervical disc desiccation and disc herniation were the most prevalent MRI findings. C4/C5 and C5/C6 disc levels were most commonly affected. Disc height reduction correlated with shoulder pain (r = 0.23, P = 0.030), unsteady gait (r = 0.27, P = 0.010), and lower limb weakness (r = 0.23, P = 0.029). Vertebral collapse correlated with shoulder pain (r = 0.22, P = 0.036), upper limbs burning sensation (r = 0.33, P = 0.001), and loss of dexterity (r = 0.22, P = 0.037). Spondylolisthesis correlated significantly with unsteady gait (r = 0.34, P = 0.001), dizziness/vertigo (r = 0.29, P = 0.005), painful neck movement (r = 0.32, P = 0.002), loss of dexterity (r = 0.37, P < 0.001) and sphincteric dysfunction (r = 0.23, P = 0.031). Modic changes correlated with loss of dexterity (r = 0.39, P < 0.001) and upper limbs burning sensation (r = 0.21, P = 0.048). Cervical canal stenosis did not correlate significantly with any symptom. Conclusion Cervical disc disease (C4/C5 and C5/C6 levels) was the most prevalent finding on MRI. Disc height reduction, vertebral collapse, spondylolisthesis, and Modic changes correlated with various clinical symptoms.
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Affiliation(s)
- Oghenetejiri Denise Ogholoh
- Department of Radiology, Delta State University, Abraka, Delta State, Nigeria
- Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
| | | | - Omuvwie Igberhi Orhrohoro
- Department of Radiology, Delta State University, Abraka, Delta State, Nigeria
- Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
- Department of Surgery, Delta State University, Abraka, Delta State, Nigeria
| | - Joyce Ekeme Ikubor
- Department of Radiology, Delta State University, Abraka, Delta State, Nigeria
- Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
| | - Bukunmi Michael Idowu
- Department of Radiology, Union Diagnostics and Clinical Services Plc, Yaba, Lagos State, Nigeria
| | - Besiginwa Harrison Tsebi
- Department of Radiology, Delta State University, Abraka, Delta State, Nigeria
- Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
| | - Nicholas Kogha
- Department of Radiology, Delta State University, Abraka, Delta State, Nigeria
- Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
| | - Nkem Nnenna Nwafor
- Department of Radiology, Faculty of Clinical Sciences, College of Health Sciences, University of Uyo, Uyo, Akwa Ibom State, Nigeria
| | - Anthony Osayomwanbor Ogbeide
- Department of Radiology, Delta State University, Abraka, Delta State, Nigeria
- Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
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Sun SP, Phang CR, Tzou SC, Chen CM, Ko LW. Integration of MRI and somatosensory evoked potentials facilitate diagnosis of spinal cord compression. Sci Rep 2023; 13:7861. [PMID: 37188786 DOI: 10.1038/s41598-023-34832-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/09/2023] [Indexed: 05/17/2023] Open
Abstract
This study aimed to integrate magnetic resonance imaging (MRI) and related somatosensory evoked potential (SSEP) features to assist in the diagnosis of spinal cord compression (SCC). MRI scans were graded from 0 to 3 according to the changes in the subarachnoid space and scan signals to confirm differences in SCC levels. The amplitude, latency, and time-frequency analysis (TFA) power of preoperative SSEP features were extracted and the changes were used as standard judgments to detect neurological function changes. Then the patient distribution was quantified according to the SSEP feature changes under the same and different MRI compression grades. Significant differences were found in the amplitude and TFA power between MRI grades. We estimated three degrees of amplitude anomalies and power loss under each MRI grade and found the presence or absence of power loss occurs after abnormal changes in amplitude only. For SCC, few integrated approach combines the advantages of both MRI and evoked potentials. However, integrating the amplitude and TFA power changes of SSEP features with MRI grading can help in the diagnosis and speculate progression of SCC.
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Affiliation(s)
- Shu-Pin Sun
- International Ph.D. Program in Interdisciplinary Neuroscience (UST), College of Biological Science and Technology, National Yang Ming Chiao Tung University, 734, Engineering Bldg. 5, 1001 Daxue Road, Hsinchu, 30010, Taiwan, ROC
- Department of Medical Research, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, 300, Taiwan, ROC
- Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, 300, Taiwan, ROC
| | - Chun-Ren Phang
- International Ph.D. Program in Interdisciplinary Neuroscience (UST), College of Biological Science and Technology, National Yang Ming Chiao Tung University, 734, Engineering Bldg. 5, 1001 Daxue Road, Hsinchu, 30010, Taiwan, ROC
- Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, 300, Taiwan, ROC
| | - Shey-Cherng Tzou
- Institute of Molecular Medicine and Bioengineering, National Yang Ming Chiao Tung University, Hsinchu, 300, Taiwan, ROC
- Department of Biomedical Science and Environment Biology, and the Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung, 807, Taiwan, ROC
| | - Chang-Mu Chen
- Department of Surgery, College of Medicine and Hospital, National Taiwan University, No. 7, Zhongshan South Road, Taipei, 10002, Taiwan, ROC.
| | - Li-Wei Ko
- International Ph.D. Program in Interdisciplinary Neuroscience (UST), College of Biological Science and Technology, National Yang Ming Chiao Tung University, 734, Engineering Bldg. 5, 1001 Daxue Road, Hsinchu, 30010, Taiwan, ROC.
- Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, 300, Taiwan, ROC.
- Institute of Electrical and Control Engineering, Department of Electronics and Electrical Engineering, National Yang Ming Chiao Tung University, Hsinchu, 300, Taiwan, ROC.
- Department of Biomedical Science and Environment Biology, and the Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung, 807, Taiwan, ROC.
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Tamai K, Terai H, Hoshino M, Tabuchi H, Kato M, Toyoda H, Suzuki A, Takahashi S, Yabu A, Sawada Y, Iwamae M, Oka M, Nakaniwa K, Okada M, Nakamura H. Deep Learning Algorithm for Identifying Cervical Cord Compression Due to Degenerative Canal Stenosis on Radiography. Spine (Phila Pa 1976) 2023; 48:519-525. [PMID: 36763843 DOI: 10.1097/brs.0000000000004595] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/06/2023] [Indexed: 02/12/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE Validate the diagnostic accuracy of a deep-learning algorithm for cervical cord compression due to degenerative canal stenosis on radiography. SUMMARY OF BACKGROUND DATA The diagnosis of degenerative cervical myelopathy is often delayed, resulting in improper management. Screening tools for suspected degenerative cervical myelopathy would help identify patients who require detailed physical evaluation. MATERIALS AND METHODS Data from 240 patients (120 with cervical stenosis on magnetic resonance imaging and 120 age and sex-matched controls) were randomly divided into training (n = 198) and test (n = 42) data sets. The deep-learning algorithm, designed to identify the suspected stenosis level on radiography, was constructed using a convolutional neural network model called EfficientNetB2, and radiography and magnetic resonance imaging data from the training data set. The accuracy and area under the curve of the receiver operating characteristic curve were calculated for the independent test data set. Finally, the number of correct diagnoses was compared between the algorithm and 10 physicians using the test cohort. RESULTS The diagnostic accuracy and area under the curve of the deep-learning algorithm were 0.81 and 0.81, respectively, in the independent test data set. The rate of correct responses in the test data set was significantly higher for the algorithm than for the physician's consensus (81.0% vs . 66.2%; P = 0.034). Furthermore, the accuracy of the algorithm was greater than that of each individual physician. CONCLUSIONS We developed a deep-learning algorithm capable of suggesting the presence of cervical spinal cord compression on cervical radiography and highlighting the suspected levels on radiographic imaging when cord compression is identified. The diagnostic accuracy of the algorithm was greater than that of spine physicians. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Koji Tamai
- Department of Orthopedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hidetomi Terai
- Department of Orthopedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Masatoshi Hoshino
- Department of Orthopedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hitoshi Tabuchi
- Department of Technology and Design Thinking for Medicine, Hiroshima University, Hiroshima, Japan
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Japan
| | - Minori Kato
- Department of Orthopedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiromitsu Toyoda
- Department of Orthopedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Akinobu Suzuki
- Department of Orthopedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Shinji Takahashi
- Department of Orthopedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Akito Yabu
- Department of Orthopedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yuta Sawada
- Department of Orthopedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Masayoshi Iwamae
- Department of Orthopedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Makoto Oka
- Department of Orthopedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kazunori Nakaniwa
- Department of Orthopedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Mitsuhiro Okada
- Department of Orthopedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Singhal S, Saran S, Saxena S, Bhadoria AS, Grimm R. Role of diffusion kurtosis imaging in evaluating microstructural changes in spinal cord of patients with cervical spondylosis. 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 2023; 32:986-993. [PMID: 36738338 DOI: 10.1007/s00586-023-07559-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/29/2022] [Accepted: 01/22/2023] [Indexed: 02/05/2023]
Abstract
STUDY DESIGN Analytical cross-sectional study. PURPOSE To study the role of diffusion kurtosis imaging (DKI) in evaluating microstructural changes in patients with cervical spondylosis. OVERVIEW OF LITERATURE Cervical spondylosis is a common progressive degenerative disorder of the spine. Conventional magnetic resonance imaging (MRI) can only detect the changes in the spinal cord once there are visual signal changes; hence, it underestimates the extent of the injury. Newer imaging techniques like Diffusion Tensor and Kurtosis Imaging can evaluate the microstructural changes in cervical spinal cord before the obvious signal changes appear. METHODS Conventional MRI, diffusion tensor imaging (DTI), and DKI scans were performed for 90 cervical spondylosis patients on 1.5-T MR Siemens Magnetom aera after obtaining informed consent. Eight patients were excluded due to poor image quality. Fractional anisotropy (FA) colour maps and diffusion kurtosis (DK) maps corresponding to spinal cord cross sections at C2-C3 intervertebral disc level (control) and at the most stenotic levels were obtained. Modified Japanese Orthopaedic Association (mJOA) scoring was used for clinical assessment of the spinal cord function. The changes in DTI and DKI parameters and their correlation with mJOA scores were analysed by SPSS 23 software. RESULTS In our study, mean FA and mean kurtosis (MK) values at the stenotic level (0.54, 1.02) were significantly lower than values at the non-stenotic segment (0.70, 1.27). The mean diffusivity (MD) value at the stenotic segment (1.25) was significantly higher than in the non-stenotic segment (1.09). We also observed a strong positive correlation between mJOA score and FA and MK values and a negative correlation between mJOA score and MD values, suggesting a correlation of FA, MK, and MD with the clinical severity of the disease. CONCLUSION Addition of DTI and DKI sequences helps in early identification of the disease without any additional cost incurred by the patient.
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Affiliation(s)
- Shailvi Singhal
- Department of Radiology, All India Institute of Medical Sciences, Rishikesh, 249203, India
| | - Sonal Saran
- Department of Radiology, All India Institute of Medical Sciences, Rishikesh, 249203, India.
| | - Sudhir Saxena
- Department of Radiology, All India Institute of Medical Sciences, Rishikesh, 249203, India
| | - Ajeet Singh Bhadoria
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Robert Grimm
- MR Application predevelopment, Siemens Healthcare, Erlangen, Germany
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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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Liu Q, Shao H, Liu C, Liu WV, Saeed A, Zhang Q, Lu J, Zhang G, Li L, Tang X, Du G, Zhu W. Quantitative evaluation of the spinal cord compression in patients with cervical spondylotic myelopathy using synthetic MRI. Front Physiol 2023; 14:1140870. [PMID: 37101700 PMCID: PMC10123267 DOI: 10.3389/fphys.2023.1140870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/27/2023] [Indexed: 04/28/2023] Open
Abstract
Objectives: This work aimed to investigate the feasibility and diagnostic value of synthetic MRI, including T1, T2 and PD values in determining the severity of cervical spondylotic myelopathy (CSM). Methods: All subjects (51 CSM patients and 9 healthy controls) underwent synthetic MRI scan on a 3.0T GE MR scanner. The cervical canal stenosis degree of subjects was graded 0-III based on the method of a MRI grading system. Regions of interest (ROIs) were manually drawn at the maximal compression level (MCL) by covering the whole spinal cord to generate T1MCL, T2MCL, and PDMCL values in grade I-III groups. Besides, anteroposterior (AP) and transverse (Trans) diameters of the spinal cord at MCL were measured in grade II and grade III groups, and relative values were calculated as follows: rAP = APMCL/APnormal, rTrans = TransMCL/Transnormal. rMIN = rAP/rTrans. Results: T1MCL value showed a decreasing trend with severity of grades (from grade 0 to grade II, p < 0.05), while it increased dramatically at grade III. T2MCL value showed no significant difference among grade groups (from grade 0 to grade II), while it increased dramatically at grade III compared to grade II (p < 0.05). PDMCL value showed no statistical difference among all grade groups. rMIN of grade III was significantly lower than that of grade II (p < 0.05). T2MCL value was negatively correlated with rMIN, whereas positively correlated with rTrans. Conclusion: Synthetic MRI can provide not only multiple contrast images but also quantitative mapping, which is showed promisingly to be a reliable and efficient method in the quantitative diagnosis of CSM.
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Affiliation(s)
- Qiufeng Liu
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haoyue Shao
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chaoxu Liu
- Department of Orthopedics, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Azzam Saeed
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiya Zhang
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Lu
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guiling Zhang
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Li
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangyu Tang
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Xiangyu Tang,
| | - Guanghui Du
- Department of Urology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Deininger-Czermak E, Gascho D, Franckenberg S, Kälin P, Blüthgen C, Villefort C, Thali MJ, Guggenberger R. Added value of ultra-short echo time and fast field echo using restricted echo-spacing MR imaging in the assessment of the osseous cervical spine. LA RADIOLOGIA MEDICA 2023; 128:234-241. [PMID: 36637741 PMCID: PMC9938813 DOI: 10.1007/s11547-023-01589-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 01/04/2023] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate the added value of ultra-short echo time (UTE) and fast field echo resembling a CT using restricted echo-spacing (FRACTURE) MR sequences in the assessment of the osseous cervical spine using CT as reference. MATERIALS AND METHODS Twenty-seven subjects underwent postmortem CT and MRI within 48 h. Datasets were anonymized and analyzed retrospectively by two radiologists. Morphological cervical spine alterations were rated on CT, UTE and FRACTURE images. Afterward, neural foraminal stenosis was graded on standard MR and again after viewing additional UTE/FRACTURE sequences. To evaluate interreader and intermodality reliability, intra-class correlation coefficients (ICC) and for stenosis grading Wilcoxon-matched-pairs testing with multiple comparison correction were calculated. RESULTS Moderate interreader reliability (ICC = 0.48-0.71) was observed concerning morphological findings on all modalities. Intermodality reliability was good between modalities regarding degenerative vertebral and joint alterations (ICC = 0.69-0.91). Compared to CT neural stenosis grades were more often considered as nonsignificant on all analyzed MR sequences. Neural stenosis grading scores differed also significantly between specific bone imaging sequences, UTE and FRACTURE, to standard MR sequences. However, no significant difference was observed between UTE and FRACTURE sequences. CONCLUSION Compared to CT as reference, UTE or FRACTURE sequence added to standard MR sequences can deliver comparable information on osseous cervical spine status. Both led to changes in clinically significant stenosis gradings when added to standard MR, mainly reducing the severity of neural foramina stenosis.
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Affiliation(s)
- Eva Deininger-Czermak
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland. .,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - Dominic Gascho
- grid.7400.30000 0004 1937 0650Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Sabine Franckenberg
- grid.7400.30000 0004 1937 0650Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland ,grid.412004.30000 0004 0478 9977Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Pascal Kälin
- grid.412004.30000 0004 0478 9977Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Christian Blüthgen
- grid.412004.30000 0004 0478 9977Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Christina Villefort
- grid.412373.00000 0004 0518 9682Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Michael J. Thali
- grid.7400.30000 0004 1937 0650Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Roman Guggenberger
- grid.412004.30000 0004 0478 9977Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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Kashiwagi N, Sakai M, Tsukabe A, Yamashita Y, Fujiwara M, Yamagata K, Nakamoto A, Nakanishi K, Tomiyama N. Ultrafast cervcial spine MRI protocol using deep learning-based reconstruction: Diagnostic equivalence to a conventional protocol. Eur J Radiol 2022; 156:110531. [PMID: 36179465 DOI: 10.1016/j.ejrad.2022.110531] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/18/2022] [Accepted: 09/16/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE A major drawback of magnetic resonance imaging (MRI) is its limited imaging speed. This study proposed an ultrafast cervical spine MRI protocol (2 min 57 s) using deep learning-based reconstruction (DLR) and compared the diagnostic results to those of conventional MRI protocols (12 min 54 s). METHODS Fifty patients who underwent cervical spine MRI using both conventional and ultrafast protocols, including sagittal T1-weighted, T2-weighted, short-TI inversion recovery, and axial T2*-weighted imaging were included in this study. The ultrafast protocol shortened the acquisition time to approximately-one-fourth of that of the conventional protocol by reducing the phase matrix, oversampling rate, and number of excitations, and by applying compressed sensing. To compensate for the decreased signal-to-noise ratio caused by acceleration, noise reduction using DLR was performed. For image interpretation, three neuroradiologists graded or classified degenerative changes, including central canal stenosis, foraminal stenosis, endplate degeneration, disc degeneration, and disc hernia. The presence of other pathologies was also recorded. Given the absence of a reference standard, we tested the interchangeability of the two protocols by calculating the 95% confidence interval (CI) of the individual equivalence index. We also assessed the inter-protocol intra-reader agreement using kappa statistics. RESULTS Except for endplate degeneration, the 95 % CI of the individual equivalence index for all variables did not exceed 5 %, indicating interchangeability between the two protocols. The kappa values ranged from 0.600 to 0.977, indicating substantial to almost perfect agreement. CONCLUSIONS The proposed ultrafast MRI protocol yielded almost equivalent diagnostic results compared as the conventional protocol.
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Affiliation(s)
- Nobuo Kashiwagi
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, Japan.
| | - Mio Sakai
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, Japan.
| | - Akio Tsukabe
- Department of Radiology, Toyonaka Municipal Hospital, Japan
| | | | - Masahiro Fujiwara
- Department of Radiology, Osaka Medical and Pharmaceutical University Hospital, Japan.
| | - Kazuki Yamagata
- Department of Radiology, Osaka University Graduate School of Medicine, Japan.
| | - Atsushi Nakamoto
- Department of Future Diagnostic Radiology, Osaka University Graduate School of Medicine, Japan.
| | - Katsuyuki Nakanishi
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, Japan.
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, Japan.
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Siroya HL, Bhat DI, Devi BI, Shukla DP, Sathyaprabha TN, Alekhya TSL. Six-year longitudinal prospective comparative study between preoperative and postoperative heart rate variability indices in congenital craniovertebral junction anomalies. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:439-453. [PMID: 36777908 PMCID: PMC9910138 DOI: 10.4103/jcvjs.jcvjs_117_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
Background Craniovertebral junction (CVJ) anomalies involve mosaic interaction of multifaceted neurovascular and bony elements. Most of them present late in the course of illness usually as acute presentations following trivial trauma. Knowing subclinical autonomic dysfunction in such anomalies when managed medically can not only indicate progression but also provide en route to early intervention for better outcomes, especially in relatively asymptomatic patients. Materials and Methods We conducted a 6-year longitudinal prospective study including 40 consecutive patients of CVJ anomalies with clinical, radiological, and heart rate variability (HRV) parameters and found their correlation in preoperative and follow-up period. Results Twenty-eight patients were male and the rest were female. The mean age was 32 years with the least age being 8 years and maximum age being 75 years old. Mean Nurick's grade and Barthel's index were 1.8 and 83.75, respectively. 38% had severe-to-moderate compression. The mean follow-up was 17.4 months. Both sympathetic and parasympathetic oscillator HRV indices were significantly affected in the preoperative period (P ≤ 0.001) with no association with Nurick's grade or degree of compression although there was association with grade of Barthel's index. Poincare plots showed "fan," "complex," or "torpedo" patterns in 36 patients. Forty patients had both preoperative and follow-up clinical grade whereas 22 patients HRV tests in the above periods. None of the HRV indices showed significant improvement at follow-up. Nonetheless both sympathetic and parasympathetic did improve at follow-up with sympathetic tone registering better scores. Poincare plots showed improvement toward "comet" patterns in all patients. Conclusion HRV indices not only help in prognosticating but may also help in predicting outcomes.
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Affiliation(s)
| | | | - Bhagavatula Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Dhaval P. Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Ornelas-Dorian C, Jhun P. A Case Report of a Man with Burning Arm and Leg Weakness. JOURNAL OF EDUCATION & TEACHING IN EMERGENCY MEDICINE 2022; 7:V4-V6. [PMID: 37465137 PMCID: PMC10332663 DOI: 10.21980/j8v659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/16/2022] [Indexed: 07/20/2023]
Abstract
A 44-year-old male presented with sudden onset of severe left arm burning dysesthesia and bilateral leg numbness and weakness for several hours. He denied any recent illnesses or trauma and was previously healthy. His exam showed decreased strength to his left upper extremity, decreased light touch sensation to bilateral lower extremities, and urinary retention. Computed tomography (CT) and magnetic resonance imaging (MRI) of the cervical spine were performed, which demonstrated acute cervical myelopathy due to congenital cervical stenosis, a less common finding. Congenital cervical stenosis is the narrowing of the cervical spinal canal that is not due to structural, infectious, vascular, or malignant causes. This is an important diagnosis to consider in patients who present with neurologic symptoms without risk factors for common myelopathy causes (eg, degenerative changes). Early diagnosis and treatment are essential to prevent long term neurologic deficits. Topics Neurosurgery, cervical myelopathy, acute neurologic deficits.
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Affiliation(s)
- Carolina Ornelas-Dorian
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, CA
| | - Paul Jhun
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, CA
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Wang Z, Ye W, Zhu Y, Tang P, Cai W. Radiographic predictors for recurrence of lumbar symptoms after prioritized cervical surgery in patients with tandem spinal stenosis. 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 2022; 31:2769-2776. [PMID: 35819541 DOI: 10.1007/s00586-022-07295-8] [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: 01/18/2022] [Revised: 05/01/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The purpose of the current study was to explore radiographic predictors for recurrence of lumbar symptoms after prioritized cervical surgery in patients with tandem spinal stenosis (TSS). METHODS The current retrospective cohort study included 74 patients with TSS, who underwent prioritized cervical surgery. Based on presence or absence of improvement in lower limb symptoms, patients were grouped into improved and non-improved groups. Medical records and radiological parameters including age, sex, body mass index, cervical and lumbar parameters were analyzed. In improved group, patients were divided into relapsed and non-relapsed groups based on recurrence in lower limb symptoms. RESULTS Lumbar symptoms improved in 70.1% (n = 52) of patients. Comparison between the improved and non-improved group showed that there were no statistically significant differences in cervical parameters while comparisons between the relapsed and non-relapsed groups showed significant differences in redundant nerve roots (RNRs) (p = 0.029), narrow segment (p = 0.042) and lumbar stenosis index (LSI) (p = 0.003). In multivariate logistic regression analysis, LSI > 10 (p = 0.016) was independently associated with recurrence of lumbar symptoms. CONCLUSIONS Finding of the current study indicated that LSI > 10 was associated with recurrence of lumbar symptoms in TSS patients following cervical surgery.
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Affiliation(s)
- Zhuanghui Wang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Wu Ye
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Yufeng Zhu
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Pengyu Tang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Weihua Cai
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China.
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Yeni YN, Azad S, Oravec D, Schildcrout A, Basheer A, Bey MJ, Bartol SW, Chang V. Intervertebral kinematics during neck motion 6.5 years after fusion and artificial disc replacement. Clin Biomech (Bristol, Avon) 2022; 99:105756. [PMID: 36063742 DOI: 10.1016/j.clinbiomech.2022.105756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Arthroplasty with artificial disc replacement for surgical treatment of cervical spine degeneration was introduced with the notion that motion-preserving approaches would prevent development of adjacent segment disease. Though clinical outcomes favor arthroplasty over the commonly used anterior cervical discectomy with fusion approach, clinical studies confirming the biomechanical basis of these results are lacking. The aim of this study was to compare intervertebral kinematics between arthroplasty and fusion patients 6.5 years post-surgery during physiological motion of the neck. METHODS Using a biplane dynamic X-ray system, computed tomography imaging and model based tracking algorithms, three dimensional intervertebral kinematics were measured during neck axial rotation and extension in 14 patients treated for cervical radiculopathy with fusion (n = 8) or arthroplasty (n = 6). The measurements were performed at 2-year (baseline) and 6.5 year post-surgical time points, with the main interest being in the interaction between surgery types and time points. 3 translations and 3 rotations were investigated for the index (C5C6), and upper- (C4C5) and lower adjacent levels (C6C7). FINDINGS Surgery-time interaction was significant for axial rotation (P < 0.04) and flexion-extension rotation (P < 0.005) in C4C5 during neck axial rotation, left-right translation (P < 0.04) in C5C6 and anterior-posterior translation in C6C7 (P < 0.04) during neck extension. In contrast with the expectations, axial rotation and flexion-extension decreased in C4C5 during neck rotation and anterior-posterior translation decreased in C6C7 during neck extension for fusion. INTERPRETATION The findings do not support the notion that adjacent segment motion increases after fusion.
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Affiliation(s)
- Yener N Yeni
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA.
| | - Sherwin Azad
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA; School of Medicine, Wayne State University, Detroit, MI, USA
| | - Daniel Oravec
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA
| | - Andrew Schildcrout
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA
| | - Azam Basheer
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA
| | - Michael J Bey
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA
| | - Stephen W Bartol
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA
| | - Victor Chang
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA
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Muacevic A, Adler JR. Identification of Degenerative Cervical Myelopathy in the Chiropractic Office: Case Report and a Review of the Literature. Cureus 2022; 14:e30508. [PMID: 36415361 PMCID: PMC9675290 DOI: 10.7759/cureus.30508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 12/14/2022] Open
Abstract
Degenerative cervical myelopathy (DCM) is a common cause of spinal cord dysfunction, yet it may be challenging to identify as it presents with variable symptoms. A 62-year-old woman presented to a chiropractor with a three-month exacerbation of neck pain, hand/finger numbness, and torso dysesthesia. She had previously seen primary care, physical therapy, rheumatology, and pain management. Previous cervical magnetic resonance imaging showed moderate cervical canal stenosis; however, previous providers had diagnosed her with radiculopathy and possible carpal tunnel syndrome yet had not requested neurosurgical consultation. On examination, the chiropractor identified sensorimotor deficits, hyperreflexia, and bilateral Hoffman reflexes, and referred the patient to a neurosurgeon for suspected DCM. The neurosurgeon performed an anterior cervical discectomy and fusion from C4-7. The patient's symptoms and disability level improved within two months of follow-up. We identified 11 previous cases in which a chiropractor suspected DCM which was then confirmed by a surgeon. Including the current case (i.e., 12 total), patients were older and mostly male; 50% had neck pain, 92% had hyperreflexia. Chiropractors referred each patient to a surgeon; 83% underwent cervical spine surgery. This case highlights the identification of DCM by a chiropractor and referral for neurosurgical evaluation with a positive outcome. Patients with previously undiagnosed DCM may present to chiropractors with varied symptoms and examination findings. DCM may contraindicate spinal manipulation and instead warrant surgery. Accordingly, chiropractors play a key role in the detection and referral of patients with misdiagnosed or overlooked DCM.
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Effect of degenerative factors on cervical spinal cord during flexion and extension: a dynamic finite element analysis. Biomech Model Mechanobiol 2022; 21:1743-1759. [PMID: 35931861 DOI: 10.1007/s10237-022-01617-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/13/2022] [Indexed: 11/02/2022]
Abstract
Spinal cord injury (SCI) is a global problem that brings a heavy burden to both patients and society. Recent investigations indicated degenerative disease is taking an increasing part in SCI with the growth of the aging population. However, little insight has been gained about the effect of cervical degenerative disease on the spinal cord during dynamic activities. In this work, a dynamic fluid-structure interaction model was developed and validated to investigate the effect of anterior and posterior encroachment caused by degenerative disease on the spinal cord during normal extension and flexion. Maximum von-Mises stress and maximum principal strain were observed at the end of extension and flexion. The abnormal stress distribution caused by degenerative factors was concentrated in the descending tracts of the spinal cord. Our finding indicates that the excessive motion of the cervical spine could potentially exacerbate spinal cord injury and enlarge injury areas. Stress and strain remained low compared to extension during moderate flexion. This suggests that patients with cervical degenerative disease should avoid frequent or excessive flexion and extension which could result in motor function impairment, whereas moderate flexion is safe. Besides, encroachment caused by degenerative factors that are not significant in static imaging could also cause cord compression during normal activities.
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Bai Q, Wang Y, Zhai J, Wu J, Zhang Y, Zhao Y. Current understanding of tandem spinal stenosis: epidemiology, diagnosis, and surgical strategy. EFORT Open Rev 2022; 7:587-598. [PMID: 35924651 PMCID: PMC9458946 DOI: 10.1530/eor-22-0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Tandem spinal stenosis (TSS) is defined as the concomitant occurrence of stenosis in at least two or more distinct regions (cervical, thoracic, or lumbar) of the spine and may present with a constellation of signs and symptoms. It has four subtypes, including cervico-lumbar, cervico-thoracic, thoraco-lumbar, and cervico-thoraco-lumbar TSS. The prevalence of TSS varies depending on the different subtypes and cohorts. The main aetiologies of TSS are spinal degenerative changes and heterotopic ossification, and patients with developmental spinal stenosis, ligament ossification, and spinal stenosis at any region are at an increased risk of developing TSS. The diagnosis of TSS is challenging. The clinical presentation of TSS could be complex, concealed, or severe, and these features may be confusing to clinicians, resulting in an incomplete or delayed diagnosis. Additionally, a consolidated diagnostic criterion for TSS is urgently required to improve consistency across studies and form a basis for establishing treatment guidelines. The optimal treatment option for TSS is still under debate; areas of controversies include choice of the decompression range, choice between simultaneous or staged surgical patterns, and the order of the surgeries. The present study reviews publications on TSS, consolidates current awareness on prevalence, aetiologies, potential risk factors, diagnostic dilemmas and criteria, and surgical strategies based on TSS subtypes. This is the first review to include thoracic spinal stenosis as a candidate disorder in TSS and aims at providing the readers with a comprehensive overview of TSS.
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Affiliation(s)
- Qiushi Bai
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuanyi Wang
- Department of Spinal Surgery, The First Hospital of Jilin University, Changchun, China
| | - Jiliang Zhai
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jigong Wu
- Chinese People's Liberation Army Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Yan Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu Zhao
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Cervical foraminal stenosis as a risk factor for cervical kyphosis following cervical laminoplasty. Spine J 2022; 22:1271-1280. [PMID: 35385788 DOI: 10.1016/j.spinee.2022.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Cervical laminoplasty (CLP) is an effective spinal cord decompression method for patients with cervical myelopathy. However, cervical kyphosis after CLP may cause insufficient decompression of the spinal cord. Thus, prevention of cervical kyphosis after CLP and identification of its risk factors are essential. PURPOSE This study aimed to investigate the relationship between preoperative cervical foraminal stenosis and kyphotic changes after CLP. STUDY DESIGN A retrospective study. PATIENT SAMPLE We reviewed 108 patients who underwent CLP for cervical myelopathy between May 2014 and May 2019 and who were followed up for at least 24 months. OUTCOME MEASURES For clinical assessments, neck pain, arm pain, neck disability index, Japanese Orthopedic Association scores, EuroQol 5-Dimension, and subjective improvement rate reported by the patients were evaluated. For radiologic parameters, C2-7 Cobb lordotic angle (CLA), C2-7 sagittal vertical axis, T1 slope (TS), TS minus CLA (TS-CLA), and cervical range of motion were assessed preoperatively and postoperatively for 24 months. Cervical foraminal stenosis was evaluated by magnetic resonance imaging and computed tomography. METHODS The study population was divided into the kyphosis group (n = 25 patients) and the lordosis group (n = 83 patients) according to the CLA at 24 months postoperatively. Preoperative risk factors related to postoperative kyphosis were analyzed. Statistical analyses were performed using independent two-sample t test, Chi-square test, logistic regression analysis, and linear mixed model. RESULTS Preoperative foraminal stenosis, CLA, TS, and TS-CLA were significantly different between the kyphosis and lordosis groups. In multivariate logistic regression analysis, foraminal stenosis (odds ratio [OR], 4.471; p = .0242) significantly increased the risk of kyphosis. The probability of developing kyphosis decreased with an increase in the CLA (OR, 0.840; p = .0001), while the probability of developing kyphosis increased with an increase in the TS-CLA (OR, 1.104; p = .0044). CONCLUSIONS Preoperative cervical foraminal stenosis is an independent risk factor for cervical kyphosis following CLP. Thus, CLP may not be a suitable surgical option for cervical myelopathy combined with foraminal stenosis.
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Ruiz Santiago F, Láinez Ramos-Bossini AJ, Wáng YXJ, Martínez Barbero JP, García Espinosa J, Martínez Martínez A. The value of magnetic resonance imaging and computed tomography in the study of spinal disorders. Quant Imaging Med Surg 2022; 12:3947-3986. [PMID: 35782254 PMCID: PMC9246762 DOI: 10.21037/qims-2022-04] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/13/2022] [Indexed: 08/15/2023]
Abstract
Computed tomography (CT) and magnetic resonance imaging (MRI) have replaced conventional radiography in the study of many spinal conditions, it is essential to know when these techniques are indicated instead of or as complementary tests to radiography, which findings can be expected in different clinical settings, and their significance in the diagnosis of different spinal conditions. Proper use of CT and MRI in spinal disorders may facilitate diagnosis and management of spinal conditions. An adequate clinical approach, a good understanding of the pathological manifestations demonstrated by these imaging techniques and a comprehensive report based on a universally accepted nomenclature represent the indispensable tools to improve the diagnostic approach and the decision-making process in patients with spinal pain. Several guidelines are available to assist clinicians in ordering appropriate imaging techniques to achieve an accurate diagnosis and to ensure appropriate medical care that meets the efficacy and safety needs of patients. This article reviews the clinical indications of CT and MRI in different pathologic conditions affecting the spine, including congenital, traumatic, degenerative, inflammatory, infectious and tumor disorders, as well as their main imaging features. It is intended to be a pictorial guide to clinicians involved in the diagnosis and treatment of spinal disorders.
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Affiliation(s)
| | | | - Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - José Pablo Martínez Barbero
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
| | - Jade García Espinosa
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
| | - Alberto Martínez Martínez
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
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Alkosha HM, El Adalany MA, Elsobky H, Zidan AS, Sabry A, Awad BI. Flexion/Extension Cervical MR imaging: A potentially useful Tool for Decision-Making in Patients with Symptomatic Degenerative Cervical Spine. World Neurosurg 2022; 164:e1078-e1086. [DOI: 10.1016/j.wneu.2022.05.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 10/18/2022]
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