Evaluation of spinal cord compression and hyperintense intramedullary lesions on T2-weighted sequences in patients with cervical spondylotic myelopathy using flexion-extension MRI protocol

Purpose:To assess the extent of demyelination in cervical spondylotic myelopathy (CSM) using myelin water imaging (MWI) and electrophysiologic techniques.Methods:Somatosensory evoked potentials (SSEPs) and MWI were acquired in 14 patients with CSM and 18 age-matched healthy controls. MWI was performed on a 3.0T whole body magnetic resonance scanner. Myelin water fraction (MWF) was extracted for the dorsal columns and whole cord. SSEPs and MWF were also compared with conventional MRI outcomes, including T2 signal intensity, compression ratio, maximum spinal cord compression (MSCC), and maximum canal compromise (MCC).Results:Group analysis showed marked differences in T2 signal intensity, compression ratio, MSCC, and MCC between healthy controls and patients with CSM. There were no group differences in MWF and SSEP latencies. However, patients with CSM with pathologic SSEPs exhibited reduction in MWF (p < 0.05). MWF was also correlated with SSEP latencies.Conclusion:Our findings provide evidence of decreased myelin content in the spinal cord associated with impaired spinal cord conduction in patients with CSM. While conventional MRI are of great value to define the extent of cord compression, they show a limited correlation with functional deficits (i.e., delayed SSEPs). MWI provides independent and complementary readouts to spinal cord compression, with a high specificity to detect impaired conduction.

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The relationship between central motor conduction time and spinal cord compression in patients with cervical spondylotic myelopathy

Spinal Cord ◽

10.1038/sc.2016.130 ◽

2016 ◽

Vol 55 (4) ◽

pp. 419-426 ◽

Cited By ~ 6

Author(s):

T Rikita ◽

N Tanaka ◽

K Nakanishi ◽

N Kamei ◽

N Sumiyoshi ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Cervical Spondylotic Myelopathy ◽

Cord Compression ◽

Conduction Time ◽

Central Motor Conduction Time ◽

The Relationship

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The use of flexion-extension magnetic resonance imaging for evaluating signal intensity changes of the cervical spinal cord

Journal of Neurosurgery Spine ◽

10.3171/2009.1.spine08567 ◽

2009 ◽

Vol 10 (4) ◽

pp. 366-373 ◽

Cited By ~ 11

Author(s):

Kern H. Guppy ◽

Mark Hawk ◽

Indro Chakrabarti ◽

Amit Banerjee

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Cervical Spine ◽

Magnetic Resonance ◽

Mr Imaging ◽

Spinal Cord Compression ◽

Cord Compression ◽

Resonance Imaging ◽

Flexion Extension ◽

Dynamic Mr

The authors present 2 cases involving patients who presented with myelopathy. Magnetic resonance imaging of the cervical spine showed spinal cord signal changes on T2-weighted images without any spinal cord compression. Flexion-extension plain radiographs of the spine showed no instability. Dynamic MR imaging of the cervical spine, however, showed spinal cord compression on extension. Compression of the spinal cord was caused by dynamic anulus bulging and ligamentum flavum buckling. This report emphasizes the need for dynamic MR imaging of the cervical spine for evaluating spinal cord changes on neutral position MR imaging before further workup for other causes such as demyelinating disease.

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Predictive Effect of Cervical Spinal Cord Compression and Corresponding Segmental Paravertebral Muscle Degeneration on the Severity of Symptoms in Patients with Cervical Spondylotic Myelopathy

The Spine Journal ◽

10.1016/j.spinee.2021.03.030 ◽

2021 ◽

Author(s):

Taotao Lin ◽

Zhenyu Wang ◽

Gang Chen ◽

Wenge Liu

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Cervical Spondylotic Myelopathy ◽

Cervical Spinal Cord ◽

Cord Compression ◽

Muscle Degeneration ◽

Paravertebral Muscle ◽

Predictive Effect

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Dynamic Compression of the Spinal Cord by Paraspinal Muscles following Cervical Laminectomy: Diagnosis Using Flexion-Extension MRI

Case Reports in Radiology ◽

10.1155/2015/275623 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Linton T. Evans ◽

S. Scott Lollis

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Dynamic Compression ◽

Cord Compression ◽

Neutral Position ◽

X Rays ◽

Paraspinal Muscles ◽

Neck Extension ◽

Cervical Laminectomy ◽

Flexion Extension

Introduction. Flexion-extension, or kinematic, MRI has been used to identify dynamic spondylotic spinal cord compression not seen with traditional static MRI. The use of kinematic MRI to diagnose postoperative complications, specifically dynamic compression, is not as well documented. The authors describe a case of dynamic spinal cord compression by the paraspinal muscles causing worsening myelopathy following cervical laminectomy. This was only diagnosed with flexion-extension MRI.Methods. The patient was a 90-year-old male presenting to the neurosurgery clinic with functional decline and cervical spondylotic myelopathy.Results. A multilevel laminectomy was performed. Following surgery the patient had progressive weakness and worsening myelopathy. No active cord compression was seen on multiple MRIs obtained in a neutral position, and flexion-extension X-rays did not show instability. A kinematic MRI demonstrated dynamic compression of the spinal cord only during neck extension, by the paraspinal muscles. To relieve the compression, the patient underwent an instrumented fusion, with cross-links used to buttress the paraspinal muscles away from the cord. This resulted in neurologic improvement.Conclusions. We describe a novel case of spinal cord compression by paraspinal muscles following cervical laminectomy. In individuals with persistent myelopathy or delayed neurologic decline following posterior decompression, flexion-extension MRI may prove useful in diagnosing this potential complication.

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