Progressive Myelopathy After Neck Pain

2021 ◽  
pp. 246-247
Author(s):  
Eoin P. Flanagan
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cervical Spine ◽  
Magnetic Resonance ◽  
Neck Pain ◽  
Cervical Spondylotic Myelopathy ◽  
Transverse Myelitis ◽  
Sensory Level ◽  
Neurologic Examination ◽  
Enhancement Pattern ◽  
Progressive Myelopathy

A 36-year-old woman with a history of hypothyroidism, gout, fibromyalgia, depression, substance use disorder, and nephrolithiasis had development of neck pain. Three months later, she noted numbness in the left leg, which slowly worsened over the course of several months, spreading to involve the right leg and eventually forming a sensory level across the trunk at T8. At that time she also noted numbness in both hands. She had stiffness and weakness in both legs and had trouble emptying her bladder. Neurologic examination showed mild weakness restricted to the bilateral iliopsoas and hyperreflexia in the upper and lower extremities. Hoffmann and Babinski signs were positive bilaterally. There was moderate spasticity in both lower extremities and mild distal vibratory sensation loss, with a sensory level across the trunk at T8. Her gait examination indicated a spastic gait, and she had a mildly positive Romberg sign. On re-evaluation of her previous magnetic resonance image, a transverse band or pancakelike enhancement pattern was noted at the center of a moderate to severely stenotic region of the cervical spine sparing gray matter on axial sequences. The magnetic resonance imaging findings were highly suggestive of cervical spondylotic myelopathy. A neurosurgical referral was made, and the patient underwent anterior cervical discectomy with decompression and fusion from C4-C7. At her follow-up visit 4 months after surgery, the patient reported improvement in her strength and walking. Her neurologic examination showed normal lower extremity strength, resolution of spasticity, and negative Babinski sign bilaterally but persistent sensory deficits. Magnetic resonance imaging of the cervical spine at that time showed a decrease in the degree of T2 hyperintensity and enhancement, consistent with interval response to surgery. The presence of a progressive myelopathy over many months in this case patient argued against a diagnosis of transverse myelitis. Furthermore, the cerebrospinal fluid was noninflammatory, which also favored cervical spondylosis over idiopathic transverse myelitis. However, the gadolinium enhancement pattern was the key diagnostic feature that strongly suggested cervical spondylotic myelopathy as the diagnosis and ultimately led to neurosurgical referral for decompression.

Progressive Myelopathy After Spine Surgery

2021 ◽  
pp. 251-253
Author(s):  
Andrew McKeon ◽  
Nicholas L. Zalewski
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Sensory Level ◽  
Additional Risk Factor ◽  
Resonance Imaging ◽  
Cerebrospinal Fluid Flow ◽  
Progressive Myelopathy ◽  
Signal Abnormality

A 69-year-old man with a progressive myelopathy for 2 years was referred for evaluation of suspected transverse myelitis. His medical history included discectomies, a severe episode of herpes simplex virus type 1 meningoencephalitis, and development of insidiously progressive numbness and weakness of his hands. Cervical spine magnetic resonance imaging showed 2 small, dural-based, gadolinium-enhancing lesions. Biopsy of these lesions showed only normal neural tissue. Subsequently, the dura was stripped away surgically from the lower cervical region, in an effort to remove these lesions. During the next year, a sensory level developed at about the level of the nipples (T4), along with a squeezing sensation on his trunk below. Imbalance and bilateral lower extremity weakness and numbness then developed. Magnetic resonance imaging showed a longitudinally extensive cord signal abnormality. The cause of the patient’s initial subjective hand numbness and weakness was indeterminate. The onset of severely progressive symptoms after surgical removal of those lesions and the reported stripping of dura made it likely that the progressive cord edema was due to chronic adhesive arachnoiditis. His prior meningoencephalitis was a potential additional risk factor for arachnoiditis. Computed tomography myelography showed a markedly abnormal spinal canal with scalloping of the cord contour, with delayed flow of contrast above C6-C7, consistent with arachnoid adhesions causing obstruction of normal cerebrospinal fluid flow. The patient was diagnosed with chronic adhesive arachnoiditis. A C4-C7 laminectomy and surgical lysis of the cord meningeal adhesions was performed, with subsequent intensive neurorehabilitation. Follow-up spinal cord magnetic resonance imaging 6 months after surgery showed improvement of the T2-signal abnormality but persistent myelomalacia and spinal cord atrophy. Adhesive arachnoiditis is an uncommon cause of progressive myelopathy resulting from an insult to the arachnoid meningeal layer, followed by inflammation and fibrosis. This process renders the arachnoid abnormally thick and adherent to the pia and dura mater. Abnormal adhesion of nerve roots or spinal cord to the dura produces neurologic impairment. Typical symptoms include back pain, paresthesias, lower limb weakness, and sensory loss. It is diagnosed clinically with supportive magnetic resonance imaging and computed tomography myelography findings.

Magnetic Resonance Imaging-Based Evaluation of the Etiology of Non-Traumatic Myelopathies in Bangladesh: A Hospital-based Observational Cross-sectional Study from Two Tertiary Care Centers of Dhaka

2018 ◽  
Vol 4 (2) ◽  
pp. 87-91
Author(s):  
Mohammad Aftab Haleem ◽  
Mohammad Shahidul Islam ◽  
Firoz Ahmed Quraishi ◽  
Shakhawat Hossain ◽  
LC Gosh ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cervical Spondylotic Myelopathy ◽  
Spinal Tuberculosis ◽  
Transverse Myelitis ◽  
Age Group ◽  
Resonance Imaging ◽  
Mri Scan ◽  
Exclusion Criteria ◽  
Mri Changes

Background: Non-traumatic myelopathies has several etiologies.Objectives: The aim of the study was to see the etiology of non-traumatic myelopathy based on magnetic resonance imaging (MRI) changes in the context of Bangladesh.Methodology: Patients clinically diagnosed as non-traumatic myelopathy in the department of neurology of Sir Salimullah Medical College and Hospital (SSMCH), and in the inpatient wards of the National Institute of Neurosciences (NINS), considering the inclusion and exclusion criteria were enrolled as the study population from May 2014 to December 2015. Age, gender, clinical presentations and type of lesion based on MRI changes were collected. All the data were analyzed statistically.Results: Total 100 cases satisfied the inclusion and exclusion criteria in this study. Among them, there were 62 males and 38 females with a male to female ratio of 1.63:1. The mean age was found to be (mean ± SD) 45.80 ±15.28 with age ranges from 15 to 74 years. The highest number of patients (26.0%) was in the age group 51-60 years, followed by 24% patients in the age group 31-40 years. Based on MRI scan, most common etiologies that commonly diagnosed are cervical spondylotic myelopathy (31%), transverse myelitis (26%), primary spinal tumour (13%), spinal tuberculosis(12%), spinal metastatic disease (12%), and unclassified (6%). MRI scan also detect the common sites of involvements of these causes.Conclusion: In this study cervical spondylotic myelopathy, transverse myelitis, and spinal tuberculosis are the most common cause of non-traumatic myelopathy in the context of Bangladesh.Journal of National Institute of Neurosciences Bangladesh, 2018;4(2): 87-91

scholarly journals DYNAMIC MAGNETIC RESONANCE IMAGING: PRELIMINARY PRESENTATION OF A TECHNIQUE

2016 ◽  
Vol 15 (3) ◽  
pp. 209-212
Author(s):  
BRUNO DA COSTA ANCHESCHI ◽  
ANIELLO SAVARESE ◽  
RAPHAEL DE REZENDE PRATALI ◽  
DANIEL AUGUSTO CARVALHO MARANHO ◽  
MARCELLO TEIXEIRA CASTILHA ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Cervical Spine ◽  
Magnetic Resonance ◽  
Cervical Spondylotic Myelopathy ◽  
Dynamic Magnetic Resonance Imaging ◽  
Neutral Position ◽  
Resonance Imaging ◽  
Significant Difference ◽  
Flexion And Extension

ABSTRACT Objective: To evaluate morphometric variations of the cervical spine in patients with cervical spondylotic myelopathy (CSM) using dynamic magnetic resonance imaging (MRI) in neutral, flexion and extension positions. Methods: This is a prospective study of patients with CSM secondary to degenerative disease of the cervical spine. The morphometric parameters were evaluated using T2-weighted MRI sequences in the sagittal plane in neutral, flexion and extension position of the neck. The parameters studied were the anterior length of the spinal cord (ALSC), the posterior length of the spinal cord (PLSC), the diameter of the vertebral canal (DVC) and the diameter of the spinal cord (DSC). Results: The ALSC and PLSC were longer in flexion than in extension and neutral position, with statistically significant difference between the flexion and extension position. The DVC and the DSC were greater in flexion than in extension and neutral position, however, there was no statistically significant difference when they were compared in the neutral, flexion and extension positions. Conclusion: Dynamic MRI allows to evaluate morphometric variations in the cervical spinal canal in patients with cervical spondylotic myelopathy.

Cervical Myelopathy

2018 ◽  
pp. 63-70
Author(s):  
Randall J. Hlubek ◽  
Nicholas Theodore
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Neck Pain ◽  
Cervical Spondylotic Myelopathy ◽  
Cervical Spinal Cord ◽  
Ct Myelography ◽  
Weighted Magnetic Resonance Imaging

Cervical spondylotic myelopathy is compression of the cervical spinal cord secondary to degenerative changes. Symptoms, which include gait disturbance, upper extremity paresthesia, weakness, and loss of dexterity, tend to progress gradually. The diagnosis of cervical spondylotic myelopathy cannot be made without imaging. T2-weighted magnetic resonance imaging allows for careful inspection of the spinal cord and can reveal hyperintensity that may represent myelomalacia secondary to chronic compression. Computed tomography (CT) myelography may be useful in patients for whom MR imaging is contraindicated. Flexion and/or extension cervical radiographs should be obtained for any patient who reports neck pain.

Cervical spine clearance in the traumatically injured patient: is multidetector CT scanning sufficient alone?

2013 ◽  
Vol 19 (5) ◽  
pp. 576-581 ◽  
Author(s):  
Brandon G. Chew ◽  
Christopher Swartz ◽  
Matthew R. Quigley ◽  
Daniel T. Altman ◽  
Richard H. Daffner ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cervical Spine ◽  
Magnetic Resonance ◽  
Neck Pain ◽  
Multidetector Ct ◽  
Altered Mental Status ◽  
Radicular Pain ◽  
Resonance Imaging ◽  
Ligamentous Injury

Object Clearance of the cervical spine in patients who have sustained trauma remains a contentious issue. Clinical examination alone is sufficient in neurologically intact patients without neck pain. Patients with neck pain or those with altered mental status or a depressed level of consciousness require further radiographic evaluation. However, no consensus exists as to the appropriate imaging modality. Some advocate multidetector CT (MDCT) scanning alone, but this has been criticized because MDCT is not sensitive in detecting ligamentous injuries that can often only be identified on MRI. Methods Patients were identified retrospectively from a prospectively maintained database at a Level I trauma center. All patients admitted between January 2004 and June 2011 who had a cervical MDCT scan interpreted by a board-certified radiologist as being without evidence of acute traumatic injury and who also had a cervical MRI study obtained during the same hospital admission were included. Data collected included patient demographics, mechanism of injury, Glasgow Coma Scale score at the time of MRI, the indication for and findings on MRI, and the number, type, and indication for cervical spine procedures. Results A total of 1004 patients were reviewed, of whom 614 were male, with an overall mean age of 47 years. The indication for MRI was neck pain in 662 patients, altered mental status in 467, and neurological signs or symptoms in 157. The MRI studies were interpreted as normal in 645 patients, evidencing ligamentous injury alone in 125, and showing nonspecific degenerative changes in the remaining patients. Of the 125 patients with ligamentous injuries, 66 (52.8%) had documentation of clearance (29 clinical, 37 with flexion-extension radiographs). Another 32 patients were presumed to be self-cleared, bringing the follow-up rate to 82% (98 of 119). Five patients died prior to clearance, and 1 patient was transferred to another facility prior to clearance. Based on these data, the 95% confidence interval for the assertion that clinically irrelevant ligamentous injury in the face of normal MDCT is 97%–100%. No patient with ligamentous injury on MRI was documented to require a surgical procedure or halo orthosis for instability. Thirty-nine patients ultimately underwent cervical surgical procedures (29 anterior and 10 posterior; 5 delayed) for central cord syndrome (21), quadriparesis (9), or discogenic radicular pain (9). None had an unstable spine. Conclusions In this study population, MRI did not add any additional information beyond MDCT in identifying unstable cervical spine injuries. Magnetic resonance imaging frequently detected ligamentous injuries, none of which were found to be unstable at the time of detection, during the course of admission, or on follow-up. Magnetic resonance imaging provided beneficial clinical information and guided surgical procedures in patients with neurological deficits or radicular pain. An MDCT study with sagittal and coronal reconstructions negative for acute injury in patients without an abnormal motor examination may be sufficient alone for clearance.

Management of The Cervical Spine Tuberculosis

2018 ◽  
Vol 1 (2) ◽  
pp. 19
Author(s):  
Sabri Ibrahim
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cervical Spine ◽  
Magnetic Resonance ◽  
Spinal Tuberculosis ◽  
Intervertebral Disk ◽  
Posterior Fixation ◽  
Resonance Imaging ◽  
Vertebral Bodies ◽  
Intervertebral Disk Space ◽  
Developed Nations

Tuberculosis of the cervical spine is a rare clinical condition (10%), most commonly affected lower thoracic region (40-50% of the cases). Spinal tuberculosis is a destructive form of tuberculosis. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Spinal tuberculosis is more common in children and young adults. The incidence of spinal tuberculosis is increasing in developed nations. Characteristically, there is a destruction of the intervertebral disk space and the adjacent vertebral bodies, collapse of the spinal elements, and anterior wedging leading to kyphosis and gibbus formation. For the diagnosis of spinal tuberculosis, magnetic resonance imaging is more sensitive than x-ray and more specific than computed tomography. Magnetic resonance imaging frequently demonstrates an involvement of the vertebral bodies on either side of the disk, disk destruction, cold abscess, vertebral collapse, and presence of vertebral column deformities. Anti-tuberculous treatment remains the cornerstone of treatment. Surgery may be required in selected cases, e.g. large abscess formation, severe kyphosis, an evolving neurological deficit, or lack of response to medical treatment. The quality of debridement and bony fusion is optimal when the anterior approach is used. Posterior fixation is the best means of achieving reduction followed by stable sagittal alignment over time. With early diagnosis and early treatment, the prognosis is generally good.

Sign in / Sign up

Export Citation Format

Share Document