Correlation between Magnetic Resonance Imaging and Surgical Findings in the Tethered Spinal Cord

Abstract Between October 1982 and August 1987, 20 patients underwent magnetic resonance imaging (MRI) and subsequent surgical release of a tethered spinal cord. The tethering was caused by a thick filum terminale in 6 patients. On MRI scans, the conus medullaris was at L4 in 2 patients, at L2 in 3 patients, and the filum terminale appeared thick in 1 patient. The spinal cord was tethered to an intradural lipoma correctly demonstrated by MRI in 6 patients. Increased epidural fat was misdiagnosed as an intradural lipoma in one patient and a lipomatous stalk was not identified in 2 other patients. Scar tissue resulting from repair of a meningocele had tethered the cord in the remaining 8 patients. On MRI scans, the conus medullaris was located between L3 and S3; in 5 of the patients, scar tissue was apparent on the MRI scan. This correlative study supports the use of MRI as the initial, and possibly the only, imaging modality when a tethered spinal cord is suspected. Improved or more recent MRI techniques will help demonstrate these anomalies better.

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Multisession CyberKnife Radiosurgery for Intramedullary Spinal Cord Arteriovenous Malformations

Neurosurgery ◽

10.1227/01.neu.0000215891.25153.ba ◽

2006 ◽

Vol 58 (6) ◽

pp. 1081-1089 ◽

Cited By ~ 89

Author(s):

John Sinclair ◽

Steven D. Chang ◽

Iris C. Gibbs ◽

John R. Adler

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Magnetic Resonance ◽

Arteriovenous Malformations ◽

Conus Medullaris ◽

Spinal Angiography ◽

Resonance Imaging ◽

Intramedullary Spinal Cord ◽

Cyberknife Radiosurgery

Abstract OBJECTIVE: Intramedullary spinal cord arteriovenous malformations (AVMs) have an unfavorable natural history that characteristically involves myelopathy secondary to progressive ischemia and/or recurrent hemorrhage. Although some lesions can be managed successfully with embolization and surgery, AVM size, location, and angioarchitecture precludes treatment in many circumstances. Given the poor outlook for such patients, and building on the successful experience with radiosurgical ablation of cerebral AVMs, our group at Stanford University has used CyberKnife (Accuray, Inc., Sunnyvale, CA) stereotactic radiosurgery (SRS) to treat selected spinal cord AVMs since 1997. In this article, we retrospectively analyze our preliminary experience with this technique. METHODS: Fifteen patients with intramedullary spinal cord AVMs (nine cervical, three thoracic, and three conus medullaris) were treated by image-guided SRS between 1997 and 2005. SRS was delivered in two to five sessions with an average marginal dose of 20.5 Gy. The biologically effective dose used in individual patients was escalated gradually over the course of this study. Clinical and magnetic resonance imaging follow-up were carried out annually, and spinal angiography was repeated at 3 years. RESULTS: After a mean follow-up period of 27.9 months (range, 3–59 mo), six of the seven patients who were more than 3 years from SRS had significant reductions in AVM volumes on interim magnetic resonance imaging examinations. In four of the five patients who underwent postoperative spinal angiography, persistent AVM was confirmed, albeit reduced in size. One patient demonstrated complete angiographic obliteration of a conus medullaris AVM 26 months after radiosurgery. There was no evidence of further hemorrhage after CyberKnife treatment or neurological deterioration attributable to SRS. CONCLUSION: This description of CyberKnife radiosurgical ablation demonstrates its feasibility and apparent safety for selected intramedullary spinal cord AVMs. Additional experience is necessary to ascertain the optimal radiosurgical dose and ultimate efficacy of this technique.

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Fetal magnetic resonance imaging of normal spinal cord: Evaluating cord visualization and conus medullaris position by T2-weigted sequences

Biomedical Journal ◽

10.4103/2319-4170.125649 ◽

2014 ◽

Vol 37 (4) ◽

pp. 232 ◽

Cited By ~ 7

Author(s):

AlexM Wong ◽

Ho-Ling Liu ◽

Yung-Liang Wan ◽

Yu-Chun Lin ◽

An-Shine Chao ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Magnetic Resonance ◽

Conus Medullaris ◽

Resonance Imaging ◽

Fetal Magnetic Resonance Imaging

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Correlation of Postmortem 9.4 Tesla Magnetic Resonance Imaging and Immunohistopathology of the Human Thoracic Spinal Cord 7 Months after Traumatic Cervical Spine Injury

Neurosurgery ◽

10.1227/01.neu.0000228929.15492.a9 ◽

2006 ◽

Vol 59 (3) ◽

pp. 671-678 ◽

Cited By ~ 13

Author(s):

Felix Scholtes ◽

Peter Adriaensens ◽

Liesbet Storme ◽

Armin Buss ◽

Byron A. Kakulas ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Magnetic Resonance ◽

Spinal Cord Injuries ◽

Spine Injury ◽

Resonance Imaging ◽

Thoracic Spinal Cord ◽

Human Spinal Cord ◽

Thoracic Spinal ◽

Mri Scans

Abstract OBJECTIVE: To correlate high-resolution magnetic resonance imaging (MRI) with immunohistopathology in the injured human spinal cord. METHODS: Postmortem MRI scans at a field strength of 9.4 T, as well as standard histology and immunohistochemistry, were performed on an excised specimen of human high thoracic spinal cord, obtained 7 months after the initial trauma, several segments below a severe spinal cord lesion (C5). RESULTS: A precise correlation is described between MRI and immunohistochemistry of the long white matter tracts undergoing Wallerian degeneration and of an extension of the cervical lesion into the high thoracic cord. CONCLUSION: MRI, the only imaging technique that currently provides useful information on the spinal cord parenchyma after trauma, is rapidly evolving. High-field scanners of up to 9.4 T are being clinically tested. The present postmortem investigation of an isolated spinal cord specimen demonstrates the precise correlation that can be achieved between imaging and pathology. In future investigations, this type of technique can lead to a more precise description of spinal cord injuries and their consequences in remote tissue. Translation into the clinical setting will improve diagnosis and follow-up of spinal cord injured patients.

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The Value of Magnetic Resonance Imaging in the Evaluation of Fatty Filum Terminale

Neurosurgery ◽

10.1227/01.neu.0000103451.63301.0b ◽

2004 ◽

Vol 54 (2) ◽

pp. 375-380 ◽

Cited By ~ 27

Author(s):

Ketan R. Bulsara ◽

Ali R. Zomorodi ◽

David S. Enterline ◽

Timothy M. George

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Clinical Symptoms ◽

Conus Medullaris ◽

Neurological Deficits ◽

Resonance Imaging ◽

Group Iii ◽

Group I ◽

Significant Difference ◽

Mri Scans

Abstract OBJECTIVE To determine whether there are magnetic resonance imaging (MRI) characteristics of fatty fila that are correlated with neurological deficits, especially in the presence of a normal-level conus medullaris. METHODS Lumbosacral MRI scans were reviewed for patients with fatty fila who were treated at Duke University Medical Center during a 5-year period. The patients were divided into three groups. Group I patients (n = 5) had fatty fila that were incidentally detected during evaluations for metastases or infections. Group II patients (n = 16) exhibited isolated low back pain but were in neurologically intact condition. Group III patients (n = 15) exhibited neurological impairments consistent with distal spinal cord dysfunction. Several characteristics were measured on the MRI scans, including the location of the conus medullaris, the filum thickness, and the distance of fat from the conus. These results were assessed for statistically significant correlation with the presence of clinical symptoms. RESULTS The majority of patients in all three groups demonstrated the normal conus position (L2 or above) and thickened fila. The distance of fat from the conus was the only parameter that demonstrated a statistically significant difference among the groups. CONCLUSION The following findings were noted: 1) patients were likely to exhibit neurological deficits at a younger age (<22 yr in Group III versus 47 yr in Groups I and II); 2) a conus level below L2 was associated with neurological deficits (Group III); 3) filum thickness was not correlated with clinical presentation; 4) fat in the filum within 13 mm of the conus medullaris was most predictive of neurological deficits (Group III).

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Correlation between magnetic resonance imaging and surgical findings in the tethered spinal cord

Neurosurgery ◽

10.1097/00006123-198909000-00003 ◽

1989 ◽

pp. 341 ◽

Cited By ~ 2

Author(s):

N A Moufarrij ◽

J M Palmer ◽

J F Hahn ◽

M A Weinstein

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Magnetic Resonance ◽

Tethered Spinal Cord ◽

Resonance Imaging

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Faculty Opinions recommendation of Diffusion tensor magnetic resonance imaging of Wallerian degeneration in rat spinal cord after dorsal root axotomy.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1158368.618517 ◽

2009 ◽

Author(s):

David Choi ◽

Carolina Kachramanoglou

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Magnetic Resonance ◽

Dorsal Root ◽

Wallerian Degeneration ◽

Diffusion Tensor ◽

Resonance Imaging ◽

Rat Spinal Cord

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Changes of Dorsal Root Ganglion Volume in Dogs with Clinical Signs of Degenerative Myelopathy Detected by Water-Excitation Magnetic Resonance Imaging

Animals ◽

10.3390/ani11061702 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1702

Author(s):

Eiji Naito ◽

Kohei Nakata ◽

Yukiko Nakano ◽

Yuta Nozue ◽

Shintaro Kimura ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Magnetic Resonance ◽

Clinical Signs ◽

Intervertebral Disc Herniation ◽

Resonance Imaging ◽

Diagnostic Potential ◽

Water Excitation ◽

Spinal Cord Segment ◽

Degenerative Myelopathy

Canine degenerative myelopathy (DM) is a progressive and fatal neurodegenerative disease. However, a definitive diagnosis of DM can only be achieved by postmortem histopathological examination of the spinal cord. The purpose of this study was to investigate whether the volumetry of DRG using the ability of water-excitation magnetic resonance imaging (MRI) to visualize the DRG in dogs has premortem diagnostic value for DM. Eight dogs with DM, twenty-four dogs with intervertebral disc herniation (IVDH), and eight control dogs were scanned using a 3.0-tesla MRI system, and water-excitation images were obtained to visualize and measure the volume of DRG, normalized by body surface area. The normalized mean DRG volume between each spinal cord segment and mean volume of all DRG between T8 and L2 in the DM group was significantly lower than that in the control and the IVDH groups (P = 0.011, P = 0.002, respectively). There were no correlations within the normalized mean DRG volume between DM stage 1 and stage 4 (rs = 0.312, P = 0.128, respectively). In conclusion, DRG volumetry by the water-excitation MRI provides a non-invasive and quantitative assessment of neurodegeneration in DRG and may have diagnostic potential for DM.

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