Significance of T2 Hyperintensity on Magnetic Resonance Imaging After Cervical Cord Injury and Return to Play in Professional Athletes

Neurosurgery ◽  
2015 ◽  
Vol 77 (1) ◽  
pp. 23-31 ◽  
Author(s):  
Zachary J. Tempel ◽  
Jeffrey W. Bost ◽  
John A. Norwig ◽  
Joseph C. Maroon
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Return To Play ◽  
Professional Athletes ◽  
Cervical Cord ◽  
Cervical Canal ◽  
Resonance Imaging ◽  
Cord Injury ◽  
T2 Hyperintensity

Abstract BACKGROUND: Cervical cord magnetic resonance imaging (MRI) T2 hyperintensity is used as evidence of cord trauma in the evaluation and management of athletes in contact sports. The long-term pathophysiologic and prognostic value of this finding is poorly understood, especially in return to play (RTP). OBJECTIVE: To examine the significance of T2 hyperintensity in the cervical spinal cord of professional athletes. METHODS: Retrospective review of MRI T2 hyperintensity findings between 2007 and 2014 in 5 professional athletes. Pertinent examination and demographics, including mechanism of injury, surgical intervention, radiographs, MRI studies, long-term outcomes, and RTP recommendations were collected. RESULTS: Four National Football League players and 1 professional wrestler had prior traumatic neurapraxia that at the time of initial consultation had resolved. MRIs showed congenitally small cervical canal (1) and multilevel spondylosis/stenosis/disc herniation (4) along with focal cord T2 hyperintensity (5). The signal abnormalities were at C3/C4 (3), C4 mid-vertebral body (1), and C5/C6 (1). Four athletes had single-level anterior cervical discectomy and fusion, and 1 was nonoperative. Serial MRI imaging at 3 months after surgery showed hyperintensity partially resolved (4) and unchanged (1), and at 9-months 3 of the 5 completely resolved. Based on the author's RTP criteria, 4 of 5 were released to return to their sport. Clearance for RTP preceded complete resolution of MRI T2 hyperintensity in 3 of 4 athletes. The 2 athletes that have returned to profession sport have not had any additional episodes of neurapraxia or any cervical spine-related complications. CONCLUSION: MRI T2 hyperintensity in contact sport athletes who are symptom-free with normal examination and no evidence of spinal instability may not be a contraindication to RTP. Additional observations are needed to confirm this observation.

scholarly journals Magnetic Resonance Imaging Atlas-Based Volumetric Mapping of the Cervical Cord Gray Matter in Cervical Canal Stenosis

2020 ◽  
Vol 134 ◽  
pp. e497-e504
Author(s):  
Zachary A. Smith ◽  
Kenneth A. Weber ◽  
Monica Paliwal ◽  
Benjamin S. Hopkins ◽  
Alexander J. Barry ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Gray Matter ◽  
Cervical Cord ◽  
Cervical Canal ◽  
Resonance Imaging ◽  
Cervical Canal Stenosis ◽  
Canal Stenosis

scholarly journals Magnetic Resonance Imaging of Acute Cervical Cord Injury.

1991 ◽  
Vol 40 (1) ◽  
pp. 161-164
Author(s):  
Eiji Mori ◽  
Keiichiro Shiba ◽  
Masaaki Ktsuki ◽  
Takayoshi Ueta ◽  
Kenzou Shirasawa ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cervical Cord ◽  
Resonance Imaging ◽  
Cord Injury ◽  
Cervical Cord Injury

Myelopathy Presenting Decades after Surgery for Congenital Cervical Cutaneous Lesions

Neurosurgery ◽  
1990 ◽  
Vol 27 (4) ◽  
pp. 635-638 ◽  
Author(s):  
Julian K. Wu ◽  
Michael R. Scott
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cervical Cord ◽  
Resonance Imaging ◽  
Previous Surgery ◽  
Cutaneous Lesions ◽  
Long Term Follow Up ◽  
Preoperative Magnetic Resonance

Abstract We report on two patients in whom cervical myelopathy developed decades after they had undergone surgery for congenital cervical cutaneous lesions. Preoperative magnetic resonance imaging demonstrated dorsal tethering and cavitation of the cervical cord in the area of the previous surgery and was helpful in decision making regarding surgical exploration and in planning for it. We stress the importance of long-term follow-up by both clinical examination and magnetic resonance imaging in children who have been operated on for cervical cutaneous masses that may have central connections.

Acute Cervical Cord Injury Associated with Ossification of the Posterior Longitudinal Ligament

Neurosurgery ◽  
2003 ◽  
Vol 53 (4) ◽  
pp. 887-892 ◽  
Author(s):  
Izumi Koyanagi ◽  
Yoshinobu Iwasaki ◽  
Kazutoshi Hida ◽  
Hiroyuki Imamura ◽  
Shin Fujimoto ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Magnetic Resonance ◽  
Posterior Longitudinal Ligament ◽  
Cervical Cord ◽  
Resonance Imaging ◽  
Cord Injury ◽  
Frankel Grade ◽  
Cervical Cord Injury

Abstract OBJECTIVE Patients with ossification of the posterior longitudinal ligament (OPLL) sometimes present with acute spinal cord injury caused by only minor trauma. In the present study, we reviewed our experience of acute cervical cord injury associated with OPLL to understand the pathomechanisms and to provide clinical information for management of this disorder. METHODS Twenty-eight patients were retrospectively analyzed. There were 26 men and 2 women, aged 45 to 78 years (mean, 63.0 yr). Most patients experienced incomplete spinal cord injury (Frankel Grade A, 3; B, 1; C, 15; and D, 9). RESULTS Radiological studies revealed continuous- or mixed-type OPLL in 14 patients and segmental-type OPLL in 14 patients. The sagittal diameter of the spinal canal was reduced to 4.1 to 10 mm at the narrowest level as a result of OPLL. Developmental size of the spinal canal was significantly smaller in the group with segmental OPLL. Magnetic resonance imaging scans revealed that spinal cord injury occurred predominantly at the caudal edge of continuous-type OPLL or at the disc levels. Surgery was performed in 24 patients either by posterior (18 patients) or anterior (6 patients) decompression at various time intervals after the trauma. Twenty patients (71%) displayed improvement in Frankel grade. CONCLUSION The present study demonstrates the preexisting factors and pathomechanisms of acute spinal cord injury associated with cervical OPLL. Magnetic resonance imaging is useful to understand the level and mechanism of injury. Further investigation will be needed to elucidate the role of surgical decompression.

351 Diffusion and Cerebrospinal Fluid Flow Magnetic Resonance Imaging in the Evaluation of Cervical Stenosis and Myelopathy: A Prospective Study

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 280-280
Author(s):  
Darryl Lau ◽  
Cynthia Chin ◽  
Philip R Weinstein ◽  
John Engstrom ◽  
Christopher P Ames
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Neurological Status ◽  
Cervical Cord ◽  
Cervical Stenosis ◽  
Resonance Imaging ◽  
Csf Flow ◽  
Mri Findings ◽  
Cord Injury

Abstract INTRODUCTION Diffusion-weighted imaging (DWI) may be more sensitive in detecting early cervical cord injury than abnormal T2-signal. Cerebrospinal fluid (CSF) flow studies may demonstrate degree of stenosis based on cervical cord motion. This study evaluates tests correlation of DWI and cord motion to myelopathy severity and degree of stenosis. METHODS Prospectively, adult patients with concern for cervical stenosis underwent cervical magnetic resonance imaging (MRI) (T2, Cine CSF Flow, and DWI). Images were reviewed neuroradiologists blinded to the patient's clinical condition. Correlation of MRI findings to neurological status and outcomes following surgery were evaluated. RESULTS >Twenty patients were enrolled. Mean age was 66 years, and 40% were male. Eleven presented with myelopathy and 9 had pain, weakness, and/or sensory changes. All patients had radiographic cervical stenosis (14 severe, 5 moderate, and 1 mild). In the presence of cervical stenosis, paradoxical cord motion (moving opposite to the rest of cord) was observed in 79% of severe and 50% of mild/moderate stenosis. The sensitivities of MRI findings to detect clinical myelopathy were 63% for T2 signal, 73% for abnormal DWI, 73% for abnormal cord motion, 91% for abnormal DWI/cord motion, and 100% for abnormal T2/DWI/cord motion. Fourteen patients underwent surgical decompression (4 anterior and 10 posterior). Ten of those 14 patients had improved Nurick myelopathy score. Of the 4 patients who did not improve, their MRI profile revealed that all preoperative MRI had abnormal cord motion (2 with normal T2-signal and DWI) (P = 0.126). Among the 6 patients (1 moderate and 5 severe stenosis) who did not undergo surgery, 1 worsened (abnormal T2-signal/DWI/cord motion) while 5 others had no change in neurological status. CONCLUSION DWI and CSF flow studies are sensitive modalities in detecting myelopathy and evaluating cervical stenosis severity. Abnormal DWI and cord motion are present in myelopathic patients without T2-signal abnormality and maybe useful prognostic indicators.

Cervical cord compression caused by a pillow in a postlaminectomy patient undergoing magnetic resonance imaging

1999 ◽  
Vol 90 (1) ◽  
pp. 145-147 ◽  
Author(s):  
Fumio Suzuki ◽  
Masayuki Nakajima ◽  
Masayuki Matsuda
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cord Compression ◽  
Cervical Cord ◽  
Resonance Imaging ◽  
Neck Extension ◽  
Content Type ◽  
Deep Wound ◽  
Extended Position ◽  
Cord Injury

✓ A 66-year-old man, who had undergone osteoplastic laminectomy for posttraumatic cervical myelopathy, underwent a second operation in which the replaced laminae were removed because of postoperative deep wound infection. Follow-up dynamic magnetic resonance imaging with flexion and extension views of the neck 1 year postsurgery demonstrated that the cervical cord was markedly compressed from behind in the extended position, although a wide subarachnoid space was observed in this region when the neck was in the flexed position. The cause of cord compression was the pillow that was placed underneath the patient's neck for maintaining the extended position, not the neck extension itself. This finding indicates that care must be taken during neuroradiological examination not to place a pillow under the neck of a patient who has undergone laminectomy. Nuchal compression could lead to cervical cord injury after laminectomy. Laminoplasty benefits the patient by protecting the cervical cord from secondary injury.

Long-term Results of Spinal Cord Injury Therapy Using Mesenchymal Stem Cells Derived From Bone Marrow in Humans

Neurosurgery ◽  
2011 ◽  
Vol 70 (5) ◽  
pp. 1238-1247 ◽  
Author(s):  
Jin Hoon Park ◽  
Dae Yul Kim ◽  
Inn Young Sung ◽  
Gyong Hyo Choi ◽  
Min Ho Jeon ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Daily Living ◽  
Long Term Results ◽  
Motor Power ◽  
Resonance Imaging ◽  
Cord Injury

Abstract BACKGROUND: Although the transplantation of mesenchymal stem cells (MSCs) after spinal cord injury (SCI) has shown promising results in animals, less is known about the effects of autologous MSCs in human SCI. OBJECTIVE: To describe the long-term results of 10 patients who underwent intramedullary direct MSCs transplantation into injured spinal cords. METHODS: Autologous MSCs were harvested from the iliac bone of each patient and expanded by culturing for 4 weeks. MSCs (8 × 106) were directly injected into the spinal cord, and 4 × 107 cells were injected into the intradural space of 10 patients with American Spinal Injury Association class A or B injury caused by traumatic cervical SCI. After 4 and 8 weeks, an additional 5 × 107 MSCs were injected into each patient through lumbar tapping. Outcome assessments included changes in the motor power grade of the extremities, magnetic resonance imaging, and electrophysiological recordings. RESULTS: Although 6 of the 10 patients showed motor power improvement of the upper extremities at 6-month follow-up, 3 showed gradual improvement in activities of daily living, and changes on magnetic resonance imaging such as decreases in cavity size and the appearance of fiber-like low signal intensity streaks. They also showed electrophysiological improvement. All 10 patients did not experience any permanent complication associated with MSC transplantation. CONCLUSION: Three of the 10 patients with SCI who were directly injected with autologous MSCs showed improvement in the motor power of the upper extremities and in activities of daily living, as well as significant magnetic resonance imaging and electrophysiological changes during long-term follow-up.

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