Magnetic resonance imaging in the evaluation of cervical foraminal stenosis: comparison of 3D T2 SPACE with sagittal oblique 2D T2 TSE

Objective The oblique orientation of the cervical neural foramina challenges the implementation of a short MRI protocol with concurrent excellent visualization of the spine. While sagittal oblique T2-weighted sequences permit good evaluation of the cervical neuroforamina, all segments may not be equally well depicted on a single sequence and conspicuity of foraminal stenosis may be limited. 3D T2-weighted sequences can be reformatted in arbitrary planes, including the sagittal oblique. We set out to compare 3D T2w SPACE sequences with sagittal oblique reformations and sagittal oblique 2D T2w TSE sequences for the evaluation of cervical foraminal visibility and stenosis. Materials and methods Sixty consecutive patients who underwent MRI of the cervical spine with sagittal oblique 2D T2w TSE and 3D T2w SPACE sequences were included. Image homogeneity of the sequences was evaluated. Imaging sets were assessed for structure visibility and foraminal stenosis by two independent readers. Results of the sequences were compared by Wilcoxon matched-pairs tests. Interreader agreement was evaluated by weighted κ. Results Visibility of most structures was rated good to excellent on both sequences (mean visibility scores ≥ 4.5 of 5), though neuroforaminal contents were better seen on sagittal oblique T2w TSE (mean scores 4.1–4.6 vs. 3.1–4.1 on 3D T2w SPACE, p < 0.01). Stenosis grades were comparable between sequences (mean 1.1–2.6 of 4), with slightly higher values for 3D T2w SPACE at some levels (difference ≤ 0.3 points). Conclusion 3D T2w SPACE is comparable with sagittal oblique 2D T2w TSE in the evaluation of cervical neural foramina.

Tomodensitometric Bone Anatomy of The Intervertebral Foramen of The Lower Cervical Spine: Measurements and Comparison of Foraminal Volume in Healthy Individuals and Patients Suffering from Cervicobrachial Neuralgia Due to Foraminal Stenosis.

Purpose Degenerative foraminal stenosis of the cervical spine can lead to cervicobrachial neuralgias. Computed tomography (CT)-scan assists in the diagnosis and evaluation of foraminal stenosis. The main objective of this study is to determine the bony dimensions of the cervical intervertebral foramen and to identify which foraminal measurements are most affected by degenerative disorders of the cervical spine. These data could be applied to the surgical treatment of this pathology, helping surgeons to focus on specific areas during decompression procedures. Methods A descriptive study was conducted between two groups: an asymptomatic one (young people with no evidence of degenerative cervical spine disorders) and a symptomatic one (experiencing cervicobrachial neuralgia due to degenerative foraminal stenosis). Using CT scans, we determined a method allowing measurements of the following foraminal dimensions: foraminal height (FH), foraminal length (FL), foraminal width in its lateral part ((UWPP, MWPP and IWPP (respectively Upper, Medial and Inferior Width of Pedicle Part)) and medial part (UWMP, MWMP and IWMP (respectively Upper, Medial and Inferior Width of Medial Part)), and disk height (DH). Foraminal volume (FV) was calculated considering the above data. Mean volumes were measured in the asymptomatic group and compared to the values obtained in the symptomatic group. Results Both groups were made up of 10 patients, and a total of 50 intervertebral discs (100 intervertebral foramina) were analyzed in each group. Comparison of C4C5, C5C6 and C6C7 levels between both groups showed several significant decreases in foraminal dimensions (p< 0,05) as well as in foraminal volume (p <0.001) in the symptomatic group. The most affected dimensions were UWPP, MWPP, UWMP, MWMP and FV. The most stenotic foraminal areas were the top of the uncus and the posterior edge of the lower plate of the overlying vertebra. Conclusion Using a new protocol for measuring foraminal volume, the present study refines the current knowledge of the normal and pathological anatomy of the lower cervical spine and allows us to understand the foraminal sites most affected by degenerative stenosis. Those findings can be applied to foraminal stenosis surgeries. According to our results, decompression of the foramen in regard of both uncus osteophytic spurs and inferior plate of the overlying vertebra might be an important step for nerve roots release.

Is the Severity of Cervical Foraminal Stenosis Related to the Severity and Sidedness of Symptoms?

(1) Background: Cervical foraminal stenosis (CFS) is a common cause of axial neck and arm pain. The aim of this study was to determine the relationship between the severity of CFS and clinical symptoms in terms of severity and sidedness. (2) Methods: We retrospectively reviewed 75 consecutive patients with degenerative CFS. We graded 900 foramina from C3–4 to T1–2 using Park’s grading system. We collected visual analogue scale (VAS) and neck disability index (NDI) values from the neck and both arms. We analyzed the relationships with CFS grades and total number. We defined four types of left/right dominance of CFS (none, left-dominant, right-dominant, and both) by comparing left and right sides using total counts and maximal grade of CFS, respectively. We compared arm pain sidedness (no arm pain, left-only, right only, and bilateral) among different left and right CFS dominance types. (3) Results: Mean neck and left and right arm VAS scores were 4.4 ± 2.5, 4.9 ± 1.6, and 4.6 ± 2.0, respectively. The mean total NDI was 16.0 ± 8.0. The CFS grade at C3–4 and total count were correlated with neck VAS. Arm VAS was also correlated with CFS grade and total counts. Total NDI score was not correlated with radiological parameters. The presence and sidedness of arm pain were significantly different between left and right CFS dominance groups divided by total count of grade 2 and 3 CFS. (4) Conclusions: The CFS grade and total count were correlated with neck and arm VAS. Arm pain occurred more frequently on the side with more grade 2 and 3 CFS.

Most Common MRI finding in Lumbosacral Degenerative changes in Nepal Police

Introduction: Low back pain (LBP) is a common problem that affects about two-thirds of adults sometimes in their life. Magnetic Resonance Imaging (MRI) with excellent tissue contrast is a better modality for assessing it. We aimed to assess the common findings overall, gender-wise and age-wise in lumbosacral degenerative changes in Nepal police personnel. Methods: The 54 Nepalese police with disc degeneration changes in the MRI report were included . The following MRI findings were evaluated: decrease disc height, disc desiccation change, diffuse disc bulge, asymmetrical disc bulge, disc protrusion, disc extrusion, annular tear, central spinal canal stenosis, foraminal stenosis, spinal nerve compromise, lumbar lordosis preserved or not, osteophyte and modic changes. Results: Mostly involved lumbosacral discs were L4-L5 and L5-S1 and the least involved lumbosacral disc was L1-L2. Disc desiccation changes were the most common finding observed. Disc desiccation changes, decreased disc height, lateral recess stenosis, foraminal stenosis was common in L5-S1. Diffuse disc bulge, asymmetric disc bulge, disc protrusion, annular tear, central spinal canal stenosis were common in L4-L5. Modic type II change was the commonest endplate change observed.. Lateral recess stenosis and foraminal stenosis showed an increasing trend with increment in age group. The most common finding in both gender was disc desiccation changes and diffuse disc bulge. However, disc protrusion, disc extrusion, and annular tear were more common in males and asymmetrical disc bulge in females. Conclusion: This study shows L4-L5 and L5-S1 is the most common intervertebral disc involved in degeneration in Nepal police. Disc desiccation change and diffuse disc bulge are the most frequent finding irrespective of age and gender. Degenerative changes have an increasing trend with increasing age. Disc herniation is more common in male police individuals than female police individuals of Nepal.

Lumbosacral Transitional Vertebrae in patients attending a Tertiary Care Hospital of Nepal

Introduction: Lumbosacral Transitional vertebrae are congenital anomalies of lumbosacral vertebral junction. It may present either as sacralization of fifth lumbar vertebrae or lumbarization of first sacral vertebrae. Various secondary pathological spinal conditions such as intervertebral disc herniation and/or degeneration, facet joint arthrosis and spinal canal or foraminal stenosis are associated with the presence of LSTV. The failure in the identification may lead to clinical consequences such as errors in diagnosis of disease and lumbosacral procedures. Objective: The aim of this study was to determine the prevalence and patterns of LSTV in patients presenting to Department of Radiology of Nobel Medical College Teaching Hospital, Nepal.. Methodology: A descriptive cross-sectional study was conducted in Department of Radiology of Nobel Medical College Teaching Hospital, Nepal.Plain radiographs including Antero-posterior (AP) and Lateral views of lumbosacral spine of 343 patients referred for the scan were analyzed for the presence of lumbosacral vertebrae. Result: Out of 343 patients, LSTV was found in 61 (17.8%) subjects. Thirty-eight subjects (11.1%) exhibited sacralization and 23 (6.7%) showed lumbarization.Out of total LSTV subjects, type I A was present in 8 (13.1%), type I B in 21 (34.4%), type II A in 10 (16.4%), type II B in 5 (8.2%) , type III A in 6 (9.8%) , type III B in 9 (14.8%) and type IV in 2 (3.3%). Conclusion: The LSTV is prevalent in almostone-fifth of subjects presenting to department of radiology of Nobel Medical College and Teaching Hospital, Biratnagar for lumbosacral scan.. Sacralization occurs more frequently than lumbarization, both of which alter the morphology of anatomical structures in spine. The presence of anomaly in this region may be related to occurrence of various pathological and clinical conditions.