Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation.

Boden, Scott D.; McCowin, P R; Davis, D O; Dina, T S; Mark, A S; Wiesel, S

doi:10.2106/00004623-199072080-00008

Cited by 1,091 publications

(429 citation statements)

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“…A recent, comprehensive review determined that needle EMG has a sensitivity of 50-71% for subjects with neurological or radiological signs of a cervical radiculopathy, although the lack of a standardized gold standard may have resulted in an underestimation of this figure [7,8]. On the other hand, asymptomatic radiological abnormalities are commonly seen with advanced imaging studies [17,20,26,37,58]. It is well accepted that the diagnostic accuracy of specialized imaging is limited, especially with regards to foraminal nerve root impingement [11,15,38].…”

Section: Introductionmentioning

confidence: 99%

A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy

et al. 2006

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Clinical provocative tests of the neck, which position the neck and arm inorder to aggravate or relieve arm symptoms, are commonly used in clinical practice in patients with a suspected cervical radiculopathy. Their diagnostic accuracy, however, has never been examined in a systematic review. A comprehensive search was conducted in order to identify all possible studies fulfilling the inclusion criteria. A study was included if: (1) any provocative test of the neck for diagnosing cervical radiculopathy was identified; (2) any reference standard was used; (3) sensitivity and specificity were reported or could be (re-)calculated; and, (4) the publication was a full report. Two reviewers independently selected studies, and assessed methodological quality. Only six studies met the inclusion criteria, which evaluated five provocative tests. In general, Spurling's test demonstrated low to moderate sensitivity and high specificity, as did traction/neck distraction, and Valsalva's maneuver. The upper limb tension test (ULTT) demonstrated high sensitivity and low specificity, while the shoulder abduction test demonstrated low to moderate sensitivity and moderate to high specificity. Common methodological flaws included lack of an optimal reference standard, disease progression bias, spectrum bias, and review bias. Limitations include few primary studies, substantial heterogeneity, and numerous methodological flaws among the studies; therefore, a meta-analysis was not conducted. This review suggests that, when consistent with the history and other physical findings, a positive Spurling's, traction/neck distraction, and Valsalva's might be indicative of a cervical radiculopathy, while a negative ULTT might be used to rule it out. However, the lack of evidence precludes any firm conclusions regarding their diagnostic value, especially when used in primary care. More high quality studies are necessary in order to resolve this issue.

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Section: Introductionmentioning

confidence: 99%

A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy

et al. 2006

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“…Cervical spines of asymptomatic healthy subjects examined by Boden et al [2] exhibited abnormal MRI scans in 14% of subjects younger than 40 years; the percentage increased to 50% in subjects 50 years old. In general, clinical studies show that stenosis in cervical or lumbar sites would positively predict stenosis in other spine regions 15% to 32% of the time.…”

Section: Discussionmentioning

confidence: 89%

“…Clinical studies of the aging cervical spine have shown that 14% of asymptomatic subjects younger than 40 years have abnormal MRI scans with an increase to 50% by 50 years old [2,6,7]. Disc space narrowing, osteophytes, and disc degeneration are common and increase with age.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Age-related Cervical Disc Degeneration in the Sand Rat

Gruber

Phillips

Ingram

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Disc space narrowing, osteophytes, and disc degeneration are common and increase with aging. Few animal models are appropriate for the study of spontaneous age-related cervical disc degeneration. Questions/purposes We used the sand rat, a member of the gerbil family with well-recognized age-related lumbar disc degeneration, to determine whether spontaneous cervical disc degeneration differed from lumbar degeneration when evaluated by (1) radiologic and (2) histologic measures. Animals 2 to 25 months of age were used in these analyses. Methods Cervical and lumbar discs of 99 sand rats were analyzed with radiology, and cervical discs of 67 sand rats were studied with histology. Lateral digital radiographs of cervical and lumbar spines were scored for presence or absence of wedging, disc space narrowing, osteophytes, end plate calcification, and irregular disc margins at C2-C3 through C6-C7 and T12-L1 through L7-S1. Percentages for presence were calculated and statistically analyzed for younger (range, 2-11.9 months old) versus older (range, 12.0-25 months old) animals. Results Cervical discs in younger animals exhibited a greater proportion of irregular margins compared with lumbar sites (94% versus 83%; p = 0.02; 95% CI for difference, 2.7, 19.0%). In older animals, cervical discs showed a greater proportion of osteophytes than did lumbar discs (7% versus 0%; p \ 0.0001). The incidence of disc space narrowing was greater in cervical versus lumbar sites (99% versus 90%; p = 0.0008). Cervical spine sites which contained osteophytes morphologically showed irregular disc margins and revealed an extrusion of herniated disc material in the osteophytes. Conclusions Radiologic and morphologic studies confirmed age-related disc degeneration in the cervical spine of the sand rat. Clinical Relevance Clinical cervical aging studies have shown that 14% of asymptomatic subjects younger than 40 years have abnormal MRI scans with an increase to 50% by 50 years old. We studied an economic rodent model for cervical age-related spontaneous disc.

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“…On the other hand, if results are ambiguous for LSS, results are taken to indicate PAD. These processes represent common flaws during the differential diagnosis of atypical claudication, because imaging studies are not specific for LSS [19]. Although electrodiagnostic testing is highly specific for the diagnosis of LSS [20], its clinical utilization is limited due to the high cost and invasiveness.…”

Section: Discussionmentioning

confidence: 99%

The validity of ankle-brachial index for the differential diagnosis of peripheral arterial disease and lumbar spinal stenosis in patients with atypical claudication

et al. 2011

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Purpose Claudication is a typical symptom of peripheral arterial disease (PAD) and lumbar spinal stenosis (LSS). Differential diagnosis of PAD and LSS is often difficult due to the subjective natures of symptoms and atypical signs. The authors aimed to determine the usefulness of ankle-brachial index (ABI) measurement for the differential diagnosis of PAD and LSS when the etiology of claudication is uncertain. Methods Forty-two consecutive patients who had been referred by spine surgeons to a lower extremity vascular surgeon for atypical claudication were retrospectively analyzed. Atypical claudication was defined as claudication not caused by PAD, as determined by clinical manifestations, or by LSS, as determined by MR imaging. A final diagnosis of PAD was established by CT angiography (CTA) and of LSS by excluding PAD. Diagnostic validity of ABI for PAD in atypical presentation was assessed. Results Sixty-two legs of 42 atypical claudication patients were analyzed. Mean patient age was 65.8 ± 8.2 years (38-85) and 29 (69.0%) had diabetes mellitus. Mean ABI was 0.73 ± 0.14 (0.53-0.94) in the PAD group and 0.92 ± 0.18 (0.52-1.10) in the LSS group (P \ 0.001). Of the 33 legs with a low ABI (ABI \ 0.9), 29 legs were diagnosed as true positives for PAD by CTA and 4 were false positives, and of the 29 legs with a high ABI, 5 were false negatives and 24 were true negatives. The sensitivity and specificity of ABI for the diagnosis of PAD in patients with atypical claudication were 85.3 and 85.7%, respectively, and its positive and negative predictive values were 87.9 and 82.8%. Conclusions ABI is a recommended screening test for the differential diagnosis of lower leg claudication when clinical symptoms are atypical.

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Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation.

Cited by 1,091 publications

References 0 publications

A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy

A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy

Spontaneous Age-related Cervical Disc Degeneration in the Sand Rat

The validity of ankle-brachial index for the differential diagnosis of peripheral arterial disease and lumbar spinal stenosis in patients with atypical claudication

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