Chronic cervical cord compression: clinical significance of increased signal intensity on MR images.

Takahashi, Mitsuru; Yamashita, Yoshimi; Sakamoto, Yuji; Kojima, Ryutaro

doi:10.1148/radiology.173.1.2781011

Cited by 235 publications

(129 citation statements)

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“…9 Intramedullary intensity changes on MRI have been reported to reflect irreversible changes in the spinal cord, to be related to pyramidal signs, and to be indicative of the prognosis, although this remains controversial. [10][11][12][13] However, the extent of spinal cord compression, even with intramedullary intensity changes on MRI, does not necessarily correlate with that of clinical symptoms.…”

Section: Discussionmentioning

confidence: 99%

Rapid progressive clinical deterioration of cervical spondylotic myelopathy

et al. 2014

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Study Design: Retrospective clinical study. Objective: To elucidate the pathophysiology of rapid progressive clinical deterioration following the onset of cervical myelopathy. Setting: Spinal Injuries Center, Fukuoka, Japan. Methods: A total of 43 cervical spondylotic myelopathy (CSM) patients were treated surgically by a senior surgeon. All patients showed intramedullary intensity changes on magnetic resonance (MR) imaging. Overall, eight patients suffered rapid progressive clinical deterioration; four of them had obvious anamnesis of minor trauma. We assessed the responsible injured segment by MR T2-weighted images. Clinical instabilities at the focal segment were evaluated using functional sagittal plain radiographs. Neurological evaluations were performed preoperatively and at 12 months postoperatively using American Spinal Injury Association (ASIA) motor scores and Japanese Orthopaedic Association (JOA) scores for cervical myelopathy. Intraoperatively, we evaluated the presence of adhesive scar tissue on the dura mater at the focal segment. Results: The responsible injured segment was C3-4 in 75% of the rapid progressive (rp)-CSM and in 28.57% of the conventional CSM subjects. One with rp-CSM showed sagittal translational segmental instability. Preoperative ASIA motor scores and JOA scores in the rp-CSM were significantly lower than those in the conventional CSM subjects. Postoperative ASIA motor scores between the subjects showed no significant differences; however, postoperative JOA scores in the rp-CSM subjects were significantly lower. Moreover, an epidural membrane was observed in 62.5% of rp-CSM and 11.4% of conventional CSM subjects. Conclusions: We hypothesized that the pathophysiology of rp-CSM might be additional cervical cord disorder following the onset of cervical myelopathy. Early decompression surgery is recommended in such patients. INTRODUCTIONThe etiologies of cervical spondylotic myelopathy (CSM) include spinal cord compression, dynamic factors and ischemia of the spinal cord. Several anatomical structures in the cervical motion segment can be involved in cervical spinal cord compression. The spondylotic changes in anterior structures, such as bulging, ossified or herniated discs, as well as anterior osteophytic spurs are generally responsible for cord compression in CSM. Disorders in posterior structures, such as hypertrophy, or rarely, ossification/calcification of the ligamentum flavum (CLF) or facet joints may also contribute to cord compression. Compression of the spinal cord within a narrow spinal canal is believed to cause neural injury and ischemia. The cord and its vascular supply have the ability to adapt to a chronic, slowly progressing compression; therefore, dynamic compression may be more important than static compression in the development of myelopathy symptoms. Patients with canal stenosis also have limited cord excursion, and spinal column motion may increase the strain and shear forces on the spinal cord. 1 CSM is a relatively slowly progressive disorder. However, we r...

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Section: Discussionmentioning

confidence: 99%

Rapid progressive clinical deterioration of cervical spondylotic myelopathy

et al. 2014

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“…[1][2][3][4][5][6][7][8] SEA is a unique radiological finding that can be observed in cases with compression myelopathy, kyphotic deformity or spinal cord injury. The term 'snake-eyes appearance' is derived from the resemblance of the bilateral small IMHSI in the compressed cord to the face of a snake.…”

Section: Discussionmentioning

confidence: 99%

“…This term may be the same as 'fried-egg appearance' demonstrated by computed-tomographic myelography by Iwasaki et al 9 Some authors suggested that SEA is an irreversible change in the spinal cord, like cystic necrosis. 3,7,8,10 Others suggested that it is a reversible change, similar to edema. 3,6,8 This confusion arises from a lack of precise pathological correlation of the compressed spinal cord with SEA.…”

Section: Discussionmentioning

confidence: 99%

“…3,7,8,10 Others suggested that it is a reversible change, similar to edema. 3,6,8 This confusion arises from a lack of precise pathological correlation of the compressed spinal cord with SEA.…”

Section: Discussionmentioning

confidence: 99%

“…Snake-eyes appearance (SEA), defined as small high-signal areas around the central gray matter and the ventrolateral posterior column, one in the right and one in the left, is a unique IMHSI of the spinal cord with compression myelopathy. [1][2][3][4][5] Although this phenomenon is commonly observed in cases with cervical spondylosis (CS) or ossification of the posterior longitudinal ligament (OPLL), it's clinical role is obscure. Seemingly, the controversy over the prognostic value of SEA is derived from the lack of clinicopathological correlations with small high-signal lesions.…”

Section: Introductionmentioning

confidence: 99%

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Postmortem study of the spinal cord showing snake-eyes appearance due to damage by ossification of the posterior longitudinal ligament and kyphotic deformity

et al. 2005

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Clinical design: A case report. Objectives: To elucidate the clinical role of snake-eyes appearance in this case, correlation between radiological, clinical and postmortem study was performed. Setting: Aichi, Japan. Case report: A 73-year-old man developed weakness and pain in the upper limbs due to kyphotic deformity secondary to laminectomy for cervical ossification of the posterior longitudinal ligament. Axial magnetic resonance imaging revealed snake-eyes appearance from C4 to C6. He died of acute myocardial infarction 3 months after anterior decompressive surgery. Results: A postmortem examination of the cervical spinal cord showed small cystic six necrotic areas at the junction of the central gray matter and the ventrolateral posterior column, one in the right and one in the left, in association with neuronal loss in the anterior horn. Conclusions: Bilateral small intramedullary high-signal areas known as 'snake-eyes appearance' located around the central gray matter and the ventrolateral posterior column, are associated with neuronal loss in the compressed anterior horn that played an important role in worsening weakness of the upper limbs.

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Specific pattern of gadolinium enhancement in spondylotic myelopathy

Flanagan

Krecke

Marsh

et al. 2014

Annals of Neurology

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Transverse pancakelike gadolinium enhancement associated with and just caudal to the site of maximal stenosis and at the rostrocaudal midpoint of a spindle-shaped T2 hyperintensity suggests that spondylosis is the cause of the myelopathy. Persistent enhancement for months to years following decompressive surgery is common. Recognition is important to prevent inappropriate interventions or delay in consideration of a potentially beneficial decompressive surgery.

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Chronic cervical cord compression: clinical significance of increased signal intensity on MR images.

Cited by 235 publications

References 0 publications

Rapid progressive clinical deterioration of cervical spondylotic myelopathy

Rapid progressive clinical deterioration of cervical spondylotic myelopathy

Postmortem study of the spinal cord showing snake-eyes appearance due to damage by ossification of the posterior longitudinal ligament and kyphotic deformity

Specific pattern of gadolinium enhancement in spondylotic myelopathy

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