Does Dynamic Supine Magnetic Resonance Imaging Improve the Diagnostic Accuracy of Cervical Spondylotic Myelopathy? A Review of the Current Evidence

Xu, Nanfang; Wang, Shaobo; Huishu, Yuan; Liu, Xiaoguang; Liu, Zhongjun

doi:10.1016/j.wneu.2017.01.047

Cited by 28 publications

(17 citation statements)

References 29 publications

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“…Quantitative measurements are attractive in their objectivity, however, as demonstrated, their relationship to myelopathy is inconsistent: some quantitative MRI measures of compromise may relate to clinical symptoms of DCM [40] but, overall, degree of radiological compromise correlates poorly with disease severity. Patients with cord compression may not suffer from myelopathy [41] and some patients suffer myelopathy without visualised compression due to dynamic injury [13].…”

Section: Discussionmentioning

confidence: 99%

“…Despite investigation, no standard MRI features consistently representing disease severity in DCM have been found [12], and whilst cord compression is considered a hallmark, its extent correlates poorly with severity. This may be due to dynamic injury mechanisms undetected by standard MRI protocols [13] or biological differences in responses to mechanical stress. Significant cord compression can be present in asymptomatic individuals [14,15].…”

Section: Introductionmentioning

confidence: 99%

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A comparison of radiological descriptions of spinal cord compression with quantitative measures, and their role in non-specialist clinical management

et al. 2019

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Introduction Magnetic resonance imaging (MRI) is gold-standard for investigating Degenerative Cervical Myelopathy (DCM), a disabling disease triggered by compression of the spinal cord following degenerative changes of adjacent structures. Quantifiable compression correlates poorly with disease and language describing compression in radiological reports is un-standardised. Study design Retrospective chart review. Objectives 1) Identify terminology in radiological reporting of cord compression and elucidate relationships between language and quantitative measures 2) Evaluate language’s ability to distinguish myelopathic from asymptomatic compression 3) Explore correlations between quantitative or qualitative features and symptom severity 4) Investigate the influence of quantitative and qualitative measures on surgical referrals. Methods From all cervical spine MRIs conducted during one year at a tertiary centre (N = 1123), 166 patients had reported cord compression. For each spinal level deemed compressed by radiologists (N = 218), four quantitative measurements were calculated: ‘Maximum Canal Compromise (MCC); ‘Maximum Spinal Cord Compression’ (MSCC); ‘Spinal Canal Occupation Ratio’ (SCOR) and ‘Compression Ratio’ (CR). These were compared to associated radiological reporting terminology. Results 1) Terminology in radiological reports was varied. Objective measures of compromise correlated poorly with language. “Compressed” was used for more severe cord compromise as measured by MCC (p<0.001), MSCC (p<0.001), and CR (p = 0.002). 2) Greater compromise was seen in cords with a myelopathy diagnosis across MCC ( p <0.001); MSCC ( p = 0.002) and CR ( p <0.001). “Compress” (p<0.001) and “Flatten” (p<0.001) were used more commonly for myelopathy-diagnosis levels. 3) Measurements of cord compromise (MCC: p = 0.304; MSCC: p = 0.217; SCOR: p = 0.503; CR: p = 0.256) and descriptive terms (p = 0.591) did not correlate with i-mJOA score. 4) The only variables affecting spinal surgery referral were increased MSCC (p = 0.001) and use of ‘Compressed’ (p = 0.045). Conclusions Radiological reporting in DCM is variable and language is not fully predictive of the degree of quantitative cord compression. Additionally, terminology may influence surgical referrals.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A comparison of radiological descriptions of spinal cord compression with quantitative measures, and their role in non-specialist clinical management

et al. 2019

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“…While not standard at this point, dynamic MRI with flexion and extension of the neck may be further considered if there is a high suspicion for myelopathy. 31 While not yet extensively used, diffusor tensor imaging of the spine is a modality that is being studied and shows promise in the assessment of myelopathy. 32 It is important to remember that the degree of compression does not necessarily correlate with the severity of symptoms, and that myelopathy is a clinical not radiographic diagnosis.…”

Section: Differential Diagnoses In Myelopathymentioning

confidence: 99%

Cervical and Thoracic Spondylotic Myelopathies

Onofrei

Henrie

2021

Semin Neurol

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Spondylotic myelopathies are among the most common disorders of the spine, yet the clinical and treatment approach is far from standardized. This article discusses our current understanding of the epidemiology, pathophysiology, clinical assessment, natural history, and treatment options in degenerative myelopathies of the cervical and thoracic spine. We additionally review diagnostic modalities including imaging modalities of the spine and neurophysiological tools such as electromyography/nerve conduction studies, somatosensory-evoked potentials, and motor-evoked potentials. Assessment instruments that can be used for the assessment of myelopathies are reviewed, including the Japanese Orthopedic Association (JOA) score, modified-JOA scale, Nurick scale, nine-hole peg test, and 30-m walking test. We also review common disorders that mimic spondylotic myelopathies, as well as helpful diagnostic clues in differentiating spondylotic and nonspondylotic myelopathies.

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“…[32][33][34] Evidence suggests that dynamic MRI can elucidate changes in the disc width and cord compression with higher sensitivity. [34][35][36] Using dynamic supine MRI, it has been shown that new appearance or increased cord compression can be identified in more than 20% of patients and that the average narrowing of the cervical canal was 20% in comparison with the neutral position. 34 Although not all of this movementrelated compression is related to DCS, it highlights the importance of incorporating dynamic factors in the diagnostic and surgical decision-making process.…”

Section: Diagnostic Toolsmentioning

confidence: 99%

Does Spondylolisthesis Affect Severity and Outcome of Degenerative Cervical Myelopathy? A Systematic Review and Meta-analysis

Gondar

Nouri

Jannelli

et al. 2020

Global Spine Journal

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Study Design: This was a systematic review and meta-analysis. Objectives: Degenerative cervical myelopathy (DCM) with spondylolisthesis remains not well defined, poorly studied, and underreported and plays a minor role in the therapeutic decision-making. Spondylolisthesis, however, is not uncommon and may result in dynamic injury to the spinal cord. We aim to describe the impact of spondylolisthesis in DCM severity and postoperative outcomes. Methods: Two independent reviewers conducted a Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA 2015)-based review between 1970 and May 2020 for articles reporting outcome of DCM in patients with degenerative cervical spondylolisthesis. Patient clinical and radiological data was recorded at baseline and during postoperative follow-up (FU). A meta-analysis comparing surgical outcome between DCM patients with and without spondylolisthesis assessed by the regular/modified Japanese Orthopaedic Association Assessment Scale (mJOA) recovery ratio was completed. Results: A total of 3 studies were included (1 ambispective and 2 retrospective cohorts); 607 patients with DCM were identified, 102 (16.8%) of whom also had spondylolisthesis. DCM patients with spondylolisthesis were significantly older ( P < .05), presented with worse baseline mJOA and Nurick grades ( P < .05 in 2 studies), and were more commonly operated via posterior approaches ( P < .05). All groups experienced a (m)JOA and/or Neck Disability Index score improvement during FU. In the pooled meta-analysis, spondylolisthesis patients showed a significantly lower functional recovery ratio at 2 years compared with other DCM patients ( P = .05). Conclusions: Spondylolisthesis is frequent in older DCM patients and may be a predictor of a more advanced degeneration and subsequent worse baseline conditions and postoperative outcome.

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Does Dynamic Supine Magnetic Resonance Imaging Improve the Diagnostic Accuracy of Cervical Spondylotic Myelopathy? A Review of the Current Evidence

Cited by 28 publications

References 29 publications

A comparison of radiological descriptions of spinal cord compression with quantitative measures, and their role in non-specialist clinical management

A comparison of radiological descriptions of spinal cord compression with quantitative measures, and their role in non-specialist clinical management

Cervical and Thoracic Spondylotic Myelopathies

Does Spondylolisthesis Affect Severity and Outcome of Degenerative Cervical Myelopathy? A Systematic Review and Meta-analysis

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