Dynamic evaluation of the cervical spine by kinematic MRI in patients with cervical spinal cord injury without fracture and dislocation

Liu, Ao; Qiu, Nan-Hai; Zhong, Xueren; Fang, Xiang; Liao, Junjian; Zhang, Zhipeng; Zheng, Pei-Feng; Hu, Yongyu; Hu, Konghe; Xiong, Ying-Hui; Lu, Lin-Jun; Xi, Xin-Hua; Wu, Qiang; Bao, Yongzheng

doi:10.1186/s13018-023-03745-1

Cited by 3 publications

(1 citation statement)

References 28 publications

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“…A study has shown that patients with minimal cord changes on MRI have the best outcome, followed by those with cord edema, and patients with parenchymatous hemorrhage and contusion on MRI fare poorly [19]. MRI of the latter cases frequently reveals hematomas and intramedullary edema [20].…”

Section: Discussionmentioning

confidence: 99%

Comparison of laminoplasty and posterior segment fusion with laminoplasty and anterior segment fusion for treating acute extensional cervical spinal cord injury in pre-existing canal stenosis: a multicenter retrospective study

Lv,

Zou,

Xiong

et al. 2024

JCTR

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Background: Patients with pre-existing cervical spinal canal stenosis (CSCS) are more likely to suffer from an extensional spinal cord injury (SCI). However, the appropriate surgical alternatives for extended cervical SCIs in individuals with pre-existing CSCS remain unknown. The purpose of this study was to evaluate the clinical efficacies of laminoplasty and posterior short-segment fusion (PSF) with laminoplasty and anterior short-segment fusion (ASF) in the treatment of these patients. Methods: The clinical data of 258 patients from six spine centers were included in this retrospective study. Patients were divided into two different groups based on the surgical approach: laminoplasty and PSF (PSF group) and laminoplasty and ASF (ASF group). ASIA grades and JOA scores were obtained before and after surgery to assess neurological function. Results: There were 116 patients in the PSF group and 142 patients in the ASF group. The average operation time, intraoperative blood loss, and hospital stay were 188 min, 298 ml, and 7.6 days, respectively, in PSF group, compared to 245 min, 366 ml, and 10.4 days in PSF group, respectively. Complete decompression was achieved in all patients, and fusion was achieved 6 months after surgery. A post-operative computed tomography scan revealed that 39/464 (8.4%) screws had perforated, but no neurovascular complications occurred. Both surgical strategies improved the ASIA grade and there was no significant difference between the two groups (P = 0.926). The JOA score improved from 6.21 ± 1.85 to 10.90 ± 3.56 in the PSF group and from 6.45 ± 2.17 to 11.48 ± 3.62 in the ASF group, but at the final follow-up, there was no significant difference between the two groups (P = 0.134). The incidence of post-operative complications in the ASF group (24/142, 16.9%) (P = 0.043) was higher than that in the PSF group (6/116, 5.17%). Conclusions: Cervical laminoplasty combined with short-segment transpedicular screw fixation is a reliable option to treat extensional cervical SCIs in patients with CSCS. This surgical strategy is beneficial for achieving sufficient cervical spinal cord decompression, preserving cervical spine stability, and avoiding extra anterior cervical decompression and fusion, thereby reducing surgery time, intraoperative blood loss volume, post-operative complication rate, and length of hospital stay. Relevance for Patients: Cervical laminoplasty combined with posterior segmental fusion (PSF) reduces operative time, bleeding, and complications and achieves adequate spinal cord decompression in the treatment of extension cervical SCI in patients with CSCS.

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Section: Discussionmentioning

confidence: 99%

Comparison of laminoplasty and posterior segment fusion with laminoplasty and anterior segment fusion for treating acute extensional cervical spinal cord injury in pre-existing canal stenosis: a multicenter retrospective study

Lv,

Zou,

Xiong

et al. 2024

JCTR

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A Study on Interobserver and Intraobserver Reliability of the Huashan Radiologic Classification System for Cervical Spinal Cord Injury Without Fracture and Dislocation

Sun,

Xu,

Wang

et al. 2024

Clinical Spine Surgery

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Study Design: Observational study. Objective: To assess the reproducibility and reliability of the system. Background: The Huashan radiologic classification system for cervical spinal cord injury without fracture and dislocation (CSCIWFD) was recently proposed and found useful for clinical practice. Patients and Methods: Patients diagnosed with CSCIWFD between 2015 and 2021 were recruited. Six spine surgeons from different institutions, three experienced and other inexperienced respectively, were trained as observers of the system, and these surgeons classified the recruited patients using the system. Then, 8 weeks later, they repeated the classification on the same patients in a different order. The interobserver and intraobserver agreement between the results was analyzed using percentage agreement, weighted kappa, and Cohen kappa (κ) statistics. Results: A total of 60 patients were included in the analysis. Type I was the most frequent type (29 cases, 48.3%), followed by type II (13 cases, 21.7%), type III (12 cases, 20%), and type IV (6 cases, 10%). For all the observers, experienced observers, and inexperienced observers, the overall agreement percentages were 77.6% (κ = 0.78), 84.4% (κ = 0.84), and 72.8% (κ = 0.74), respectively, indicating substantial to nearly perfect interobserver reproducibility. A higher level of agreement was found for differentiating type I from other types, with the percentage agreement ranging from 87.8% to 94.4% (κ= 0.74–0.88). For distinguishing compression on the spinal cord (types I and II vs types III and IV) among the different groups of observers, the percentage agreement was 97.8% (κ = 0.94), indicating nearly perfect reproducibility. As for intraobserver agreement, the percentage agreement ranged from 86.7% to 96.7% (κ = 0.78–0.95), indicating at least substantial reliability. Conclusions: The Huashan radiologic classification system for CSCIWFD was easy to learn and apply in a clinical environment, showing excellent reproducibility and reliability. Therefore, it would be promising to apply and promote this system for the precise evaluation and personalized treatment strategy.

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Predictive value of dynamic diffusion tensor imaging for surgical outcomes in patients with cervical spondylotic myelopathy

Wang,

Tian,

Zhang

et al. 2024

Preprint

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Background： Cervical spondylotic myelopathy (CSM) is the most common chronic spinal cord injury with poor surgical and neurologic recovery in the advanced stages of the disease. DTI parameters can serve as important biomarkers for CSM prognosis. The study aimed to investigate the predictive value of dynamic diffusion tensor imaging (DTI) for the postoperative outcomes of CSM. Methods: One hundred and five patients with CSM who underwent surgery were included in this study. Patients were assessed using mJOA before and one year after surgery and then divided into groups with good (≥50%) and poor (<50%) prognoses according to the rate of recovery. All patients underwent preoperative dynamic magnetic resonance imaging of the cervical spine, including T2WI and DTI in natural（N）, extension （E）, and flexion（F） positions. Cross-sectional area, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were measured at the narrowest level in three neck positions. Univariate and multivariate logistic regression were used to identify risk factors for poor postoperative recovery based on clinical characteristics, dynamic T2WI, and DTI parameters. Predictive models were developed for three different neck positions. Results: Forty-four (41.9%) patients had a good postoperative prognosis, and 61 (58.1%) had a poor prognosis. Univariate analysis showed statistically significant differences in diabetes, number of compression segments, preoperative score, cross-sectional area ((Area-N), (Area-E), (Area-F)), ADC(ADC-N), (ADC-E), (ADC-F)) and FA (natural neck position (FA-N), (FA-E), (FA-F)) (p<0.05). Multivariable logistic regression showed that natural neck position: Area-N ([OR] 0.226; [CI] 0.069-0.732, p=0.013), FA-N ([OR] 3.028; [CI] 1.12-8.19, p=0.029);extension neck position:Area-E ([OR]0.248;[CI]0.076-0.814,p=0.021),FA-E ([OR]4.793;[CI]1.737-13.228,p=0.002); And flextion postion: Area-F([OR] 0.288; [CI] 0.095-0.87, p=0.027), FA-F ([OR] 2.964; [CI] 1.126-7.801, p=0.028) were independent risk factors for poor prognosis.The area under the curve (AUC) of the prediction models in the natural neck position, extension neck position and flexion neck positions models were 0.734, 0.760 and 0.730, respectively. Conclusion: Dynamic DTI can predict postoperative outcomes in CSM. Reduced FA in the extension position is a valid predictor of poor postoperative neurological recovery in patients with CSM.

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Dynamic evaluation of the cervical spine by kinematic MRI in patients with cervical spinal cord injury without fracture and dislocation

Cited by 3 publications

References 28 publications

Comparison of laminoplasty and posterior segment fusion with laminoplasty and anterior segment fusion for treating acute extensional cervical spinal cord injury in pre-existing canal stenosis: a multicenter retrospective study

Comparison of laminoplasty and posterior segment fusion with laminoplasty and anterior segment fusion for treating acute extensional cervical spinal cord injury in pre-existing canal stenosis: a multicenter retrospective study

A Study on Interobserver and Intraobserver Reliability of the Huashan Radiologic Classification System for Cervical Spinal Cord Injury Without Fracture and Dislocation

Predictive value of dynamic diffusion tensor imaging for surgical outcomes in patients with cervical spondylotic myelopathy

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