Dynamic MRI Reveals Soft-Tissue Compression Causing Progressive Myelopathy in Postlaminectomy Patients

Stamm, Sarah; McClellan, John W.; Knierim, Annie; Suiter, Ian P.; Riew, K. Daniel

doi:10.2106/jbjs.cc.l.00174

Cited by 12 publications

(15 citation statements)

References 6 publications

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“…Of note, although the spinal canal diameter may increase in flexion, some studies reported that in this position, the tension forces applied to the spinal cord causes ventral spinal cord compression against osteophytes and discs – worsening an eventual ventral compression [11]. For this reason, it is not accurate to assume that in all patients with CSM, flexion is a protective position.…”

Section: Spinal Canal Changes In Flexion and Extensionmentioning

confidence: 99%

“…For this reason, it is not accurate to assume that in all patients with CSM, flexion is a protective position. On the other hand, extension shortens the cervical cord, decreasing the space available for it, with ligamentum flavum (LF) buckling which could potentially aggravate posterior compression, especially in patients with pre-existing stenosis [8,11].…”

Section: Spinal Canal Changes In Flexion and Extensionmentioning

confidence: 99%

“…Dynamic MRI studies are not performed routinely due to the additional time, cost, and resources required. In clinical practice, they are often not covered by health insurance plans [11]. Additionally, there is not yet a standardized technique for obtaining the dynamic exams.…”

Section: Dynamic Mri Studiesmentioning

confidence: 99%

“…Some authors recommended maximum flexion and extension until pain tolerance or new a neurological deficits, but this may result in patient discomfort or even risk neurological deterioration in patients with unstable spines or severe cord compression [12]. Stamm et al [11] suggested to place the patients on a wedge of about 5-in high to flex the head and then put the same wedge under the shoulders to extend the neck. These differences in the position to obtain the exam may change the image and consequently are confounding factors in dMRI evaluation.…”

Section: Dynamic Mri Studiesmentioning

confidence: 99%

“…Stamm et al [11] reported that dMRI was useful for revealing soft tissue compression after postlaminectomy patients. Three cases of progressive myelopathy, despite good satisfactory decompression with laminectomy documented in static cervical MRI scans, revealed clear and evident compression in extension by posterior soft tissues buckling into the laminectomy defect.…”

Section: Dynamic Mri Studiesmentioning

confidence: 99%

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Dynamic Cord Compression Causing Cervical Myelopathy

et al. 2019

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Due to the highly mobile nature of the cervical spine, and the fact that most magnetic resonance imagings (MRIs) and computed tomography scans are obtained only in one single position, dynamic cord compression can be an elusive diagnosis that is often missed and not well-understood. In this context, dynamic MRI (dMRI) has been utilized to improve the diagnostic accuracy of cervical stenosis. We performed a literature review on dynamic cord compression in the context of cervical spondylotic myelopathy (CSM), with particular emphasis on the role of dMRI. Cadaveric studies report that the spinal cord lengthens in flexion and the spinal canal dimension increases, whereas the spinal cord relaxes and shortens in extension and the spinal canal decreases. These changes may lead to biomechanical stress in the spinal cord with movement, especially in patients with critical cervical stenosis. The majority of the studies using dMRI in CSM reported that this imaging modality is more sensitive at detecting cervical cord compression compared to routine MRIs done in a neutral position, especially with the neck in extension. Dynamic MRI was also useful to diagnose dynamic cervical cord compression after laminectomies in patients with clinical deterioration without evident cord compression on neutral static MRI. Finally, dMRI is more sensitive in detecting stenosis in patients with CSM than in those with ossification of the posterior longitudinal ligament (OPLL), likely because OPLL patients often have a more limited range of motion than CSM patients. Thus, dMRI is a promising new tool that can help spine surgeons in diagnosing and treating CSM.

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Section: Spinal Canal Changes In Flexion and Extensionmentioning

confidence: 99%

Section: Spinal Canal Changes In Flexion and Extensionmentioning

confidence: 99%

Section: Dynamic Mri Studiesmentioning

confidence: 99%

Section: Dynamic Mri Studiesmentioning

confidence: 99%

Section: Dynamic Mri Studiesmentioning

confidence: 99%

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