Magnetic Resonance Imaging of the Cervical Spine Under-Represents Sagittal Plane Deformity in Degenerative Myelopathy Patients

Abstract

We would recommend the use of standing x-rays when considering surgical planning in all myelopathy patients. This manuscript was reviewed and approved by an institutional review board. Informed consent was not obtained because patient specific identifying information was not used. It was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Magnetic Resonance Imaging Is Inadequate to Assess Cervical Sagittal Alignment Parameters

“…2,[11][12][13][14] While direct comparisons are limited, the differences in the findings and conclusions are notable and summarized in Table 3. In a related study consisting of 101 patients with cervical myelopathy, Weinberg et al 18 found significant differences in cervical curvature angle This study has several limitations. Our patient cohort was defined as patients who underwent posterior-based cervical surgery for cervical spondylotic myelopathy; all patients had either a laminoplasty or laminectomy with fusion.…”

“…Oftentimes, in the workup of patients with clinical signs and symptoms of cervical spondylotic myelopathy, MRI is the primary imaging modality used to characterize central spinal cord and nerve root compression 16,17. The nearly ubiquitous nature of MR imaging in spinal care has led some healthcare providers, and even payors, to question the utility of obtaining radiographs in the setting of an existing magnetic resonance imaging 18. Upright lateral radiographs, however, have traditionally been the gold standard to assess sagittal alignment and are thought to be necessary for preoperative surgical planning.…”

“…While direct comparisons are limited, the differences in the findings and conclusions are notable and summarized in Table 3. In a related study consisting of 101 patients with cervical myelopathy, Weinberg et al18 found significant differences in cervical curvature angle and curvature index as measured by XR and MRI, concluding that MRI underrepresented sagittal plane deformity and that upright XR should be used for preoperative planning in this patient subset.…”

“…16,17 The nearly ubiquitous nature of MR imaging in spinal care has led some healthcare providers, and even payors, to question the utility of obtaining radiographs in the setting of an existing magnetic resonance imaging. 18 Upright lateral radiographs, however, have traditionally been the gold standard to assess sagittal alignment and are thought to be necessary for preoperative surgical planning. Nonetheless, there remains inconclusive evidence regarding how positioning can affect sagittal parameters across these 2 imaging modalities.…”