Risk Factors for Missed Dynamic Canal Stenosis in the Cervical Spine

Hayashi, Tetsuo; Wang, Jeffrey C.; Suzuki, Akinobu; Takahashi, Shinji; Scott, Trevor P.; Phan, Kevin; Lord, Elizabeth L.; Ruangchainikom, Monchai; Shiba, Keiichiro; Daubs, Michael D.

doi:10.1097/brs.0000000000000289

Cited by 45 publications

(37 citation statements)

References 16 publications

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“…Our findings are consistent with what has been observed in humans. In a study of humans that evaluated kMRI in patients with cervical myelopathy, extension identified new spinal cord compressions most commonly at C5‐C6, followed by C4‐C5 . In a study that evaluated kMRI in human patients with cervical pain, extension caused the number of cervical disc protrusions to increase by 16.4% ,.…”

Section: Discussionmentioning

confidence: 99%

“…In humans, flexion has been shown to identify new compressive lesions that were not apparent in neutral position. In 1 study of human patients, the number of compressive lesions identified at C5‐C6 increased by 3.7% with flexion …”

Section: Discussionmentioning

confidence: 99%

“…In a study of humans that evaluated kMRI in patients with cervical myelopathy, extension identified new spinal cord compressions most commonly at C5-C6, followed by C4-C5. 17 In a study that evaluated kMRI in Table 1. Morphometric data (mean AE SD) comparing neutral, traction, flexion, and extension in 9 Doberman Pinschers with DA-CSM.…”

Section: Discussionmentioning

confidence: 99%

“…In human patients, kinematic MRI (kMRI) of the cervical vertebral column is used to assess the dynamic component of human CSM. For this technique, an MRI‐compatible positioning device is used to provide controlled flexion and extension of the cervical vertebral column . Results of kMRI have been shown to direct therapy in 26% of human patients, and to change the surgical approach over what is predicted by neutral position alone in 40% of patients with human CSM .…”

mentioning

confidence: 99%

“…For this technique, an MRI-compatible positioning device is used to provide controlled flexion and extension of the cervical vertebral column. 11,[15][16][17][18][19][20][21][22] Results of kMRI have been shown to direct therapy in 26% of human patients, 15 and to change the surgical approach over what is predicted by neutral position alone in 40% of patients with human CSM. 15 Prospective studies investigating kMRI in dogs with CSM are lacking.…”

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confidence: 99%

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Kinematic Magnetic Resonance Imaging for Evaluation of Disc‐Associated Cervical Spondylomyelopathy in Doberman Pinschers

Provencher

Habing

Moore

et al. 2016

Veterinary Internal Medicne

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BackgroundThe dynamic component of disc‐associated cervical spondylomyelopathy (DA‐CSM) currently is evaluated using traction magnetic resonance imaging (MRI), which does not assess changes in flexion and extension of the cervical vertebral column. In humans with cervical spondylotic myelopathy, kinematic MRI is used to identify dynamic compressions.Hypothesis/ObjectivesTo evaluate the feasibility and utility of kMRI in Doberman Pinschers with DA‐CSM using a novel positioning device. We hypothesized that kMRI would identify compressive lesions not observed with neutral positioning and change the dimensions of the spinal cord and cervical vertebral canal.AnimalsNine client‐owned Doberman Pinschers with DA‐CSM.MethodsProspective study. After standard MR imaging of the cervical spine confirmed DA‐CSM, dogs were placed on a positioning device to allow imaging in flexion and extension. Morphologic and morphometric assessments were compared between neutral, flexion, and extension images.ResultsFlexion was associated with improvement or resolution of spinal cord compression in 4/9 patients, whereas extension caused worsening of compressions in 6/9 patients. Extension identified 6 new compressive lesions and was significantly associated with dorsal and ventral compression at C5‐C6 (P = .021) and C6‐C7 (P = .031). A significant decrease in spinal cord height occurred at C6‐C7 from neutral to extension (P = .003) and in vertebral canal height at C5‐C6 and C6‐C7 from neutral to extension (P = .011 and .017, respectively).Conclusions and clinical importanceOur results suggest that kMRI is feasible and provides additional information beyond what is observed with neutral imaging, primarily when using extension views, in dogs with DA‐CSM.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Kinematic Magnetic Resonance Imaging for Evaluation of Disc‐Associated Cervical Spondylomyelopathy in Doberman Pinschers

Provencher

Habing

Moore

et al. 2016

Veterinary Internal Medicne

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Best practices in peri‐operative management of patients with skeletal dysplasias

White

Bompadre

Goldberg

et al. 2017

American J of Med Genetics Pt A

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Patients with skeletal dysplasia frequently require surgery. This patient population has an increased risk for peri-operative complications related to the anatomy of their upper airway, abnormalities of tracheal-bronchial morphology and function; deformity of their chest wall; abnormal mobility of their upper cervical spine; and associated issues with general health and body habitus. Utilizing evidence analysis and expert opinion, this study aims to describe best practices regarding the peri-operative management of patients with skeletal dysplasia. A panel of 13 multidisciplinary international experts participated in a Delphi process that included a thorough literature review; a list of 22 possible care recommendations; two rounds of anonymous voting; and a face to face meeting. Those recommendations with more than 80% agreement were considered as consensual. Consensus was reached to support 19 recommendations for best pre-operative management of patients with skeletal dysplasia. These recommendations include pre-operative pulmonary, polysomnography; cardiac, and neurological evaluations; imaging of the cervical spine; and anesthetic management of patients with a difficult airway for intubation and extubation. The goals of this consensus based best practice guideline are to provide a minimum of standardized care, reduce perioperative complications, and improve clinical outcomes for patients with skeletal dysplasia.

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Degenerative Cervical Myelopathy: A Spectrum of Degenerative Spondylopathies

Nouri

Murray

Fehlings

2018

Degenerative Cervical Myelopathy and Radiculopathy

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Risk Factors for Missed Dynamic Canal Stenosis in the Cervical Spine

Abstract: Dynamic cord compression was most common at the C5-C6 segment. Cervical segments with greater disc bulge, more severe disc degeneration, greater angular motion, segmental kyphosis, and developmental stenosis may be at risk for missed dynamic stenosis.

Cited by 45 publications

References 16 publications

Kinematic Magnetic Resonance Imaging for Evaluation of Disc‐Associated Cervical Spondylomyelopathy in Doberman Pinschers

Kinematic Magnetic Resonance Imaging for Evaluation of Disc‐Associated Cervical Spondylomyelopathy in Doberman Pinschers

Best practices in peri‐operative management of patients with skeletal dysplasias

Degenerative Cervical Myelopathy: A Spectrum of Degenerative Spondylopathies

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