The Neuroimaging Spectrum of Septum Posticum Derangement and Associated Thoracic Myelopathy

Hakky, Michael; Justaniah, Almamoon I.; David, Carlos A.; French, Robert J.; Martin, Dann; Kwok, Nathan; Erbay, Sami H.

doi:10.1111/jon.12243

Cited by 13 publications

(14 citation statements)

References 24 publications

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“…Attempts to differentiate these two conditions have also been made in humans. 26 interesting to note that only a few cases had spondylosis at the affected site (8/27) and that the majority of the dogs had widespread degenerative IVD changes rather than focal IVD changes. In humans, it has been demonstrated that destruction of the articular process joints accelerates degeneration of the adjacent IVD, due to the transference of axial loads to the annulus and anterior longitudinal ligament.…”

Section: Resultsmentioning

confidence: 99%

Clinical features and MRI characteristics of presumptive constrictive myelopathy in 27 pugs

Lourinho

Holdsworth

McConnell

et al. 2020

Vet Radiology Ultrasound

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Constrictive myelopathy has been described in pugs with paraparesis and is characterized by fibrous connective and granulation tissue within the dura mater causing spinal cord compression and focal gliosis. An association between constrictive myelopathy and caudal articular process (CAP) dysplasia is suspected; however, some studies have reported CAP dysplasia as an incidental finding. The imaging appearance of constrictive myelopathy is currently limited to a small number of cases. The aim of this multicenter, retrospective, descriptive study was to detail the magnetic resonance imaging (MRI) characteristics and to correlate these with clinical signs of presumptive constrictive myelopathy in pugs. Medical databases from five veterinary referral hospitals were reviewed to identify pugs with pelvic limb ataxia and paresis, that had a complete record of signalment, neurological examination, and MRI of the thoracolumbar spinal cord. The exclusion criteria were pugs with other conditions, such as unequivocal subarachnoid diverticula, hemivertebrae causing vertebral canal stenosis, intervertebral disc extrusions/protrusions, and multifocal/diffuse lesions. Twenty‐seven pugs met the inclusion criteria. All cases were ambulatory with paraparesis and ataxia. Nearly 60% were incontinent. Magnetic resonance imaging revealed a focal myelopathy in all cases showing one or more of the following lesions: CAP dysplasia (25/27), focal subarachnoid space irregular margination (26/27) with circumferential or dorsal contrast enhancement (10/12), and a symmetric V‐shaped ventral extradural lesion (23/27). This study describes specific MRI features of pugs with presumptive constrictive myelopathy, which authors hypothesize to be a consequence of chronic micro‐motion. Our results may help in diagnosing and subsequently treating this condition, which may warrant vertebral stabilization.

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Section: Resultsmentioning

confidence: 99%

Clinical features and MRI characteristics of presumptive constrictive myelopathy in 27 pugs

Lourinho

Holdsworth

McConnell

et al. 2020

Vet Radiology Ultrasound

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“…In each documented case, the AW has occurred dorsal to the spinal cord at the upper or middle thoracic level. Hakky et al 12) reviewed the CT myelograms for 7 patients with AW and suggested that the web might be derived from a derangement of the septum posticum in the thoracic spine. Freund et al 13) evaluated the flow of CSF in the whole spine using an optimized MRI protocol and concluded that its velocity was highest in the thoracic spine.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Surgical Treatment for Arachnoid Web: A Case Series

Hirai

Taniyama

Yoshii

et al. 2019

Spine Surg Relat Res

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Introduction: We describe 5 patients who underwent operative treatment for arachnoid web (AW) and discuss the postoperative clinical outcome in each case. AW is an extremely rare disease that causes cord compression and syringomyelia in the thoracic spine. To date, 14 cases only of AW have been reported, and the effect of surgical intervention on clinical and radiologic outcomes is unknown. Methods: Five patients who underwent surgical treatment for AW were retrospectively reviewed. The clinical outcomes were evaluated using the thoracic Japanese Orthopaedic Association (T-JOA) score. Preoperative and postoperative images were reviewed. Results: All the patients presented with spastic gait and numbness in the lower extremities. Two patients also presented with bladder-bowel dysfunction (BBD). AW, or the so-called "scalpel" sign, was seen dorsally in the thoracic spine on magnetic resonance imaging in all the patients. Syringomyelia adjacent to the web was observed in 4 patients. Fenestration and web resection without instrumentation was performed in all the cases. Overall, significant improvement was seen in locomotion and the total T-JOA score postoperatively. However, numbness in the lower extremities improved in 2 patients but was unchanged in 3 cases. BBD was ameliorated in 1 patient but remained unchanged in the other patient. Conclusions: Our experience suggests that surgical treatment, including the another patient and resection of the web, can correct the flow dynamics of cerebrospinal fluid and allow neurologic recovery, in particular locomotion, in patients with AW.

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“…The reinforcements provide stability to the cord during movement [ 6 ]. The fibrous septum posticum divides the posterior aspect of the subarachnoid space by running opposite the posterior median sulcus [ 6 7 ]. The septum posticum is best developed in the upper thoracic spine and is believed to provide additional dorsal stability to the thoracic cord ( Fig.…”

Section: Discussionmentioning

confidence: 99%

Pathophysiology and Grading of the Ventral Displacement of Dorsal Spinal Cord Spectrum

et al. 2018

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Study DesignA retrospective study of the ventral displacement of dorsal spinal cord (VDDSC) spectrum pathophysiology and grading.PurposeThis study aimed at examining the pathophysiology of VDDSC between D3 and D7, using magnetic resonance imaging (MRI) correlation and severity grading.Overview of LiteratureThe pathologies that lead to VDDSC were previously discussed in various articles. We attempted to group these pathological conditions under a single spectrum, and grade them according to their severity.MethodsWe reviewed the MRI images of the dorsal spines of 1,350 patients over a period of 4 years (February 2013–February 2017); all MRI images were analyzed by two experienced radiologists.ResultsOf the 1,350 patients, 28 exhibited VDDSC between D3 and D7. Additional findings included ventral transdural herniation of the spinal cord (n=10), anterior spinal cord adhesion (n=7), arachnoid web (n=6), and arachnoid cyst (n=5).ConclusionsWe grouped the pathologies that lead to VDDSC at the thoracic level into a single spectrum of varying severity and graded VDDSC, from mild to severe.

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The Neuroimaging Spectrum of Septum Posticum Derangement and Associated Thoracic Myelopathy

Cited by 13 publications

References 24 publications

Clinical features and MRI characteristics of presumptive constrictive myelopathy in 27 pugs

Clinical features and MRI characteristics of presumptive constrictive myelopathy in 27 pugs

Clinical Outcomes of Surgical Treatment for Arachnoid Web: A Case Series

Pathophysiology and Grading of the Ventral Displacement of Dorsal Spinal Cord Spectrum

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