Cervical compressive myelopathy (CM) remains a common entity in the practice of spine surgery. Though MRI is the diagnostic modality for CM, there are a subset of patients whose clinical features are suggestive of multilevel compression caused by dynamic factors, which however cannot be detected by a static MRI study. The causes include buckling of ligamentum flavum, collapse of disc height and changes in posterior longitudinal ligaments at the level of compression. These changes can only be detected on dynamic MRI. The application of Dynamic MRI can reveal not just additional levels of compression but even the site of maximum pressure, thus playing a vital role in surgical planning. It is also seen that adjaent level disease, commonly thought to be secondary to Cervical fusion was actually pre-existing and could have been picked up if dynamic MRI were used. We thus planned a prospective cohort of 24 patients of multilevel cervical compessive myelopathy who were studied with dynamic MRI at the Sakra Spine centre in Bangalore India. The clinical symptoms were correlated to the dynamic changes in MRI and were considered for planning appropriate treatment. Of the 24 patients in our study, 17 patients had a change in the original plan of treatment, either between conservative therapy and surgery, or the approach (Anterior vs. Posterior) of surgery. It was also noted that additional levels of compression discovered on the dynamic MRI were instrumental in changing the treatment protocol. Thus Flexion and Extension MRI is an important tool in planning the appropriate management in cervical compressive myelopathy.
| Published in | International Journal of Neurosurgery (Volume 2, Issue 1) |
| DOI | 10.11648/j.ijn.20180201.14 |
| Page(s) | 17-22 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2018. Published by Science Publishing Group |
Cervical Compressive Myelopathy, MRI, Ligamentum Flavum, Surgery
| [1] | Zhang L, Zeitoun D, Rangel A, Lazennec JY, Catonné Y, Pascal-Moussellard H. Preoperative evaluation of the cervical spondylotic myelopathy with flexion-extension magnetic resonance imaging: about a prospective study of fifty patients. Spine. 2011 Aug 1; 36 (17):E1134-9. |
| [2] | Machino M, Yukawa Y, Ito K, Nakashima H, Kato F. Dynamic changes in dural sac and spinal cord cross-sectional area in patients with cervical spondylotic myelopathy: cervical spine. Spine. 2011 Mar 1; 36 (5):399-403. |
| [3] | Harada T, Tsuji Y, Mikami Y, Hatta Y, Sakamoto A, Ikeda T, Tamai K, Hase H, Kubo T. The clinical usefulness of preoperative dynamic MRI to select decompression levels for cervical spondylotic myelopathy. Magnetic resonance imaging. 2010 Jul 31; 28 (6):820-5. |
| [4] | Morishita Y, Naito M, Hymanson H, Miyazaki M, Wu G, Wang JC. The relationship between the cervical spinal canal diameter and the pathological changes in the cervical spine. European Spine Journal. 2009 Jun 1; 18 (6): 877-83. |
| [5] | Lebl DR, Hughes A, Cammisa FP, O’Leary PF. Cervical spondylotic myelopathy: pathophysiology, clinical presentation, and treatment. HSS journal. 2011 Jul 1; 7 (2):170-8. |
| [6] | Kuwazawa Y, Bashir W, Pope MH, Takahashi K, Smith FW. Biomechanical aspects of the cervical cord: effects of postural changes in healthy volunteers using positional magnetic resonance imaging. Clinical Spine Surgery. 2006 Jul 1; 19 (5):348-52. |
| [7] | Henderson FC, Geddes JF, Vaccaro AR, Woodard E, Berry KJ, Benzel EC. Stretch-associated injury in cervical spondylotic myelopathy: new concept and review. Neurosurgery. 2005 May 1; 56 (5):1101-13. |
| [8] | Bakhsheshian J, Mehta VA, Liu JC. Current Diagnosis and Management of Cervical Spondylotic Myelopathy. Global Spine J. 2017 Sep; 7(6): 572–586. Published online 2017 May 31. |
| [9] | Lu K, Gao X, Tong T, Miao D, Ding W, Shen T. Clinical Predictors of Surgical Outcomes and Imaging Features in Single Segmental Cervical Spondylotic Myelopathy with Lower Cervical Instability. Med Sci Monit. 2017; 23: 3697–3705. Published online 2017 Jul 30 |
| [10] | Zhang C, Das SK, Yang DJ, Yang H. Application of magnetic resonance imaging in cervicalspondylotic myelopathy. World J Radiol. 2014 Oct 28; 6(10): 826–832. Published online 2014 Oct 28. |
| [11] | Ellingson BM, Salamon N, Holly NT. Advances in MR Imaging for Cervical Spondylotic Myelopathy. Eur Spine J. 2015 Apr; 24 (Suppl 2): 197–208. Published online 2013 Aug 6. |
APA Style
Sibhi Ganapathy, Venkataramakrishna Tukapuram, Nikunj Godhani, Swaroop Gopal. (2018). Dynamic Mri of the Cervical Spine – An Important Tool in Planning Surgical Treatment of Cervical Compressive Myelopathy. International Journal of Neurosurgery, 2(1), 17-22. https://doi.org/10.11648/j.ijn.20180201.14
ACS Style
Sibhi Ganapathy; Venkataramakrishna Tukapuram; Nikunj Godhani; Swaroop Gopal. Dynamic Mri of the Cervical Spine – An Important Tool in Planning Surgical Treatment of Cervical Compressive Myelopathy. Int. J. Neurosurg. 2018, 2(1), 17-22. doi: 10.11648/j.ijn.20180201.14
AMA Style
Sibhi Ganapathy, Venkataramakrishna Tukapuram, Nikunj Godhani, Swaroop Gopal. Dynamic Mri of the Cervical Spine – An Important Tool in Planning Surgical Treatment of Cervical Compressive Myelopathy. Int J Neurosurg. 2018;2(1):17-22. doi: 10.11648/j.ijn.20180201.14
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Download@article{10.11648/j.ijn.20180201.14,
author = {Sibhi Ganapathy and Venkataramakrishna Tukapuram and Nikunj Godhani and Swaroop Gopal},
title = {Dynamic Mri of the Cervical Spine – An Important Tool in Planning Surgical Treatment of Cervical Compressive Myelopathy},
journal = {International Journal of Neurosurgery},
volume = {2},
number = {1},
pages = {17-22},
doi = {10.11648/j.ijn.20180201.14},
url = {https://doi.org/10.11648/j.ijn.20180201.14},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20180201.14},
abstract = {Cervical compressive myelopathy (CM) remains a common entity in the practice of spine surgery. Though MRI is the diagnostic modality for CM, there are a subset of patients whose clinical features are suggestive of multilevel compression caused by dynamic factors, which however cannot be detected by a static MRI study. The causes include buckling of ligamentum flavum, collapse of disc height and changes in posterior longitudinal ligaments at the level of compression. These changes can only be detected on dynamic MRI. The application of Dynamic MRI can reveal not just additional levels of compression but even the site of maximum pressure, thus playing a vital role in surgical planning. It is also seen that adjaent level disease, commonly thought to be secondary to Cervical fusion was actually pre-existing and could have been picked up if dynamic MRI were used. We thus planned a prospective cohort of 24 patients of multilevel cervical compessive myelopathy who were studied with dynamic MRI at the Sakra Spine centre in Bangalore India. The clinical symptoms were correlated to the dynamic changes in MRI and were considered for planning appropriate treatment. Of the 24 patients in our study, 17 patients had a change in the original plan of treatment, either between conservative therapy and surgery, or the approach (Anterior vs. Posterior) of surgery. It was also noted that additional levels of compression discovered on the dynamic MRI were instrumental in changing the treatment protocol. Thus Flexion and Extension MRI is an important tool in planning the appropriate management in cervical compressive myelopathy.},
year = {2018}
}
TY - JOUR T1 - Dynamic Mri of the Cervical Spine – An Important Tool in Planning Surgical Treatment of Cervical Compressive Myelopathy AU - Sibhi Ganapathy AU - Venkataramakrishna Tukapuram AU - Nikunj Godhani AU - Swaroop Gopal Y1 - 2018/07/26 PY - 2018 N1 - https://doi.org/10.11648/j.ijn.20180201.14 DO - 10.11648/j.ijn.20180201.14 T2 - International Journal of Neurosurgery JF - International Journal of Neurosurgery JO - International Journal of Neurosurgery SP - 17 EP - 22 PB - Science Publishing Group SN - 2640-1959 UR - https://doi.org/10.11648/j.ijn.20180201.14 AB - Cervical compressive myelopathy (CM) remains a common entity in the practice of spine surgery. Though MRI is the diagnostic modality for CM, there are a subset of patients whose clinical features are suggestive of multilevel compression caused by dynamic factors, which however cannot be detected by a static MRI study. The causes include buckling of ligamentum flavum, collapse of disc height and changes in posterior longitudinal ligaments at the level of compression. These changes can only be detected on dynamic MRI. The application of Dynamic MRI can reveal not just additional levels of compression but even the site of maximum pressure, thus playing a vital role in surgical planning. It is also seen that adjaent level disease, commonly thought to be secondary to Cervical fusion was actually pre-existing and could have been picked up if dynamic MRI were used. We thus planned a prospective cohort of 24 patients of multilevel cervical compessive myelopathy who were studied with dynamic MRI at the Sakra Spine centre in Bangalore India. The clinical symptoms were correlated to the dynamic changes in MRI and were considered for planning appropriate treatment. Of the 24 patients in our study, 17 patients had a change in the original plan of treatment, either between conservative therapy and surgery, or the approach (Anterior vs. Posterior) of surgery. It was also noted that additional levels of compression discovered on the dynamic MRI were instrumental in changing the treatment protocol. Thus Flexion and Extension MRI is an important tool in planning the appropriate management in cervical compressive myelopathy. VL - 2 IS - 1 ER -
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