Dynamic spinal cord compression has been investigated for several years, but until the advent of open MRI, the use of dynamic MRI (dMRI) did not gain popularity. Several publications have shown that cervical cord compression is both static and dynamic. On many occasions the evaluation of cervical spondylotic myelopathy (CSM) is straightforward, but patients are frequently encountered with a significantly worse clinical examination than would be suggested by radiological images. In this paper, we present an extensive review of the literature in order to describe the importance of dMRI in various settings and applications. A detailed literature review was performed in the Medline and Pubmed databases using the terms “cervical spondylotic myelopathy”, “dynamic MRI”, “kinetic MRI”, and “myelomalalcia” for the period of 1980-2016. The study was limited to English language, human subjects, case series, retrospective studies, prospective reports, and clinical trials. Reviews, case reports, cadaveric studies, editorials, and commentaries were excluded. The literature search yielded 180 papers, 19 of which met inclusion criteria. However, each paper had evaluated results and outcomes in different ways. It was not possible to compile them for meta-analysis or pooled data evaluation. Instead, we evaluated individual studies and present them for discussion. We describe a number of parameters evaluated in 2661 total patients, including dynamic changes to spinal cord and canal dimensions, transient compression of the cord with changes in position, and the effects of position on the intervertebral disc. dMRI is a useful tool for understanding the development of CSM. It has found several applications in the diagnosis and preoperative evaluation of many patients, as well as certain congenital dysplasias and Hirayama disease. It is useful in correlating symptoms with the dynamic changes only noted on dMRI, and has reduced the incidence of misdiagnosis of myelopathy.
Cadaver ; Cervical Cord ; Diagnosis ; Diagnostic Errors ; Humans ; Incidence ; Intervertebral Disc ; Magnetic Resonance Imaging* ; Prospective Studies ; Retrospective Studies ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Diseases*

Cervical Vertebrae/diagnostic imaging* ; Humans ; Magnetic Resonance Imaging ; Nitrous Oxide/adverse effects* ; Spinal Cord Diseases/diagnostic imaging* ; Substance-Related Disorders

A 53-year-old man presented with acute cervical myelopathy following a fall. Cervical radiography and computed tomography showed ossification of the posterior longitudinal ligament (OPLL) from C2 to C6 level, with severe cervical canal stenosis and cord compression. Magnetic resonance imaging further showed increased T2-weighted signal in the spinal cord at the level of greatest central spinal canal stenosis. OPLL is a significant cause of myelopathy in Asian populations and is found in up to 25% of patients presenting with cervical compression myelopathy. The clinical presentation, radiological evaluation and management of OPLL are discussed.
Cervical Vertebrae ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Ossification of Posterior Longitudinal Ligament ; diagnostic imaging ; Spinal Cord ; diagnostic imaging ; Spinal Cord Compression ; diagnostic imaging ; Spinal Cord Diseases ; pathology ; Tomography, X-Ray Computed

Though diagnosis of myelopathy can be easily made by history and neurological examination, modern technologies, such as MRI and evoked potential study (EPS), have played an important role in making the anatomical and pathological diagnosis of myelopathy. To assess the accuracy of clinical diagnosis and the role of the laboratory studies, we prospectively studied 26 patients with myelopathy, admitted to S.N.U.H. We tried to decide, by clinical history and examination, the anatomical location and the pathological diagnosis, and compared them with final diagnosis. 1. The final diagnosis could be made in 23 out of 26 patients. 2. Of 17 patients with the initial clinical diagnosis of intramedullary lesion (IML), two patients turned out to have extramedullary lesions (EML). Final diagnosis could not be made in three patients, and imaging studies and EPS didn't reveal definite local lesions. In another group of nine patients with the initial clinical diagnosis of EML, three patients had IML. 3. The clinically suspected levels of lesions were shown to be accurate within one level in 20 out of 26 patients after MRI. 4. Clinical diagnosis was accurate in 18 out of 26 patients. 5. Among the laboratory tests, MRI helped localize the lesions and make the final diagnosis. EPS was most helpful in making a diagnosis of multiple sclerosis by finding out asymptomatic second lesions. Even with thorough work-up the etiologies of myelopathy in three patients could not be elucidated. 6. Review of wrong diagnosis showed that diagnostic errors were attributed to incomplete history taking or examination, misinterpretation of clinical data, and unusual presentations or unsuspected rare diseases. Therefore, the authors conclude that the physician's clinical examinations in the diagnosis of neurologic diseases are still valuable despite the technology of the laboratory studies is developing further in present days.
Diagnosis ; Diagnostic Errors ; Evoked Potentials ; Humans ; Magnetic Resonance Imaging ; Multiple Sclerosis ; Neurologic Examination* ; Prospective Studies ; Rare Diseases ; Spinal Cord Diseases

Idiopathic spinal cord herniation (ISCH) is a rare cause of progressive myelopathy. This condition has recently seen an increased frequency of diagnosis, possibly due to increased awareness and the use of magnetic resonance (MR) imaging. ISCH is characterised by herniation of the thoracic spinal cord through an anterior or anterolateral dural defect. Patients usually present with a Brown-Séquard-like syndrome, which is gradually progressive and may evolve into severe paraparesis. This disease has a characteristic radiological appearance, and in most cases, excellent postsurgical outcome. We report ISCH and its imaging appearance in a 31-year-old woman with classical presentation, and discuss the current concepts regarding the aetiopathogenesis, radiological features and management of the disease.
Adult ; Female ; Hernia ; diagnosis ; diagnostic imaging ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging ; Radiography ; Spinal Cord ; diagnostic imaging ; pathology ; physiopathology ; Spinal Diseases ; diagnosis ; diagnostic imaging

Cervical spondylotic myelopathy (CSM) is a common cause of spinal cord dysfunction clinical disease. Surgery is the main therapeutic tool for CSM. However, there are obvious differences in clinical functional recovery after operation. For the past few years, the influence factors of prognosis in cervical spondylosis myelopathic has been widely concerned. Age, nerve function, course of desease, imaging findings,surgical method and related factors became the investigative point for prognosis of cervical spondylotic myelopathy. Present viewpoint showed that the older patient, preoperative worse nerve function, longer the course of disease would result in worse outcomes. Imaging examination maybe can indicate the prognosis, but the correlation is unclear. Selection of surgical method and approach should be based on the principles of sufficient decompression, stabilize the alignment of the cervical spine, keeping backward extension of cervical spine, maintain effective decompression, preventing complications. Therefore, the treatment of cervical spondylotic myelopathy should be on the basis of pathogenic condition and imaging examination at early stage and a suitable usrgical procedure should be performed to obtain a better prognosis.
Cervical Vertebrae ; surgery ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Radiography ; Spinal Cord Diseases ; diagnosis ; diagnostic imaging ; surgery ; Spondylosis ; diagnosis ; diagnostic imaging ; surgery

Ossification of the ligamentum flavum is a rare cause of thoracic myelopathy. It develops in East Asians more frequently than in people from other areas. The exact pathophysiology has not been elucidated yet; however, it largely depends on biomechanical alterations, especially changes in the tensile force. Because the spinal cord is compressed from the posterior side, the first and most common clinical manifestation is usually loss of functional gait and spastic paralysis, which develop as the spinal cord compression progresses. The choice of diagnostic imaging is T2 sagittal magnetic resonance imaging scanning. Whole spine scanning is mandatory to identify multiple areas of compression and any associated distal lumbar diseases. Fine computed tomography imaging is necessary to make a differential diagnosis and set up a precise surgical plan. Conservative treatment does not work in this disorder. Decompression surgery is the only option and prognosis after surgical treatment is better with this disorder than with other causes of thoracic myelopathy. The severity of preoperative symptoms and the time interval before surgical treatment are the most important prognostic factors.
Asian Continental Ancestry Group ; Decompression ; Diagnosis, Differential ; Diagnostic Imaging ; Gait ; Humans ; Ligamentum Flavum* ; Magnetic Resonance Imaging ; Muscle Spasticity ; Paralysis ; Prognosis ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Diseases ; Spine

Fatal Outcome ; Humans ; Magnetic Resonance Imaging ; Male ; Mediastinal Neoplasms ; complications ; diagnostic imaging ; pathology ; surgery ; Mediastinum ; diagnostic imaging ; pathology ; Neuroectodermal Tumors, Primitive, Peripheral ; complications ; diagnostic imaging ; pathology ; surgery ; Radiography ; Spinal Cord Diseases ; diagnostic imaging ; etiology ; pathology ; Young Adult

OBJECTIVETo compare the clinical outcomes of anterior cervical decompression plus sublevel fusion and posterior cervical laminoplasty in treating multilevel cervical spondylotic myelopathy.

METHODSThe clinical data of 56 patients with multilevel cervical spondylotic myelopathy were retrospectively analyzed from July 2009 to June 2012. There were 32 males and 24 females, aged from 42 to 79 years old with an average of (56.9 +/- 12.8) years. All patients had the typical clinical features of cervical spondylotic myelopathy,radiological evidences, and courses of disease were from 2 months to 16 years with an average of (10.6 +/- 3.2)years. Of them,34 patients were treated with anterior cervical decompression plus sublevel fusion (anterior fusion group) and 22 patients with posterior cervical laminoplasty (posterior laminoplasty group). JOA score and radiological data were used to evaluate the clinical results:

RESULTSNo complications about nerve and blood vessel was found and the patients were followed up from 24 to 36 months with an average of 28.6 months. In anterior fusion group, the cervical anterior column height was significantly increased and the anterior cervical curvature angle was significantly decreased at 2 weeks after surgery (P < 0.05). In posterior laminoplasty group, there was no significant difference in above items between preoperative and postoperative at 2 weeks,final follow-up. Postoperative at 2 weeks and final follow-up, there was significant difference in anterior cervical curvature angle between two groups (P<0.05). Postoperative JOA score had obviously improved in all patients, at 3 months after operation and final follow-up, anterior fusion group was better than that of posterior laminoplasty group (P < .05).

CONCLUSIONThe anterior sublevel fusion can effectively restore cervical anterior column height, and compared with the posterior cervical laminoplasty, it can obviously improve the spinal cord function. It is an effective method for the multilevel cervical spondylotic myelopathv.

Adult ; Aged ; Case-Control Studies ; Cervical Vertebrae ; diagnostic imaging ; surgery ; Decompression, Surgical ; Female ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Spinal Cord Diseases ; diagnostic imaging ; surgery ; Spinal Fusion ; Spondylosis ; diagnostic imaging ; surgery

BACKGROUNDOssification of the ligamentum flavum (OLF) is being increasingly recognized as a cause of thoracic myelopathy. This study was to describe a rare clinical entity of spinal cord kinking (SK) in thoracic myelopathy secondary to OLF.

METHODSThe data of 95 patients with thoracic myelopathy secondary to OLF were analyzed retrospectively. The incidence and location of SK were determined using preoperative magnetic resonance imaging (MRI). The clinical presentation and radiological characteristics in patients with SK were analyzed. Posterior en bloc laminectomy with OLF was performed, and the surgical results were evaluated.

RESULTSSK was found in seven patients (7.4%) based on preoperative MRI. The patients included one male and six females with an average age of 55.6 years (range, 48-64 years). Five patients presented with radiculomyelopathy and two presented with typical thoracic myelopathy of spastic paraparesis. In all cases, the kinking was located just above the end of the spinal cord where the conus medullaris (CM) was compressed by the OLF. The degree of SK varied from mild to severe. The tip of the CM was located between the upper third of T11 to the lower third of L1, above the lower edge of L1. With an average follow-up of 30.4 months, the modified Japanese Orthopedic Association score significantly improved from 5.7 ± 1.8 preoperatively to 8.9 ± 1.4 postoperatively (t = 12.05; P < 0.0001) with an improvement rate of 63.1 ± 12.3%.

CONCLUSIONSSK is a rare radiological phenomenon. It is typically located at the thoracolumbar junction, where the CM is compressed by the OLF. Our findings indicate that these patients may benefit from a posterior decompressive procedure.

Female ; Humans ; Ligamentum Flavum ; pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Ossification, Heterotopic ; complications ; Radiography ; Spinal Cord Compression ; diagnosis ; diagnostic imaging ; surgery ; Spinal Cord Diseases ; diagnosis ; diagnostic imaging ; etiology ; surgery