Spinal cord magnetic resonance imaging (MRI) is an advanced imaging technique (mainly in the cervical cord) and has been gradually used in basic scientific research such as human sensation and motor function, and clinical applications such as spinal cord injury, myelitis, and chronic pain, etc. The development of spinal cord MRI is still at the early stage compared with brain MRI and limited by the current MRI technology and data analysis methods. This review focuses on the methods and applications of spinal cord MRI technology in the basic research fields of cognitive neuroscience and clinical application. Firstly, we will introduce the imaging principle, methods, measurement standards, and applications of most commonly used multimodal spinal cord MRI techniques, including quantitative spinal cord MRI (such as structural, diffusion, spectroscopy, myelin water, magnetization transfer, and chemical exchange saturation transfer imaging, etc.) and spinal functional MRI (fMRI). Secondly, we will discuss the technical challenges and possible solutions of spinal cord MRI data processing from the three dimensions of denoising, data processing pipeline optimization, and repeatability and reliability. Finally, we will discuss the application status and development prospects of spinal cord MRI.
Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Reproducibility of Results ; Spinal Cord/diagnostic imaging* ; Spinal Cord Injuries

The incidence of multiple noncontiguous spinal injuries (MNSI) in the cervical spine is rare but has catastrophic consequences. The patient in this report was a 34-year-old woman with five-level cervical MNSI. CT and MRI showed that injuries included atlantoaxial instability, burst fracture of C6, dislocation of C6/7, rupture of the intervertebal disc or ligamentous complex, and irreversible cord damage. The mechanism for this case was a combined pattern of hyperflexion, compression, and hyperextension injuries. A review of the literature revealed that this case is the first report in the literature of a vehicle related accident causing five-level noncontiguous injuries of the cervical spine.
Adult ; Cervical Vertebrae ; diagnostic imaging ; injuries ; Female ; Humans ; Magnetic Resonance Imaging ; Spinal Injuries ; diagnosis ; diagnostic imaging ; Tomography, X-Ray Computed

OBJECTIVETo examine the contribution of flexion and extension radiographs in the evaluation of ligamentous injury in awake adults with acute blunt cervical spine trauma, who show loss of cervical lordosis and neck pain.

METHODSAll patients who presented to our emergency department following blunt trauma were enrolled in this study, except those with schiwora, neurological deficits or fracture demonstrated on cross-table cervical spine X-rays, and those who were either obtunded or presented after cervical spine surgery. Adequacy of flexion and extension views was checked by the neurosurgery and radiology team members. All these patients underwent cross-table cervical spine view followed by flexion/extension views based on the loss of lordosis on cross-table imaging and the presence of neck pain.

RESULTSA total of 200 cases were reviewed, of whom 90 (45%) underwent repeat X-rays because of either inadequate exposure or limited motion. None of the patients with loss of lordosis on cross-table view had positive flexion and extension views of cervical spine for instability.

CONCLUSIONSOur results show that in patients who underwent acute radiographic evaluation of blunt cervical spine trauma, flexion and extension views of the cervical spine are unlikely to yield positive results in the presence of axial neck pain and/or loss of cervical lordosis. We can also hypothesize that performing flexion and extension views will be more useful once the acute neck pain has settled.

Cervical Vertebrae ; injuries ; Humans ; Radiography ; Range of Motion, Articular ; Spinal Injuries ; Wounds, Nonpenetrating ; diagnostic imaging

A 24-year-old male was transferred to the emergency department while being in the state of quadriplegia with a history of performing Parkour sport, which is also called double front flip. Neurological examination revealed that the patient's muscle power was 0/5 at all extremities. The patient did not show any sense of light touch or pain in his extremities. In radiological studies, cervical spine X-ray and CT scan images showed C4-C5 subluxation with bilateral locked facets and spinal cord injury. The results of this very rare case study revealed that exercising Parkour sport without taking into account safety standards could result in irreversible injuries to the cervical spinal cord with fatal outcome.
Cervical Vertebrae ; Humans ; Male ; Radiography ; Running ; injuries ; Spinal Cord Injuries ; diagnostic imaging ; etiology ; Young Adult

As one of the severe injuries, spinal injury is common in major blunt trauma and a spinal cord injury can make the patient be disabled or life-threatened with poor long-term physical and psychological consequences. The treatment of spinal injuries is a significant proportion of all the workload of trauma management based on the neurologic defect, spinal column instability, and the compression of spinal cord. Multidetector computed tomography (MDCT) is the better examination than conventional radiography in depicting the type of injuries, spinal column instability, spinal canal narrowing degree and neurologic defect, and can be performed alone in patients sustaining severe trauma. The purpose of this review is to evaluate the MDCT features of this types of injuries based on the mechanism.
Humans ; Imaging, Three-Dimensional ; methods ; Multidetector Computed Tomography ; methods ; Spinal Injuries ; diagnostic imaging ; physiopathology

Type 2 manubriosternal dislocations with concomitant spinal fracture are rare and may be associated with thoracic visceral injuries. The complication of delayed haemothorax has not been reported yet. We report a case of a young male who suffered manubriosternal dislocation with chance type thoracic spine fracture due to fall of a tree branch over his back. The haemothorax presented late on day three. The possible injury mechanism is discussed along with review of literature. We conclude that a lateral chest radiograph is indicated in spinal fracture patients complaining of midsternal pain. Computerized axial tomography scan of chest with contrast is indicated to rule out visceral injuries and a chest radiograph should be repeated before the patient is discharged to look for delayed haemothorax.
Adult ; Hemothorax ; etiology ; Humans ; Joint Dislocations ; complications ; diagnostic imaging ; Male ; Manubrium ; injuries ; Radiography, Thoracic ; Spinal Fractures ; complications ; diagnostic imaging ; Sternum ; injuries ; Thoracic Vertebrae ; injuries

OBJECTIVETo discuss surgical procedures and curative effect of ankylosing spondylitis with cervical spine fracture.

METHODSFrom January 2003 to October 2011, 8 patients with ankylosing spondylitis with cervical spine fracture were respectively treated by surgical treatment (7 cases) and conservative treatment (1 case), 8 cases were male with an average of age 41 years old (ranged, 27 to 49). All patients were confirmed by CT and MRI,and 6 cases combined with spinal cord injury. One case was treated with skull-neck-thorax model, 7 cases were treated by surgery. The procedures included anterior approach (5 cases), posterior approach (1 case), and combined anteroposterior approach (1 case). Fracture fusion condition were evaluated according to CT at the final following up, improvement of spinal cord injury were assessed according to Frankel classification.

RESULTSEight patients were followed up from 4 to 38 months with an average of 34 months. Seven cases obtained bone healing, 3 patients without spinal cord injury remained intact after operation, 5 patients with spinal cord injury improved at different degree after operation. Frankel classification of 7 patients were improved 1 degree, and 1 case delayed union for following up.

CONCLUSIONAnkylosing spondylitis with cervical spine fracture is a special kind of trauma, which have a high rate of neurological deficits. Surgery should be performed as early as possible, and procedures were chosen depending on particular case.

Adult ; Cervical Vertebrae ; diagnostic imaging ; injuries ; surgery ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Spinal Fractures ; diagnostic imaging ; surgery ; Spondylitis, Ankylosing ; diagnostic imaging ; surgery

STUDY DESIGN: Radiologic imaging measurement study. PURPOSE: To assess the accuracy of detecting lateral mass and facet joint injuries of the subaxial cervical spine on plain radiographs using computed tomography (CT) scan images as a reference standard; and the integrity of morphological landmarks of the lateral mass and facet joints of the subaxial cervical spine. OVERVIEW OF LITERATURE: Injuries of lateral mass and facet joints potentially lead to an unstable subaxial cervical spine and concomitant neurological sequelae. However, no study has evaluated the accuracy of detecting specific facet joint injuries. METHODS: Eight spinal surgeons scored four sets of the same, randomly re-ordered, 30 cases with and without facet joint injuries of the subaxial cervical spine. Two surveys included conventional plain radiographs series (test) and another two surveys included CT scan images (reference). Facet joint injury characteristics were assessed for accuracy and reliability. Raw agreement, Fleiss kappa, Cohen's kappa and intraclass correlation coefficient statistics were used for reliability analysis. Majority rules were used for accuracy analysis. RESULTS: Of the 21 facet joint injuries discerned on CT scan images, 10 were detected in both plain radiograph surveys (sensitivity, 0.48; 95% confidence interval [CI], 0.26-0.70). There were no false positive facet joint injuries in either of the first two X-ray surveys (specificity, 1.0; 95% CI, 0.63-1.0). Five of the 11 cases with missed injuries had an injury below the lowest visible articulating level on radiographs. CT scan images resulted in superior inter- and intra-rater agreement values for assessing morphologic injury characteristics of facet joint injuries. CONCLUSIONS: Plain radiographs are not accurate, nor reliable for the assessment of facet joint injuries of the subaxial cervical spine. CT scans offer reliable diagnostic information required for the detection and treatment planning of facet joint injuries.
Diagnostic Imaging ; Humans ; Reproducibility of Results ; Spinal Injuries ; Spine* ; Tomography, X-Ray Computed ; Zygapophyseal Joint*

A 45-year-old male car driver died in a traffic accident of four cars rear-end collision on the highway. He was found to have died after a respiratory and cardiac arrest at the scene. No sign of skin injuries was observed from the external inspection. The autopsy was not permitted by the family members because of the local culture. Multislice computed tomography (MSCT) was applied to the current case, showing dislocation of C3-4 cervical vertebrae with II degree, C4 vertebral plate fractures, and spinal stenosis. Post-mortem MSCT confirmed the diagnosis as whiplash injuries. MSCT was verified to be effective in showing the severity of whiplash injuries, thus providing certain objective evidence for medicolegal expertise.
Accidents, Traffic ; Autopsy ; Humans ; Male ; Middle Aged ; Multidetector Computed Tomography ; Spinal Fractures ; Whiplash Injuries/diagnostic imaging*

OBJECTIVETo evaluate the efficacy and safety of percutaneous balloon kyphoplasty as a new therapy for patients with painful osteoporotic vertebral compressive fractures of the lumbar and thoracic spine.

METHODSA retrospective analysis was conducted in 38 consecutive patients (28 females, 10 males), whose ages ranged from 56 to 82 years (mean age 72 years). The symptom- and sign-positive spinal segment was identified by MRI. The time between onset of symptoms and surgical intervention ranged from 2 days to 1 year. 62 segments (36 thoracic, 26 lumbar) were treated in this cohort. The pain score estimated by Visual Analog Scale and activity degree were assessed immediately after operation and at 1-, 6-, and 12-month postoperative follow-up. Preoperative and postoperative anterior, midline vertebral heights in fractured vertebrae were measured on lateral radiographs to evaluate the effect of the procedure.

RESULTSThe method achieved a swift pain relief associated with an evidently increased weight-bearing ability. The pain score was reduced from 8.2 to 2.4 points. The anterior and midline vertebral heights in 62 fractured vertebral bodies increased up to 82.76%+/-26.84%, 88.82%+/-21.75% and the wedge decreased from 15 to 8 degrees. This effect persisted at least over a period of two years. The procedure did not induce narrowing of the spinal canal and no severe complications occurred.

CONCLUSIONSBalloon kyphoplasty can result in immediate clinical improvement of mobility and pain relief, increase vertebral body height, and quickly return patient's activity. The short-term results are approved excellent, and the long-term results need further judgment.

Aged ; Aged, 80 and over ; Female ; Humans ; Lumbar Vertebrae ; diagnostic imaging ; injuries ; surgery ; Male ; Middle Aged ; Osteoporosis ; complications ; diagnostic imaging ; Pain Measurement ; Radiography ; Spinal Fractures ; diagnostic imaging ; etiology ; surgery ; Thoracic Vertebrae ; diagnostic imaging ; injuries ; surgery ; Treatment Outcome