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Cervical extension magnetic resonance imaging in evaluating cervical spondylotic myelopathy

  • Clinical Article - Spine
  • Published:
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Abstract

Background

Cervical spondylotic myelopathy (CSM) may be caused by static and dynamic spinal cord compression, particularly during neck extension. Dynamic compression may be better evaluated with dynamic magnetic resonance (MR) images. We performed a retrospective study to determine the clinical indication for dynamic MR imaging, and conducted a survey regarding image interpretation by clinicians.

Method

A total of 32 patients (M:F = 20:12, 60.1 ± 10.7 years) who had undergone neutral/extension cervical MR imaging were included. The study population consisted of 22 patients with signs of cervical myelopathy (M group) and 10 patients without signs of myelopathy (NM group). The number of compression levels (complete obliteration of the anterior and posterior subarachnoid space) was assessed at each level in mid-sagittal, T2-weighted, neutral and extension MR images. Reproduced images from 22 patients in the M group were randomly arranged, and four experienced spine surgeons at four different institutes interpreted them to reach a clinicians’ agreement. The agreements were then assessed with inter-rater correlation coefficients (ICC).

Results

Analysis with extension MR images found an increased number of compression levels in 23/32 (72 %) of patients; 20/22 in the M group and 3/10 in the NM group (p < 0.01, chi-squared test), as compared to findings of the neutral MR images. Clinical factors for increased compression levels in extension MR images were age (p < 0.01, 63.3 ± 10.0 years vs. 51.9 ± 8.1) and signs of myelopathy (p < 0.01, odds ratio, 23.33). Clinician agreement was improved with extension MR images; ICC was 0.67 with neutral and 0.81 with extension MR images.

Conclusions

The evaluation of CSM may be improved with dynamic MR images. Dynamic MR scanning may be considered for elderly patients with signs of myelopathy, but an interpretation for asymptomatic spinal compression based exclusively on extension MR image should be made with caution.

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Acknowledgement

The authors appreciate the statistical advice from the Medical Research Collaborating Center at the Seoul National University Hospital and the Seoul National University College of Medicine.

Conflict of Interest

This work was supported by a National Research Foundation of Korea (NRF) grant, funded by the Korean government (MSIP)(2010-0028631). The authors report no conflict of interest concerning the materials or methods used in this study or the findings described in this paper. No benefits in any form have been or will be received from any commercial party related directly or indirectly to the subject of this manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Seoul National University College of Medicine and Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea

    Chi Heon Kim, Chun Kee Chung, Ki-Jeong Kim & Sung Bae Park

  2. Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea

    Chi Heon Kim & Chun Kee Chung

  3. Clinical Research Institute, Seoul National University Hospital, Seoul, Korea

    Chi Heon Kim & Chun Kee Chung

  4. Seoul National University Bundang Hospital, Kyung-Gi, Korea

    Ki-Jeong Kim

  5. Seoul National University Boramae Hospital, Seoul, Korea

    Sung Bae Park

  6. Inje University College of Medicine and Ilsan Paik Hospital, Ilsan, Korea

    Seung Jun Lee

  7. The Armed Forces Capital Hospital, Kyung-Gi, Korea

    Sang Hoon Yoon

  8. Medical Research Collaborating Center, Seoul National University College of Medicine, Seoul, Korea

    Byung Joo Park

  9. Department of Medicine, Seoul National University College of Medicine, Seoul, Korea

    Byung Joo Park

  10. Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea

    Byung Joo Park

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  1. Chi Heon Kim
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Correspondence to Chun Kee Chung.

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Kim, C.H., Chung, C.K., Kim, KJ. et al. Cervical extension magnetic resonance imaging in evaluating cervical spondylotic myelopathy. Acta Neurochir 156, 259–266 (2014). https://doi.org/10.1007/s00701-013-1951-2

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  • DOI: https://doi.org/10.1007/s00701-013-1951-2

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