The value of cervical MRI in surgical lumbar canal stenosis patients

Background The prevalence of cervical canal stenosis alone is estimated to be present in 4.9% of the adult population. Co-existence of dual pathology may complicate clinical presentation and necessitates a wise and individually based decision process. Objectives To estimate the co-existence of cervical canal stenosis in surgical lumbar canal stenosis patients and its reflection on decision-making regarding surgery. Methods It is a prospective study that was conducted on 70 cases with symptomatic lumbar canal stenosis by investigating them for cervical canal stenosis clinically and radiologically. Results The co-existence of cervical and lumbar canal stenoses was seen in 62 cases (88.57%); cases with relative cervical stenosis were 25 (35.714%) and absolute cervical stenosis was 37 (52.857%). Cases with no cervical stenosis were 8 (11.428%) and cases with relative lumbar stenosis were 22 (31.428%), while cases with absolute lumbar stenosis were 48 (68.571%). Cases with symptomatic cervical canal stenosis were 30 (42.857%). Cases with asymptomtic cervical canal stenosis were 32 (45.71%). Conclusion Tandem spinal stenosis (TSS) is not uncommon and MRI cervical spine should be done for every lumbar canal stenosis patient especially if indicated by history or clinical examination.

A New grading system based on T2-weighted axial MRI for Cervical Canal stenosis

Background: Cervical Canal Stenosis (CCS) is a common cervical disease that occurs during and after middle age. There are a variety of grading systems and Measurement methods based on X-ray, Computed Tomography(CT) for cervical canal stenosis. Although many authors measured and classified cervical canal stenosis on the basis of T2-weighted sagittal MRI after the appearance of magnetic resonance, the research on Cervical Canal Stenosis remains to be improved. To explore a more detailed grading system on MRI for cervical canal stenosis and could be used to the clinical diagnosis and treatment.Methods: We retrospectively studied 200 patients with cervical spinal stenosis. Cervical canal stenosis was classified according to the T2-weighted axial MRI with the most serious compression into the following grades: grade 0,normal; grade 1, mild canal stenosis with obliteration of anterior or posterior of cerebrospinal fluid (CSF) space ; grade 2, moderate canal stenosis with obliteration of both sides of the CSF space but no significant changes in spinal morphology; Grade 3, severe canal stenosis with spinal cord deformity, 3A the oppression ratio of cervical spinal cord is under 50%, 3B the angle of the protrusion less than 90°; Grade 4, serious canal stenosis with spinal cord deformity and the oppression ratio of cervical spinal cord is exceeding 50%, 4A the non-ossification protrusion, 4B the ossific protrusion. We collected the relevant clinical and imaging data of the patients and analyzed the relationship between them and our new grading system. Patients were followed up one year later.Results: Our new grading system was easy to learn and communication. The the ICC reliabilities between six readers was between 0.817-0.865. And the Effective sagittal spinal canal was significantly different along with our grades at each disc level. In terms of clinical data, our grading system is correlated with the patient's preoperative mJOA score and had impact on the choice of surgical strategy. Conclusions: We suggest our new grading system can provided as a reliable assessment that can guide clinical treatment for Cervical Canal Stenosis.

A New grading system based on T2-weighted axial MRI for Cervical Canal Stenosis

Background: Cervical Canal Stenosis (CCS) is a common cervical disease that occurs during and after middle age. There are a variety of grading systems and Measurement methods based on X-ray, Computed Tomography(CT) for cervical canal stenosis. Although many authors measured and classified cervical canal stenosis on the basis of T2-weighted sagittal MRI after the appearance of magnetic resonance, the research on Cervical Canal Stenosis remains to be improved.Purposes: To explore a more detailed grading system on MRI for cervical canal stenosis and could be used to the clinical diagnosis and treatment.Patient and Methods: We retrospectively studied 200 patients with cervical spinal stenosis. Cervical canal stenosis was classified according to the T2-weighted axial MRI with the most serious compression into the following grades: grade 0,normal; grade 1, mild canal stenosis with obliteration of anterior or posterior of cerebrospinal fluid (CSF) space ; grade 2, moderate canal stenosis with obliteration of both sides of the CSF space but no significant changes in spinal morphology; Grade 3, severe canal stenosis with spinal cord deformity, 3A the oppression ratio of cervical spinal cord is under 50%, 3B the oppression ratio of cervical spinal cord is between 50% to 75%, 3C the angle of the protrusion less than 90°; Grade 4, serious canal stenosis with spinal cord deformity and the oppression ratio of cervical spinal cord is exceeding 75%, 4A the non-ossification protrusion, 4B the ossific protrusion. We collected the relevant clinical and imaging data of the patients and analyzed the relationship between them and our new grading system. Patients were followed up one year later.Results: Our new grading system was easy to learn and communication. The the ICC reliabilities between six readers was between 0.817-0.865. And the Effective sagittal spinal canal was significantly different along with our grades at each disc level. In terms of clinical data, our grading system is correlated with the patient's preoperative JOA score and had impact on the choice of surgical strategy.Conclusions: We suggest our new grading system can provided as a reliable assessment that can guide clinical treatment for Cervical Canal Stenosis.

FRACTIONAL ANISOTROPY AND MEAN DIFFUSIVITY VALUE IN 2ND GRADE OF DEGENERATIVE CERVICAL CANAL STENOSIS

Background: By using T2 weighted image (T2WI) of Magnetic Resonance Imaging (MRI), a radiologist can classify degenerative cervical canal stenosis (DCCS) into three grade, but there is no correlation between stenosis classification with clinical symptoms. It means that radiologist need a new parameter to make an early detection for spinal cord injury (SCI). Objective: Proving decrease of FA and increase of MD at the most proximal level of 2nd grade DCCS patient compared with C1-2. Methods: Cervical MR examination with 15-direction DTI sequens was performed on twenty one patient with neurological signs and symptoms of 2nd grade DCCS. Apparent FA and MD maps were generated on axial plane. The FA and MD measurements in each individual were made at the most proximal level of 2nd grade DCCS and C1-2. Wilcoxon rank sump test was used to compare FA and paired t-test was used for MD. Result : There are significant differences for FA (p = 0,00) and MD (p = 0,00) at the most proximal level of 2nd grade DCCS compared with C1-2. Conclusion: This research shows that FA and MD value at DTI sequens can be used for SCI early detection at 2nd grade DCCS patient