Comparative Imaging of Cervical Myelopathy

Myelopathy describes any neurologic deficit related to the spinal cord. Myelopathy is usually due to compression of the spinal cord by osteophyte or extruded disk material in the cervical spine. Any space occupying lesion within the cervical spine with the potential to compress the spinal cord can cause cervical myelopathy. According to Nuti, Vassal and Brunon (2013) conditions such as vascular, inflammatory, nutritional deficiency and post-radiation are commonly lead to myelopathy.  Other common sources of myelopathy are cord compression due to extradural mass caused by carcinoma metastatic to bone, and blunt or penetrating trauma. Many primary neoplastic, infectious, inflammatory, neurodegenerative, vascular, nutritional, and idiopathic disorders can also result in myelopathy, though these are much less common than a discogenic disease, metastases, and trauma. A variety of cysts and benign neoplasms can also compress the cord; they tend to arise intradurally. The most common...

Cervical  myelopathy is the most common disorder of the spinal cord in persons older than 55 years of age. Radiologic spondylotic changes increase with patient age - 90% of asymptomatic persons older than 70 years have some form of degenerative change in the cervical spine. Cervical spine myelopathy resulting from sagittal narrowing of the spinal canal and compression of the spinal cord is present in 90% of individuals by the seventh decade of life. Both sexes are affected equally. Cervical spondylosis usually starts earlier in men (50 years) than in women (60 years). It causes hospitalization at a rate of 4.04 per 100,000 person-years. Find this Pin and more on  Cervical Myelopathy  by  Donna Cowden .

This blog is an assignment for one of our core courses in Bachelor of Radiography and Diagnostic Imaging, Comparative Imaging (AHRD 4152). Before that, we would like to express our gratitude to Dr Norhanna Binti Sohaimi , our course coordinator. The purpose of this blog is to review few articles regarding Cervical Myelopathy and determine what is the gold standard to diagnose the pathology. In this blog, we compared literature details of various modalities which are conventional radiography, magnetic resonance imaging, computed tomography, and myelography. Thus, the objective of this blog is to study the most effective modality in assessing cervical myelopathy with the best image quality and diagnostic accuracy. Based on the articles reviewed, it is proved that there is no gold standard to facilitate the diagnosis of cervical myelopathy but magnetic resonance imaging is the most common used result from the details of the image generated. All articles showed that indicati...

Author’s Name C. Green, J. Butler, S. Eustace, A. Poynton, and J. M. O’Byrne Article Title Imaging Modalities for Cervical Spondylotic Stenosis and Myelopathy (2012) Journal Name Advances in Orthopedics 1) Bibliography Green, C., Butler, J., Eustace, S., Poynton, A., & Obyrne, J. M. (2012). Imaging Modalities for Cervical Spondylotic Stenosis and Myelopathy. Advances in Orthopedics, 2012, 1-4. doi:10.1155/2012/908324 2) Purpose of the Article The purpose of this article was to compare the imaging modalities employed for a central assessment of the cervical spine which should determine the extent and site of canal stenosis and any associated myelopathy. 3) Brief Description of Procedure and Findings/Results This article summarizes that in CM, MRI can show the pathological spinal cord changes in cervical spondylotic myelopathy as well as the anatomy of spinal cord compression. Signal change not only indicates the presence of myelopathic change...

Author’s Name Chuan Zhang, Sushant K Das, Dong-Jun Yang, Han-Feng Yang Article Title Application of magnetic resonance imaging in cervical spondylotic myelopathy (2014) Journal Name Advances in Orthopedics 1) Bibliography Zhang, C. (2014). Application of magnetic resonance imaging in cervical spondylotic myelopathy. World Journal of Radiology, 6(10), 826. doi:10.4329/wjr.v6.i10.826 2) Purpose of the Article The purpose of this article was to investigate the application of MR technology to the management of CSM patients and discusses recent and future advances in both conventional and novel MR techniques. 3) Brief Description of Procedure and Findings/Results This article summarizes that: i) Conventional MRI provides excellent anatomical information about the spinal cord macrostructure and gives insight into structural histopathological changes in CSM patients. ii) Diffusion tensor imaging (DTI) is a noninvasive MRI technique that measures the random motion of wat...

Author’s Name Feras J. Waly, Fahad H. Abduljabbar, Maryse Fortin, Anas Nooh and Michael Weber Article Title Preoperative Computed Tomography Myelography Parameters as Predictors of Outcome in Patients with Degenerative Cervical Myelopathy: Results of a Systematic Review (2017) Journal Name Global Spine Journal 1) Bibliography Waly, F. J., Abduljabbar, F. H., Fortin, M., Nooh, A., & Weber, M. (2017). Preoperative Computed Tomography Myelography Parameters as Predictors of Outcome in Patients With Degenerative Cervical Myelopathy: Results of a Systematic Review. Global Spine Journal, 7(6), 521-528. doi:10.1177/2192568217701101 2) Purpose of the Article The purpose of this article was to determine the preoperative computed tomography (CT) myelogram imaging parameters in patients diagnosed with degenerative cervical myelopathy (DCM) that correlate with severity of DCM and predict postoperative patients’ functional outcome.  3) Brief Description o...

Author’s Name Andrei F. Joaquim, Enrico Ghizoni, Helder Tedeschi, Wellington K. Hsu, Alpesh A. Patel Article Title Management of Degenerative Cervical Myelopathy – An Update (2016) Journal Name Revista Da Associação Médica Brasileira 1) Bibliography Joaquim, A. F., Ghizoni, E., Tedeschi, H., Hsu, W. K., & Patel, A. A. (2016). Management of degenerative cervical myelopathy – An update. Revista Da Associação Médica Brasileira, 62(9), 886-894. doi:10.1590/1806-9282.62.09.886 2) Purpose of the Article The purpose of this article was to discuss the most important factors involved in the surgical management of degenerative cervical myelopathy (DCM), including the approaches.  3) Brief Description of Procedure and Findings/Results This article summarizes the different imaging approaches as an additional work-up in managing DCM: i) Plain radiography - Initial investigation of DCM is based on simple plain cervical radiographs, including flexion-...

Author’s Name Linda I. Suleiman, Surabhi A. Bhatt, Todd B. Parrish, and Alpesh A. Patel Article Title Imaging Modalities and Tests for Cervical Myelopathy (2014) Journal Name Seminars in Spine Surgery 1) Bibliography Suleiman, L. I., Bhatt, S. A., Parrish, T. B., & Patel, A. A. (2014). Imaging modalities and tests for cervical myelopathy. Seminars in Spine Surgery, 26(2), 68-72. doi:10.1053/j.semss.2014.05.003 2) Purpose of the Article The purpose of this article was to summarize the current techniques that are routinely used in the diagnosis of cervical spondylotic myelopathy (CSM) – plain X-ray radiographs, MRI, and CT/CT myelography; as well as discuss two innovative MRI techniques – magnetization transfer (MT) MRI and diffusion tensor imaging (DTI). 3) Brief Description of Procedure and Findings/Results This article told that several dynamic factors play a key role in the pathophysiology of CSM. These dynamic factors may be associated with...

Authors’ Names Ronaldo C. Da Costa, Joane Parent, Howard Donson, David Holmberg, Gary Partlow Article Title Comparison of Magnetic Resonance Imaging and Myelography in 18 Doberman Pinscher Dogs with Cervical Spondylomelopathy Journal Name Veterinary Radiology & Ultrasound, Vol. 47 1. Bibliography DA COSTA, R. C., PARENT, J., DOBSON, H., HOLMBERG, D., & PARTLOW, G. (2006). COMPARISON OF MAGNETIC RESONANCE IMAGING AND MYELOGRAPHY IN 18 DOBERMAN PINSCHER DOGS WITH CERVICAL SPONDYLOMYELOPATHY. Veterinary Radiology & Ultrasound, 47(6), 523–531. doi:10.1111/j.1740-8261.2006.00180.x 2. Purpose of the article The purpose of this article was to compare the findings of the diagnosis of cervical myelopathy in Doberman Pinscher dogs by using Magnetic Resonance Imaging and myelography. 3. Brief Description of Procedure and Findings/Results Traction myelography was performed using a cervical harness exerting 9kg of linear traction. MR imaging wa...

Authors' names Douglas S. Weinberg, Arunit J. Chugh, Jeremy J. Gebhart, Jason D. Eubanks. Article title Magnetic Resonance Imaging of the Cervical Spine Under-Represents Sagittal Plane Deformity in Degenerative Myelopathy Patients Journal name International Journal of Spine Surgery Bibliography Weinberg, D. S., Chugh, A. J., Gebhart, J. J., & Eubanks, J. D. (2016). Magnetic Resonance Imaging of the Cervical Spine Under-Represents Sagittal Plane Deformity in Degenerative Myelopathy Patients. International journal of spine surgery, 10, 32. doi:10.14444/3032 Purpose of the article The purpose of this article was to show differentiate of magnetic resonance imaging images and plain radiographs in identifying the curvature index of cervical myelopathy patients. Brief Description of Procedure and Findings/Results This experiment was conducted using retrospective study which involved series of 151 patients whose history, physical exam, and imaging were consi...

Author’s Name Allan R. Martin, Nobuaki Tadokoro, Lindsay Tetreault, Elsa V. Arocho-Quinones, Matthew D. Budde, Shekar N. Kurpad, Michael G. Fehlings Article Title Imaging Evaluation of Degenerative Cervical Myelopathy: Current State of the Art and Future Directions (2018) Journal Name Neurosurgery Clinics of North America 1) Bibliography Martin, A. R., Tadokoro, N., Tetreault, L., Arocho-Quinones, E. V., Budde, M. D., Kurpad, S. N., & Fehlings, M. G. (2018). Imaging Evaluation of Degenerative Cervical Myelopathy. Neurosurgery Clinics of North America, 29(1), 33-45. doi:10.1016/j.nec.2017.09.003 2) Purpose of the Article The purpose of this article was to review each of the imaging modalities (plain radiography, CT and MRI) and describe their strengths, limitations, and clinical utility for the clinical uses, followed by a discussion of emerging spinal cord imaging techniques and their implications for the future of clinical management of degenerati...

Author’s Name Paula Martin-Vaquero, Ronaldo C. Da Costa, and Wm Tod Drost  Article Title Comparison of Non-Contrast Computed Tomography and High-Field Magnetic Resonance Imaging in The Evaluation of Great Danes with Cervical Spondylo-myelopathy (2014) Journal Name Veterinary Radiology & Ultrasound 1) Bibliography Martin-Vaquero, P., Costa, R. C., & Drost, W. T. (2014). Comparison Of Noncontrast Computed Tomography And High-Field Magnetic Resonance Imaging In The Evaluation Of Great Danes With Cervical Spondylomyelopathy. Veterinary Radiology & Ultrasound, 55(5), 496-505. doi:10.1111/vru.12148 2) Purpose of the Article The purpose of this article was to determine the preoperative computed tomography (CT) myelogram imaging parameters in patients diagnosed with degenerative cervical myelopathy (DCM) that correlate with severity of DCM and predict postoperative patients’ functional outcome.  3) Brief Description of Proced...

Author’s Name Monique Boukobza, Jurgita Ušinskienė, Simona Letautienė Article Title Case report of cervical myelopathy due to ossification of the posterior longitudinal ligament in association with flavum ligament ossification: MRI and CT appearance (2013) Journal Name Acta Medica Lituanica 1) Bibliography Boukobza, M., Ušinskienė, J., & Letautienė, S. (2013). Case report of cervical myelopathy due to ossification of the posterior longitudinal ligament in association with flavum ligament ossification: MRI and CT appearance. Acta Medica Lituanica, 20(2). doi:10.6001/actamedica.v20i2.2696 2) Purpose of the Article The purpose of this article was to analyze the cervical spinal cord damage and spinal canal stenosis due to ossification of the posterior longitudinal ligament (OPLL) which usually affects the cervical spine and leads to progressive myelopathy in 50–60s in Asian population. 3) Brief Description of Procedure and Findings/Results This arti...

Authors’ names O. Wayne Houser, M.D., Burton M. Onofrio, M.D., Gary M. Miller, M.D., W. Neath Folger, M.D., and Patsy L. Smith, R.N. Article name Cervical Spondylotic Stenosis and Myelopathy: Evaluation With Computed Tomography Myelography Journal Name Mayo Clinic Foundation for Medicine and Research, Mayo Clic Proc Bibliography HOUSER, O. W., ONOFRIO, B. M., MILLER, G. M., FOLGER, W. N., & SMITH, P. L. (1994). Cervical Spondylotic Stenosis and Myelopathy: Evaluation With Computed Tomographic Myelography. Mayo Clinic Proceedings, 69(6), 557–563. doi:10.1016/s0025-6196(12)62248-4 Purpose of the article The purpose of this article was to determine which components of cervical spondylosis are most frequently present in patients with myelopathy. Brief Description of Procedure and Findings/Results The research was done by reviewed the findings in 93 patients who underwent surgical decompression for cervical spondylotic myelopathy between January 1...

Authors’ names Scott R. Laker, M.D,. Leah G. Concannon, M.D. Article name Radiologic Evaluation of the Neck: A Review of Radiography, Ultrasonography, Computed Tomography, Magnetic Resonance Imaging, and Other Imaging Modalities for Neck Pain Journal Name Radiology evaluation of the neck, Phys Med Rehabil Clin N Am 22 (2011) Bibliography Laker, S. R., & Concannon, L. G. (2011). Radiologic Evaluation of the Neck: A Review of Radiography, Ultrasonography, Computed Tomography, Magnetic Resonance Imaging, and Other Imaging Modalities for Neck Pain. Physical Medicine and Rehabilitation Clinics of North America, 22(3), 411–428. doi:10.1016/j.pmr.2011.03.010 Purpose of the article The purpose of this article was to reviews the current literature on imaging for the patient with neck pain, illustrates several imaging abnormalities, and discusses the workup of commonly seen patient populations. Brief Description of Procedure and Findings/Results This articl...