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Case 94 - Disc herniation and cord compression

Published online by Cambridge University Press:  18 December 2013

Nafi Aygun
Affiliation:
The Johns Hopkins University
Gaurang Shah
Affiliation:
University of Michigan Health System
Dheeraj Gandhi
Affiliation:
University of Maryland Medical Center
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Summary

Imaging description

Cervical myelopathy (CM) can result from extrinsic compression of the cord or cord inflammation, demyelination, ischemia, or infection. The most common reason for CM is spondylosis of the cervical spine. MRI is the modality of choice in the work-up of CM, and it can differentiate intrinsic cord lesions from extrinsic ones such as cervical spondylosis. In patients with CM secondary to cervical spondylotic changes, MRI shows narrowing of the spinal canal, complete effacement of the CSF spaces at the stenotic level(s), and deformity of the cord, although presence of these findings does not always predict clinically detectable CM. Although the primary mechanism of cervical spondylotic myelopathy is the compression of nervous tissue, there is some evidence that ischemia at the cellular level may be a contributing factor [1].

Increased T2 signal within the cord at the level of compression can be seen in some patients and heralds a worse outcome after surgical decompression compared to patients who do not have increased T2 signal in their cords [2]. Other factors that are associated with lack or diminished levels of improvement following surgery include old age, longer duration of symptoms, diminished T1 signal in the cord, and worse preoperative neurologic status [2–4].

Type
Chapter
Information
Pearls and Pitfalls in Head and Neck and Neuroimaging
Variants and Other Difficult Diagnoses
, pp. 424 - 426
Publisher: Cambridge University Press
Print publication year: 2013

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References

Tracy, JA, Bartleson, JD. Cervical spondylotic myelopathy. Neurologist 2010; 16: 176–87.CrossRefGoogle ScholarPubMed
Okada, Y, Ikata, T, Yamada, H, Sakamoto, R, Katoh, S. Magnetic resonance imaging study on the results of surgery for cervical compression myelopathy. Spine (Phila Pa 1976) 1993; 18: 2024–9.CrossRefGoogle ScholarPubMed
Morio, Y, Teshima, R, Nagashima, H, et al. Correlation between operative outcomes of cervical compression myelopathy and MRI of the spinal cord. Spine (Phila Pa 1976) 2001; 26: 1238–45.CrossRefGoogle ScholarPubMed
Yukawa, Y, Kato, F, Yoshihara, H, Yanase, M, Ito, K. MR T2 image classification in cervical compression myelopathy: predictor of surgical outcomes. Spine (Phila Pa 1976) 2007; 32: 1675–8.CrossRefGoogle ScholarPubMed

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