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European Spine Journal : Official... Jun 2009A congenitally narrow cervical spinal canal has been established as an important risk factor for the development of cervical spondylotic myelopathy. However, few reports...
A congenitally narrow cervical spinal canal has been established as an important risk factor for the development of cervical spondylotic myelopathy. However, few reports have described the mechanism underlying this risk. In this study, we investigate the relationship between cervical spinal canal narrowing and pathological changes in the cervical spine using positional magnetic resonance imaging (MRI). Two hundred and ninety-five symptomatic patients underwent cervical MRI in the weight-bearing position with dynamic motion (flexion, neutral, and extension) of the cervical spine. The sagittal cervical spinal canal diameter and cervical segmental angular motion were measured and calculated. Each segment was assessed for the extent of intervertebral disc degeneration and cervical cord compression. Based on the sagittal canal diameter, the subjects were classified into three groups: A, subjects with a congenitally narrow canal, diameter of less than 13 mm; B, subjects with a normal canal, diameter of 13-15 mm; C, subjects with a wide canal, diameter of more than 15 mm. When compared with Groups A and B, the disc degeneration grades at the C3-4, C5-6, and C6-7 segments and the cervical cord compression scores at the C3-4 and C5-6 segments showed significant differences. Additionally, when compare with Groups A and C, the disc degeneration grades at all segments, except C2-3, and the cervical cord compression scores at all segments, except C2-3, showed significant differences. With respect to the cervical kinematics, few differences in the kinematics were observed between Groups B and C, however, the kinematics in Group A was different with other two groups. In Group A, the segmental mobility at the C4-5 and C6-7 segments were significantly higher than those observed in Group B, and the segmental mobility at the C3-4 segment was significantly lower than that observed in Groups B or C. We demonstrated the unique pathological and kinematic traits of cervical spine that exist in a congenitally narrow canal. We hypothesize that kinematic trait associated with a congenitally narrow canal may greatly contribute to pathological changes in the cervical spine. Our results suggest that cervical spinal canal diameter of less than 13 mm may be associated with an increased risk for development of pathological changes in cervical intervertebral discs. Subsequently, the presence of a congenitally narrow canal can expose individuals to a greater risk of developing cervical spinal stenosis.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biomechanical Phenomena; Causality; Cervical Vertebrae; Disease Progression; Female; Head Movements; Humans; Intervertebral Disc Displacement; Magnetic Resonance Imaging; Male; Middle Aged; Predictive Value of Tests; Radiculopathy; Range of Motion, Articular; Risk Factors; Spinal Canal; Spinal Cord Compression; Spondylosis; Young Adult
PubMed: 19357877
DOI: 10.1007/s00586-009-0968-y -
Anatomia, Histologia, Embryologia Feb 2014The goal of this study was to establish Magnetic resonance imaging (MRI) reference ranges for spinal measurements in normal dogs. Forty dogs (1-10 kg, 11-20 kg,...
The goal of this study was to establish Magnetic resonance imaging (MRI) reference ranges for spinal measurements in normal dogs. Forty dogs (1-10 kg, 11-20 kg, 21-30 kg, > 30 kg; 10 dogs per category) underwent spinal MRI. Measurements were performed on sagittal T2-W images at the level of the 4th thoracic vertebra (T4), the 9th thoracic vertebra (T9) and the 3rd lumbar vertebra (L3). Spinal canal diameter (mm) ranged from 6.07 ± 0.63 (1-10 kg) to 8.27 ± 1.15 (> 30 kg) at the level of T4; 6.55 ± 0.61 (1-10 kg) to 9.04 ± 1.26 (> 30 kg) at the level of T9; and 6.80 (6.47-7.00; 1-10 kg) to 9.00 (7.90-9.73; > 30 kg) at the level of L3. There were significant differences (P < 0.05) in spinal canal diameter between groups. Mean spinal cord diameter (mm) ranged from 4.46 ± 0.51 (11-20 kg) to 4.70 ± 0.35 (1-10 kg) at the level of T4; 4.41 ± 0.50 (> 30 kg) to 4.85 ± 0.57 (1-10 kg) at the level of T9; and 4.52 ± 0.51 (> 30 kg) to 5.14 ± 0.68 (1-10 kg) at the level of L3. There were no significant differences in spinal cord diameter between groups. Spinal cord-to-spinal canal ratio varied significantly, ranging from 0.51 ± 0.08 (> 30 kg at L3) to 0.78 (0.69-0.80; 1-10 kg at T4) (P < 0.05). These findings are important when using MRI to evaluate patients with suspected diffuse spinal cord disease.
Topics: Animals; Dogs; Female; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Reference Values; Spinal Canal; Spinal Cord; Spinal Cord Diseases
PubMed: 23488993
DOI: 10.1111/ahe.12045 -
Medicine Aug 2023Thickened ligamentum flavum has been considered as a major cause of central lumbar spinal canal stenosis (CLSCS). Previous studies have demonstrated that ligamentum...
Thickened ligamentum flavum has been considered as a major cause of central lumbar spinal canal stenosis (CLSCS). Previous studies have demonstrated that ligamentum flavum thickness (LFT) is correlated with aging, degenerative spinal stenosis, and disc degeneration. Thus, hypertrophy of the ligamentum flavum is a major cause of CLSCS, and measurement of LFT has been considered a morphologic parameter in the diagnosis of CLSCS. To our knowledge, comparison of LFT between central and lateral lesions has not been reported. In addition, no research has analyzed best clinical cutoff values of central ligament flavum thickness (CLFT) and lateral ligament flavum thickness (LLFT). This study aimed to compare CLFT with LLFT in patients with CLSCS and further compare the CLFT and LLFT findings between the 2 groups to analyze LFT variation. Both CLFT and LLFT samples were collected from 101 participants with CLSCS and from 103 participants in the control group who underwent lumbar magnetic resonance imaging without evidence of CLSCS. Axial T2-weighted lumbar magnetic resonance scans were acquired at the L4 to 5 facet joint level from each participant. Average CLFT value was 2.25 ± 0.51 mm in the control group and 4.02 ± 0.74 mm in the CLSCS group. Average LLFT value was 2.50 ± 0.51 mm in the control group and 3.38 ± 0.66 mm in the CLSCS group. CLSCS patients had significantly higher CLFT and LLFT (both P < .001). Regarding the validity of both CLFT and LLFT as predictors of CLSCS, a receiver operating characteristic estimation revealed that the most suitable cutoff value for CLFT was 3.10 mm, with sensitivity of 95.0%, specificity of 94.2%, and an area under the curve of 0.97. The best cut-off value of LLFT was 2.92 mm, with sensitivity of 78.2%, specificity of 77.7%, and area under the curve of 0.87. We have 4 important new findings: The mean CLFT is significantly lower than that of the mean LLFT in the normal control group; CLFT and LLFT are both significantly associated with CLSCS; Increase rate of CLFT is faster than that of LLFT in the CLSCS group; and CLFT is a more sensitive measurement parameter to predict CLSCS than LLFT.
Topics: Humans; Spinal Stenosis; Constriction, Pathologic; Ligamentum Flavum; Lumbosacral Region; Spinal Canal
PubMed: 37603515
DOI: 10.1097/MD.0000000000034873 -
The Neuroradiology Journal Feb 2023Extrarenal malignant rhabdoid tumors are rare, aggressive lesions that primarily affect infants and children with characteristic SMARCB1/INI1 mutations. While rhabdoid...
Extrarenal malignant rhabdoid tumors are rare, aggressive lesions that primarily affect infants and children with characteristic SMARCB1/INI1 mutations. While rhabdoid tumors are most commonly found in the kidneys and central nervous system, they have been reported in virtually every soft tissue in the body. A 20-year-old previously healthy male presented with a 4-month history of left upper extremity weakness and pain and a 1-week history of lower extremity weakness. MRI showed a combined intradural and extradural mass arising from the C8 root and involving the lower trunk of the brachial plexus. CT guided biopsy followed with onsite cytologic analysis initially concerning for plasma cell etiology. Full body PET/CT showed no evidence of metastases. The tumor was surgically resected and debulked. Extensive immunohistochemical testing on the resected specimen revealed a diagnosis of extrarenal malignant rhabdoid tumor. Recurrence invading paraspinous muscles, left lateral paravertebral space, left apical lung, and brachial plexus was noted within 2 months. Radiation and chemotherapy were initiated. Here we present imaging findings, image-guided biopsy, surgical management, and pathologic diagnosis of a rare case of extrarenal, extracranial malignant rhabdoid tumor of the brachial plexus and surrounding paraspinous muscles in a young adult male.
Topics: Humans; Male; Young Adult; Central Nervous System; Mutation; Positron Emission Tomography Computed Tomography; Rhabdoid Tumor; Spinal Canal
PubMed: 35534016
DOI: 10.1177/19714009221098368 -
International Orthopaedics Oct 2011The lower cervical segments are commonly the level responsible for cervical spondylotic myelopathy; however, we rarely encounter stenosis at the upper cervical segment...
The lower cervical segments are commonly the level responsible for cervical spondylotic myelopathy; however, we rarely encounter stenosis at the upper cervical segment in a clinical setting. We assumed that there might be some differences between the pathogenetic mechanisms underlying the development of cervical canal stenosis at different segments. We performed positional MRI in the weight-bearing position for 295 consecutive symptomatic patients. All subjects were classified into four groups (A: normal; B: C3-4 stenosis; C: C5-6 stenosis; D: two-level cervical segments stenosis, stenosis at C3-4 and C5-6). Age, sagittal cervical canal diameter, cervical intervertebral disc degeneration, cervical cord compression, and cervical mobilities were evaluated for each group. Group B showed a narrow cervical spinal canal structure at the C3 to C4 pedicle levels, while groups C and D showed narrow structures at the C4 to C6 pedicle levels in the cervical spine. Additionally, the sagittal cervical canal diameters at all pedicle levels, except C7, in group D were significantly smaller than those observed in group C. We demonstrated the differences in the pathogenetic processes for the development of cervical spinal canal stenosis between C3-4, C5-6, and two-level cervical segments stenosis. Our results suggest that the developmental morphological structure of the cervical spinal canal plays an important role in the development of cervical canal stenosis at different segments. Moreover, individuals with sagittal cervical canal diameters of less than 13 mm may be exposed to an increased risk for future development of cervical spinal canal stenosis at the upper cervical segments following stenosis at the lower cervical segments.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cervical Vertebrae; Female; Humans; Male; Middle Aged; Risk Factors; Spinal Canal; Spinal Stenosis; Young Adult
PubMed: 21113592
DOI: 10.1007/s00264-010-1169-3 -
Nerve root compression due to lumbar spinal canal tophi: A case report and review of the literature.Medicine Nov 2022Gout in the spine and adnexa is rare in clinical practice and can also be easily misdiagnosed, we reported a patient with nerve root compression due to lumbar gout... (Review)
Review
RATIONALE
Gout in the spine and adnexa is rare in clinical practice and can also be easily misdiagnosed, we reported a patient with nerve root compression due to lumbar gout stones in the lumbar spinal canal.
PATIENT CONCERNS
A 51-year-old male was admitted to the hospital with lumbar pain with numbness in the left lower limb for more than 6 months. The physical examination showed that tenderness and percussion pain were present at L4-S1 spinous process. Straight leg raise test: 50° on the left side were positive. Laboratory tests showed that the sUA was 669 μmol/L, MRI of the lumbar spine showed that cystic T1WI low signal and T2WI mixed high signal shadows were seen in the spinal canal at the level of L4-L5.
DIAGNOSES
Combining with lab examinations, imaging examinations, and histopathological results, the patient was diagnosed with lumbar spinal canal tophi.
INTERVENTIONS
After active improvement of all examinations, the patient underwent surgical treatment with decompression and internal fixation of the L4-L5 segment.
OUTCOMES
After surgery, the patient's symptoms improved and muscle strength returned to normal. Among the 95 previously reported patients with lumbar gout, the ratio of men to women was 2.96:1, and the peak age group of incidence was 56 to 65 years. The onset of the disease was mainly in a single segment of the lumbar spine, with 34.41% of all cases occurring at the L4-L5 level. 61.05% of the patients had a history of gout attacks or hyperuricemia, and the most frequently involved site was the foot and ankle, followed by the wrist. Sixty-seven patients underwent surgical treatment, and 22 chose conservative treatment, with overall satisfactory results.
LESSONS SUBSECTIONS
The incidence of lumbar gout is low and relatively rare in the clinic and pathological biopsy is still the gold standard. Vertebral plate incision and decompression are often selected for surgical treatment, and whether to perform fusion should be comprehensively considered for the destruction of vertebral bone by gout and the reasonable selection of the extent of surgical resection. Whether choosing surgical treatment or conservative therapy, the control of uric acid levels should be emphasized.
Topics: Male; Humans; Female; Middle Aged; Aged; Radiculopathy; Spinal Canal; Lumbosacral Region; Arthritis, Gouty; Gout; Pain
PubMed: 36397389
DOI: 10.1097/MD.0000000000031562 -
American Journal of Veterinary Research Jan 2018OBJECTIVE To compare the percentage of the C3-C7 vertebral canal occupied by the spinal cord in small-breed dogs with that in Doberman Pinschers and Great Danes with and... (Comparative Study)
Comparative Study
Comparison of the percentage of the C3-C7 vertebral canal occupied by the spinal cord in small-breed dogs with that in Doberman Pinschers and Great Danes with and without cervical spondylomyelopathy.
OBJECTIVE To compare the percentage of the C3-C7 vertebral canal occupied by the spinal cord in small-breed dogs with that in Doberman Pinschers and Great Danes with and without cervical spondylomyelopathy (CSM). ANIMALS 30 small-breed dogs (body weight, < 15 kg), 15 clinically normal Doberman Pinschers, 15 Doberman Pinschers with CSM, 15 clinically normal Great Danes, and 15 Great Danes with CSM. PROCEDURES In a retrospective study, sagittal and transverse T2-weighted MRI images of the cervical (C3 to C7) vertebral column obtained from dogs that met study criteria and were free of extensive abnormalities that could affect the spinal cord diameter between January 2005 and February 2015 were reviewed. The area and height of the vertebral column and spinal cord were measured at the cranial and caudal aspect of each vertebra from C3 to C7, and the percentage of the vertebral canal occupied by the spinal cord at each location was calculated and compared among groups of dogs. RESULTS Mean percentage of the vertebral canal occupied by the spinal cord was greatest for small-breed dogs and lowest for Great Danes, but did not differ between Doberman Pinschers and small-breed dogs at approximately half of the locations evaluated or between Doberman Pinschers with and without CSM or between Great Danes with and without CSM. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that the percentage of the vertebral canal occupied by the spinal cord, although expected to increase with vertebral canal stenosis, may not have a primary role in the pathogenesis of CSM.
Topics: Animals; Cervical Vertebrae; Dog Diseases; Dogs; Female; Magnetic Resonance Imaging; Male; Retrospective Studies; Spinal Canal; Spinal Cord Diseases
PubMed: 29287165
DOI: 10.2460/ajvr.79.1.83 -
Scientific Reports Apr 2018The dynamics of human CSF in brain and upper spinal canal are regulated by inspiration and connected to the venous system through associated pressure changes. Upward CSF...
The dynamics of human CSF in brain and upper spinal canal are regulated by inspiration and connected to the venous system through associated pressure changes. Upward CSF flow into the head during inspiration counterbalances venous flow out of the brain. Here, we investigated CSF motion along the spinal canal by real-time phase-contrast flow MRI at high spatial and temporal resolution. Results reveal a watershed of spinal CSF dynamics which divides flow behavior at about the level of the heart. While forced inspiration prompts upward surge of CSF flow volumes in the entire spinal canal, ensuing expiration leads to pronounced downward CSF flow, but only in the lower canal. The resulting pattern of net flow volumes during forced respiration yields upward CSF motion in the upper and downward flow in the lower spinal canal. These observations most likely reflect closely coupled CSF and venous systems as both large caval veins and their anastomosing vertebral plexus react to respiration-induced pressure changes.
Topics: Adult; Cerebral Ventricles; Cerebrospinal Fluid; Female; Humans; Magnetic Resonance Imaging; Male; Respiration; Spinal Canal; Young Adult
PubMed: 29618801
DOI: 10.1038/s41598-018-23908-z -
European Spine Journal : Official... Oct 2010The purpose of this study was to compare the degree of enlargement of the spinal canal between two methods of cervical laminoplasty (open-door laminoplasty and... (Comparative Study)
Comparative Study
The purpose of this study was to compare the degree of enlargement of the spinal canal between two methods of cervical laminoplasty (open-door laminoplasty and double-door laminoplasty) and to determine their appropriate surgical indications based on the results. Tension-band laminoplasty (TBL, one method of open-door type) was performed in 33 patients and double-door laminoplasty (DDL) in 20 patients. The operation level ranged from C2 to C7 in all patients. The width of the spinal canal and the inclination angle of the lamina at the C5 and C6 levels were measured using a computer software program (Image J) and pre- and postoperative CT films. Concerning the degree of enlargement of the spinal canal, the mean expansion ratio at the C5 level was 148.9% in TBL and 148.2% in DDL, and there was no significant difference between them. However, at the C6 level, it was 159.0% in TBL and 140.3% in DDL, which was significantly larger in TBL than DDL (p < 0.05). The increase of inclination angle of the lamina was 11.0° in TBL and 19.0° in DDL at the C5 level, and 9.2° in TBL and 19.3° in DDL at the C6 level. At both the C5 and C6 levels, it was significantly larger in DDL than TBL (p < 0.0001). In conclusion, the appropriate surgical indications of TBL were considered to be (1) cervical spondylotic myelopathy (CSM) combined with hemilateral radiculopathy, (2) severe prominence of ossification of the posterior longitudinal ligament (OPLL), and (3) patients with tiny spinous processes who cannot undergo DDL. Those of DDL were considered to be (1) usual CSM, (2) small and slight prominence of OPLL, (3) CSM combined with bilateral radiculopathy, and (4) cervical canal stenosis combined with instability necessitating posterior spinal instrumentation surgery.
Topics: Adult; Aged; Aged, 80 and over; Cervical Vertebrae; Female; Humans; Laminectomy; Male; Middle Aged; Radiography; Spinal Canal; Spinal Cord Compression; Spinal Stenosis; Spondylosis
PubMed: 20309712
DOI: 10.1007/s00586-010-1369-y -
European Spine Journal : Official... Feb 2001Bone fragments in the spinal canal after thoracolumbar spine injuries causing spinal canal narrowing is a frequent phenomenon. Efforts to remove such fragments are often...
Bone fragments in the spinal canal after thoracolumbar spine injuries causing spinal canal narrowing is a frequent phenomenon. Efforts to remove such fragments are often considered. The purpose of the present study was to evaluate the effects of surgery on spinal canal dimensions, as well as the subsequent effect of natural remodelling, previously described by other authors. A base material of 157 patients operated consecutively for unstable thoracolumbar spine fractures at Sahlgrenska University Hospital in Gothenburg during the years 1980-1988 were evaluated, with a minimum of 5-years follow-up. Of these, 115 had suffered burst fractures. Usually the Harrington distraction rod system was employed. Patients underwent computed tomography (CT) preoperatively, postoperatively and at follow-up. From digitized CT scans, cross-sectional area (CSA) and mid-sagittal diameter (MSD) of the spinal canal at the level of injury were determined. The results showed that the preoperative CSA of the spinal canal was reduced to 1.4 cm2 or 49% of normal, after injury. Postoperatively it was widened to 2.0 cm2 or 72% of normal. At the time of follow-up, the CSA had improved further, to 2.6 cm2 or 87%. The extent of widening by surgery depended on the extent of initial narrowing, but not on fragment removal. Remodelling was dependent on the amount of bone left after surgery. The study shows that canal enlargement during surgery is caused by indirect effects when the spine is distracted and put into lordosis. Remodelling will occur if there is residual narrowing. Acute intervention into the spinal canal, as well as subsequent surgery because of residual bone, should be avoided.
Topics: Follow-Up Studies; Humans; Internal Fixators; Lumbar Vertebrae; Spinal Canal; Spinal Fractures; Spinal Stenosis; Thoracic Vertebrae; Time Factors; Tomography, X-Ray Computed
PubMed: 11276837
DOI: 10.1007/s005860000194