Dynamic Cervical Cord Compression: Demonstration Using Weight-Bearing MRI Using Tiltable Esaote G-Scan MRI
Author: Dr. Douglas K. Smith, Musculoskeletal Imaging Consultants
Positional Cervical Cord Compression by Cervical Disc Herniation
During my past 25 years of spinal radiology practice, I have encountered numerous individuals that report myelopathic symptoms (i.e. bilateral radicular symptoms) when they are sitting or standing but the symptoms are relived when they lie down. Traditional MRI scans of these patients obtained in the spine position frequently showed flattening of the cervical spinal cord adjacent to a small disc herniation although there was no cord contact by the disc herniation. There was cerebrospinal fluid (CSF) between the disc herniation and the cervical cord. I noticed that the flattening of the cervical cord matched the shape and location of the disc herniation.
Last summer I had the opportunity to read the MRI examinations form the second Tiltable MRI scanner installed in the United States. The Esaote G-Scan Brio MRI scans individuals in both the supine and upright (weight-bearing sitting) position. Immediately, I saw the explanation for what I had been observing for 25 years. The supine images showed the same finding I had observed over the years: a small disc herniation with adjacent flattening of the cervical cord but CSF between the disc herniation and the cervical cord (Figs. 1A and 2A).
Figure 1A Supine C4-C5
Figure 2A Suprine C5-C6
The axial images with the patient bearing weight in a sitting position showed increased size of the disc herniation with cord compression and obliteration of the CSF between the disc herniation and cervical cord. These dynamic disc herniations with dynamic cord compression are frequently associated with dynamic myelopathy. Individuals frequently report reproduction of their symptoms in the sitting position where the cord is compressed. This is frequently described as positional numbness or weakness in the hands or feet while sitting and especially with cervical flexion. The attached images (Figs. 1B and 2B) show increased size of the disc herniations with cord compression not present at the same levels in the supine position (Figs. 1A & 2A).
Figure 1B Sitting C4-C5
Figure 2B Sitting C5-C6
The sagittal plane T2-weighted images show similar findings. The supine images show disc herniations (Fig.3A) with impression on the thecal sac but no cord compression. The sagittal images with the patient sitting applies body weight to the discs, causing them to increase in size, with dynamic compression of the cervical spinal cord. At the same time, the patient experienced muscle spasm and reproduction of bilateral upper extremity extremity numbness and weakness and muscle spasm producing image unsharpness.
Tiltable MRI scanning provides an un precedented opportunity to see why patients hurt or have neurologic dysfunction when they are standing or bearing weight when previous MRI examinations have been negative or have failed to explain their symptoms. SEE WHAT YOU HAVE BEEN MISSING!!
In the setting of personal injuries, Tiltable MRI at Salubrio MRI makes the difference between a dismissed case and getting the injured party the treatment for the injuries sustained during the accident.
Spinal surgeons find their surgical pre-authorization applications are more successful when accompanied by pictures showing neurologic compression during weight-bearing whereas images while supine show no neurologic compression. Traditional supine non-weight-bearing MRI examinations would fail to show the neurologic compression required to justify surgical treatment. In this setting, a Tiltable weight-bearing MRI showing why the patient hurts is priceless to the suffering patient.
Figure 3A Sagittal Supine
Figure 3B Sagittal Sitting
Salubrio Tiltable weight-bearing MRI is the “MRI WORTH WEIGHTING FOR”!!!