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cervical_disc_herniation_diagnosis

Cervical disc herniation diagnosis

Evaluation for myelopathy

Upper motor neuron findings usually in the lower extremities.

Weakness may occur without atrophy or fasciculations.

Spasticity: Poor control of the legs when walking, scissoring of the legs.


Sensation:

Any loss below the level of involvement will follow spinal cord patterns:

Complete loss

Brown Sequard pattern.

Central cord syndrome.

Pathologic reflexes: Hoffmann's reflex, Babinski sign, ankle clonus.

Magnetic resonance imaging

Magnetic resonance imaging (MRI) is currently considered the imaging modality of choice in patients with cervical radiculopathy, because it does not expose patients to a radiation hazard, has excellent soft-tissue resolution, and can create multi-planar images 1) 2) 3) 4).

An MRI scan can image any nerve root pinching caused by a herniated cervical disc, and it does not deliver any radiation to patients who are suffering from cervical radiculopathy 5) 6) 7) 8).

However, MRI requires almost 30 minutes to perform and is very sensitive to patient motion. CT requires less time to perform than MRI and is considered superior to MRI for evaluation of disc containment (e.g., bone) 9).

Multidetector row computed tomography (MDCT) and MRI showed a moderate-to-substantial degree of inter-modality agreement for the assessment of herniated cervical discs. MDCT images have a tendency to underestimate the anterior/posterior extent of the herniated disc compared with MRI 10).

Diffusion tensor imaging (DTI) can potentially be used to assess microstructural abnormalities in the cervical nerve roots in patients with disc herniation 11).

Additionally, contrast-enhanced CT 12) and CT myelography 13) remain useful imaging tools in the evaluation of cervical radiculopathy, but they carry the risk of anaphylactic reactions and nephrotoxicity with the use of iodinated contrast material.

1) , 5)
Daniels DL, Grogan JP, Johansen JG, Meyer GA, Williams AL, Haughton VM. Cervical radiculopathy: computed tomography and myelography compared. Radiology. 1984;151:109–113.
2) , 6)
Shim JH, Park CK, Lee JH, Choi JW, Lee DC, Kim DH, et al. A comparison of angled sagittal MRI and conventional MRI in the diagnosis of herniated disc and stenosis in the cervical foramen. Eur Spine J. 2009;18:1109–1116.
3) , 7)
Miyazaki M, Hong SW, Yoon SH, Morishita Y, Wang JC. Reliability of a magnetic resonance imaging-based grading system for cervical intervertebral disc degeneration. J Spinal Disord Tech. 2008;21:288–292.
4) , 8)
Yousem DM, Atlas SW, Hackney DB. Cervical spine disk herniation: comparison of CT and 3DFT gradient echo MR scans. J Comput Assist Tomogr. 1992;16:345–351.
9) , 12)
Douglas-Akinwande AC, Rydberg J, Shah MV, Phillips MD, Caldemeyer KS, Lurito JT, et al. Accuracy of contrast-enhanced MDCT and MRI for identifying the severity and cause of neural foraminal stenosis in cervical radiculopathy: a prospective study. AJR Am J Roentgenol. 2010;194:55–61.
10)
Yi JS, Cha JG, Han JK, Kim HJ. Imaging of Herniated Discs of the Cervical Spine: Inter-Modality Differences between 64-Slice Multidetector CT and 1.5-T MRI. Korean J Radiol. 2015 Jul-Aug;16(4):881-8. doi: 10.3348/kjr.2015.16.4.881. Epub 2015 Jul 1. PubMed PMID: 26175589; PubMed Central PMCID: PMC4499554.
11)
Chen YY, Lin XF, Zhang F, Zhang X, Hu HJ, Wang DY, Lu LJ, Shen J. Diffusion Tensor Imaging of Symptomatic Nerve Roots in Patients with Cervical Disc Herniation. Acad Radiol. 2013 Dec 19. pii: S1076-6332(13)00519-9. doi: 10.1016/j.acra.2013.11.005. [Epub ahead of print] PubMed PMID: 24361075.
13)
Larsson EM, Holtås S, Cronqvist S, Brandt L. Comparison of myelography, CT myelography and magnetic resonance imaging in cervical spondylosis and disk herniation. Pre- and postoperative findings. Acta Radiol. 1989;30:233–239.
cervical_disc_herniation_diagnosis.txt · Last modified: 2018/08/18 10:21 by administrador