Incidence of discoligamentous injuries in patients with acute central cord syndrome and underlying degenerative cervical spinal stenosis
Introduction: Surgical treatment for CCS in patients with an underlying cervical stenosis without instability remains controversial. Research question: The aim was to assess the incidence of concomitant discoligamentous injury (DLI) in patients with CCS and underlying degenerative cervical spinal st...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-01-01
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| Series: | Brain and Spine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772529422000236 |
| _version_ | 1797977750952214528 |
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| author | Melanie Barz Insa K. Janssen Kaywan Aftahy Sandro M. Krieg Jens Gempt Chiara Negwer Bernhard Meyer |
| author_facet | Melanie Barz Insa K. Janssen Kaywan Aftahy Sandro M. Krieg Jens Gempt Chiara Negwer Bernhard Meyer |
| author_sort | Melanie Barz |
| collection | DOAJ |
| description | Introduction: Surgical treatment for CCS in patients with an underlying cervical stenosis without instability remains controversial. Research question: The aim was to assess the incidence of concomitant discoligamentous injury (DLI) in patients with CCS and underlying degenerative cervical spinal stenosis and to determine the sensitivity of MRI by comparing intraoperative site inspection to preoperative imaging findings. Material and methods: We performed a retrospective analysis of our clinical prospective database. Fifty-one patients (39 male, 12 female) between January 2010 and June 2019 were included. Age, sex, neurological deficits, preoperative MRI, and surgical treatment were recorded. Sensitivity was determined by the quotient of patients in whom all levels of DLI were correctly identified on MRI and the total number of patients with intraoperatively confirmed DLI. Results: Mean age at surgery was 64.1 ± 11.3 (range 41–86). DLI was suspected in 33 (62.1%) patients based on MRI findings, which could be confirmed intraoperatively in 29 patients (56.9%). In 2 patients, DLI was detected intraoperatively that was not suspected in preoperative MRI; in 5 patients, another level was affected intraoperatively than was indicated by MRI. The overall specificity and sensitivity of preoperative MRI imaging to identify discoligamentous lesions of the cervical spine was 73% and 79%, respectively. Discussion and conclusion: The incidence of DLI in patients with traumatic CCS based on preexisting spinal stenosis was 60.78%, which is higher than previously reported. The sensitivity of MRI imaging to detect DLI of 79% suggests that these patients are at risk of missing traumatic DLI on imaging. |
| first_indexed | 2024-04-11T05:11:58Z |
| format | Article |
| id | doaj.art-87d56adc99e943cfb6cf87862fa6b47a |
| institution | Directory Open Access Journal |
| issn | 2772-5294 |
| language | English |
| last_indexed | 2024-04-11T05:11:58Z |
| publishDate | 2022-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain and Spine |
| spelling | doaj.art-87d56adc99e943cfb6cf87862fa6b47a2022-12-25T04:20:09ZengElsevierBrain and Spine2772-52942022-01-012100882Incidence of discoligamentous injuries in patients with acute central cord syndrome and underlying degenerative cervical spinal stenosisMelanie Barz0Insa K. Janssen1Kaywan Aftahy2Sandro M. Krieg3Jens Gempt4Chiara Negwer5Bernhard Meyer6Technical University Munich, School of Medicine, Klinikum rechts der Isar, Department of Neurosurgery, Ismaningerstr. 22, 81675, Munich, GermanyTechnical University Munich, School of Medicine, Klinikum rechts der Isar, Department of Neurosurgery, Ismaningerstr. 22, 81675, Munich, Germany; Department of Neurosurgery, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland; Corresponding author. Department of Neurosurgery, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland.Technical University Munich, School of Medicine, Klinikum rechts der Isar, Department of Neurosurgery, Ismaningerstr. 22, 81675, Munich, GermanyTechnical University Munich, School of Medicine, Klinikum rechts der Isar, Department of Neurosurgery, Ismaningerstr. 22, 81675, Munich, GermanyTechnical University Munich, School of Medicine, Klinikum rechts der Isar, Department of Neurosurgery, Ismaningerstr. 22, 81675, Munich, GermanyTechnical University Munich, School of Medicine, Klinikum rechts der Isar, Department of Neurosurgery, Ismaningerstr. 22, 81675, Munich, GermanyTechnical University Munich, School of Medicine, Klinikum rechts der Isar, Department of Neurosurgery, Ismaningerstr. 22, 81675, Munich, GermanyIntroduction: Surgical treatment for CCS in patients with an underlying cervical stenosis without instability remains controversial. Research question: The aim was to assess the incidence of concomitant discoligamentous injury (DLI) in patients with CCS and underlying degenerative cervical spinal stenosis and to determine the sensitivity of MRI by comparing intraoperative site inspection to preoperative imaging findings. Material and methods: We performed a retrospective analysis of our clinical prospective database. Fifty-one patients (39 male, 12 female) between January 2010 and June 2019 were included. Age, sex, neurological deficits, preoperative MRI, and surgical treatment were recorded. Sensitivity was determined by the quotient of patients in whom all levels of DLI were correctly identified on MRI and the total number of patients with intraoperatively confirmed DLI. Results: Mean age at surgery was 64.1 ± 11.3 (range 41–86). DLI was suspected in 33 (62.1%) patients based on MRI findings, which could be confirmed intraoperatively in 29 patients (56.9%). In 2 patients, DLI was detected intraoperatively that was not suspected in preoperative MRI; in 5 patients, another level was affected intraoperatively than was indicated by MRI. The overall specificity and sensitivity of preoperative MRI imaging to identify discoligamentous lesions of the cervical spine was 73% and 79%, respectively. Discussion and conclusion: The incidence of DLI in patients with traumatic CCS based on preexisting spinal stenosis was 60.78%, which is higher than previously reported. The sensitivity of MRI imaging to detect DLI of 79% suggests that these patients are at risk of missing traumatic DLI on imaging.http://www.sciencedirect.com/science/article/pii/S2772529422000236Acute central cord syndromeDegenerative cervical spinal stenosisDiscoligamentous injuryMagnetic resonance imagingSpinal cord injuryHyperextension injury |
| spellingShingle | Melanie Barz Insa K. Janssen Kaywan Aftahy Sandro M. Krieg Jens Gempt Chiara Negwer Bernhard Meyer Incidence of discoligamentous injuries in patients with acute central cord syndrome and underlying degenerative cervical spinal stenosis Brain and Spine Acute central cord syndrome Degenerative cervical spinal stenosis Discoligamentous injury Magnetic resonance imaging Spinal cord injury Hyperextension injury |
| title | Incidence of discoligamentous injuries in patients with acute central cord syndrome and underlying degenerative cervical spinal stenosis |
| title_full | Incidence of discoligamentous injuries in patients with acute central cord syndrome and underlying degenerative cervical spinal stenosis |
| title_fullStr | Incidence of discoligamentous injuries in patients with acute central cord syndrome and underlying degenerative cervical spinal stenosis |
| title_full_unstemmed | Incidence of discoligamentous injuries in patients with acute central cord syndrome and underlying degenerative cervical spinal stenosis |
| title_short | Incidence of discoligamentous injuries in patients with acute central cord syndrome and underlying degenerative cervical spinal stenosis |
| title_sort | incidence of discoligamentous injuries in patients with acute central cord syndrome and underlying degenerative cervical spinal stenosis |
| topic | Acute central cord syndrome Degenerative cervical spinal stenosis Discoligamentous injury Magnetic resonance imaging Spinal cord injury Hyperextension injury |
| url | http://www.sciencedirect.com/science/article/pii/S2772529422000236 |
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