Assessment of nerve involvement in the lumbar spine: agreement between magnetic resonance imaging, physical examination and pain drawing findings

<p>Abstract</p> <p>Background</p> <p>Detection of nerve involvement originating in the spine is a primary concern in the assessment of spine symptoms. Magnetic resonance imaging (MRI) has become the diagnostic method of choice for this detection. However, the agreement between MRI and other diagnostic methods for detecting nerve involvement has not been fully evaluated. The aim of this diagnostic study was to evaluate the agreement between nerve involvement visible in MRI and findings of nerve involvement detected in a structured physical examination and a simplified pain drawing.</p> <p>Methods</p> <p>Sixty-one consecutive patients referred for MRI of the lumbar spine were - without knowledge of MRI findings - assessed for nerve involvement with a simplified pain drawing and a structured physical examination. Agreement between findings was calculated as overall agreement, the p value for McNemar's exact test, specificity, sensitivity, and positive and negative predictive values.</p> <p>Results</p> <p>MRI-visible nerve involvement was significantly less common than, and showed weak agreement with, physical examination and pain drawing findings of nerve involvement in corresponding body segments. In spine segment L4-5, where most findings of nerve involvement were detected, the mean sensitivity of MRI-visible nerve involvement to a positive neurological test in the physical examination ranged from 16-37%. The mean specificity of MRI-visible nerve involvement in the same segment ranged from 61-77%. Positive and negative predictive values of MRI-visible nerve involvement in segment L4-5 ranged from 22-78% and 28-56% respectively.</p> <p>Conclusion</p> <p>In patients with long-standing nerve root symptoms referred for lumbar MRI, MRI-visible nerve involvement significantly underestimates the presence of nerve involvement detected by a physical examination and a pain drawing. A structured physical examination and a simplified pain drawing may reveal that many patients with "MRI-invisible" lumbar symptoms need treatment aimed at nerve involvement. Factors other than present MRI-visible nerve involvement may be responsible for findings of nerve involvement in the physical examination and the pain drawing.</p

Assessment of correlation between spinal canal shape and spinal cord injury in thoracolumbar spine fractures

Traumatic spinal cord injury is one of the important causes of disability. In some of vertebral fractures, spinal canal is deformed and compromised. The relationship between the shape of the cervical canal and spinal cord injury has been proved but such a correlation for thoracolumbar spine has not been documented yet. Thus, 100 consecutive patients with traumatic fracture of thoracolumbar spine [50 patients with compromised canal (cases) and 50 patients with intact canal] were evaluated in the light of spinal canal shape (Using CT scan), neurological defects (Using Frankle classification), mechanism of trauma and level of the spinal fracture. Of the 100 patients studied, 23 had spinal cord injury and most of injuries were at T12-L2. The most common mechanisms of trauma were road traffic accident and fall. The difference in age, sex and mechanism of trauma between the two groups was not statistically significant. No significant difference was found between canal intact group and canal compromised group in neurological deficit (P=0.09). In traumatic spinal cord injury, it seems that dynamic spinal canal encroachment is more important than static canal compromise. Keywords: Spinal cord injury, Thoracolumbar spine, Neurological defici

Evaluation of correlation between cases of depressed fracture and associated brain lesion

This cross-sectional study was performed on 382 patients with depressed skull fracture admitted to the neurosurgery ward of Kerman Bahonar Hospital between 1994 and 1999. 329 of the patients (86.1%) had open fractures, while the fracture was of closed type in 53 cases (13.9%). Of those with open fracture, 42% were associated with dura tearing, whereas the rate was 34% in closed fractures. The most common causes of depressed fracture were accidents with motor vehicles (59.4%). In most cases (77%) Glasgow Coma Scale (GCS) on admission was 13-15. There was no associated lesion in 247 patients (64.7%), but 135 (35.3%) had one or more lesions, with contusion (34%) and epidural hematoma (23.7%) as the most common ones. In cases when the fracture was caused by motor vehicle accidents, the occurence of clinical manifestations was more than that of the other causes. Of 15 patients who died (3.9%) 14 cases (93.3%) had associated lesions. Keywords: Depressed fracture, Brain lesion, Clinical sig

The Relationship Between Gastrointestinal Comorbidities, Clinical Presentation and Surgical Outcome in Patients with DCM: Analysis of a Global Cohort

Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord impairment in adults, presenting most frequently in patients 50 years or older. Gastrointestinal comorbidities (GICs) commonly occur in this group; however, their relationship with DCM has not been thoroughly investigated. It is the objective of the present study to investigate the difference between patients with or without GICs who are surgically treated for DCM. A cohort of 757 patients with clinical data and 458 with magnetic resonance imaging (MRI) data from the AOSpine North America and AOSpine International studies on DCM was evaluated. GICs were obtained at presentation and included gastric, intestinal, hepatic, and pancreatic conditions. Patients were dichotomized into 2 groups: those with GICs and those without GICs. Both clinical and MRI presentation, as well as baseline neurological and functional status, were compared. Neurological and functional outcomes at 2-year follow-up were also compared. GICs were present in 121 patients (16%). These patients were less commonly male (48.76% vs. 65.4%, p = 0.001) and were slightly less neurologically impaired based on the Nurick grade (3.05 &plusmn; 1.10 vs. 3.28 &plusmn; 1.16, p = 0.044) but not based on mJOA (12.74 &plusmn; 2.62 vs. 12.48 &plusmn; 2.76, p = 0.33). They also had a worse physical health score (32.80 &plusmn; 8.79 vs. 34.65 &plusmn; 9.38 p = 0.049), worse neck disability (46.31 &plusmn; 20.04 vs. 38.23 &plusmn; 20.44, p &lt; 0.001), a lower prevalence of upper motor neuron signs (hyperreflexia, 70.2% vs. 78.9%, p = 0.037; Babinski&rsquo;s sign 24.8% vs. 37.3%, p = 0.008), and a higher rate of psychiatric comorbidities (31.4% vs. 10.4%, p &lt; 0.0001). On MRI, GIC patients less commonly exhibited signal intensity changes (T2 hyperintensity, 49.2% vs. 75.6%, p &lt; 0.001; T1 hypointensity, 9.7% vs. 21.1%, p = 0.036), and had a lower number of T2 hyperintensity levels (0.82 &plusmn; 0.98 vs. 1.3 &plusmn; 1.11, p = 0.001). There was no difference in surgical outcome between the groups. DCM patients with GICs are more likely to be female and have significantly more general health impairment and neck disability. However, these patients have less clinical and MRI features typical of more severe neurological impairment. This constellation of symptoms is considerably different than those typically observed in DCM, and it is therefore plausible that nutritional factors may contribute to this unique observation