Some changes of spinal cord would be missed in the static MRI and can be demonstrable in dMRI. Dynamic MRI could show the flexional and extensional position of cervical spine, which is more similar with the natural condition of cervical spine. Dynamic MRI (dMRI) is firstly described in 1980s, which is a modification of static MRI. Typically, static MRI can only show the neutral and static condition of the spinal cord, which is not adequate for the description of CSM because the cervical motion also plays an important role in the development of CSM. Compare to x-ray and CT scan, MRI can directly demonstrate the disc, spinal cord and the abnormal signal in spinal cord, which is the standard examination for CSM currently. The diagnosis of CSM is based on clinical symptoms, physical and radiological examination including x-ray, computed-tomography (CT) and magnetic resonance image (MRI). Decompression surgery is the most appropriate treatment after the diagnosis of CSM, which includes anterior, posterior and anterior-posterior approaches. The symptom of CSM ranges from mild impact on the daily life to paralysis. The clinical syndrome of CSM occurs when the stenosis impinges on the spinal cord, and the severity of CSM is generally thought to be related to the amount of mechanical compression of the various spinal cord tracts. Registered on May 7th, 2019.Ĭervical spondylotic myelopathy (CSM) is the most severe type of cervical spondylosis and the most common cause of spinal cord dysfunction among adults over 55 years old. Dynamic MRI can be a useful tool in the treatment of CSM patients. This study will help us to explore the indication of dynamic MRI and the value of dynamic MRI in the treatment of CSM, especially the surgical decision making. Finally, data collection and statistical analysis will be finished by researchers who are blinded to recruitment and treatment. Follow-up will be maintained at 3, 6, and 12 months after surgery through outpatient or telephone interview, including mJOA score, 10-s G&R (grip and release) and 10-s step test, SF-36 score, radiographic examination and complications. Two surgical plans will be made for each participant by one professional surgeon according to the static MRI and dynamic MRI respectively and we will randomly choose one to perform via a random number system. Group C (spinal cord compression) means shape change of spinal cord. Group B (complete dura compression) means no CSF signal and no shape change of spinal cord. Group A (incomplete dura compression) means the signal of cerebral spinal fluid (CSF) is still visible. MethodĪ total of 180 CSM patients who have indications for surgery will be recruited in outpatient of Peking University Third Hospital and assigned to three groups (Group A, B and C) based on their static MRI after consent. Dynamic MRI demonstrating the extension and flexion position of spinal cord can be a better tool for the treatment of CSM, especially the surgical decision making. Static MRI can only show the static and neutral position of spinal cord, which is not enough to understand the pathogenesis of CSM. MRI plays an important role in the diagnosis and evaluation of CSM, which can directly demonstrate the correlation between disc, spinal cord, posterior structures and abnormal signal in spinal cord. Cervical spondylotic myelopathy (CSM) is the most severe type of cervical spondylosis and the most common cause of spinal cord dysfunction among adults over 55 years old.
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