Just as you can’t know a person just by their photo, surgeons can’t make clinical decisions based solely on X-Ray or MRI images. Whether the images look good or bad, they have to consider the whole person. This is especially true when it comes to a degenerative disorder involving the spinal cord called cervical spondylotic myelopathy (CSM).
Dr. Michael Kaiser, a neurosurgeon from The Spine Hospital at the Neurological Institute of New York who specializes in the treatment of this disorder, often emphasizes this point.
Before we talk more about that point you first need to understand what cervical spondylotic myelopathy is. To do this, you need to know a little more about the spine and how it ages.
The spinal cord runs from head to tail through a bony canal that with age can become more narrow. In the neck or cervical spine, thickening of ligaments, bulging disks, or bony build up in places can start to squeeze in on the spinal cord. When this happens, it can result in a loss of feeling and function in the arms, difficulty walking, and even bowel or bladder problems–this is cervical spondylotic myelopathy.
Unfortunately, once the spinal cord is damaged, symptoms may be irreversible. Surgeons can go in and take pressure off the spinal cord by removing part of the bone around it, but this may not change the patients current condition. What it can do though, is keep the problem from getting much worse.
Many of the patients with cervical spondylotic myelopathy who come to see a neurosurgeon like Dr. Kaiser, have been sent because their X-Ray or MRI images look bad. And often they come in thinking they absolutely need surgery. Sometimes they do, but that decision is based on much more than the medical images they walk in with.
Dr. Kaiser says that cervical spondylotic myelopathy varies substantially from person to person and there is, in fact, a “lack of correlation between severity of symptoms and imaging.” This means that the image alone can’t be used to determine whether the patient needs surgery. He says a number of other factors must also be taken into consideration.
A thorough history and neurological examination must be given to determine if and how much the spinal cord is damaged or at risk. In particular, the patient’s age, intensity and duration of symptoms are important. Dr. Kaiser says that, “mild to moderate cervical spondylotic myelopathy can be stable.” Meaning it won’t get any worse and may not require surgery.
A set of dynamic images may also be taken; these are like MRI or X-Ray movies that can show if the spinal cord is in more danger when the patient moves.
Ultimately it is the combination of all these factors that helps the surgeon make the right choice for his patient. When that includes surgery, medical images can be invaluable in not only confirming the diagnosis but also as a guide to the surgeon.
Image Credit: ctpaep / Adobe Images
Originally Published December 30, 2009
Updated January 11, 2017