Imaging and Investigations

A variety of imaging techniques are available to study the anatomy and pathology of the cervical spine for spondylosis and other spinal disorders. Although the primary objective of the imaging studies is still to identify the foci of compression of the spinal cord and nerve roots and determine the stability of the spine, other manifestations of the spondylotic process can be investigated in an attempt to identify focal pain generators. The advent of computer-

assisted imaging studies has significantly improved the ability to delineate the extent of spondylosis involving the motion segments of the cervical spine.

Plain films are typically used as the initial study in a patient with symptomatic spondylosis. The alignment and stability of the cervical spine can be outlined on the lateral X-ray in dynamic and static views. Bony changes associated with spondylosis, including sclerosing of the endplates and accumulation of osteophyte, can be seen directly. Encroachment upon the intervertebral foramina, and sometimes the central spinal canal, can be seen on the plain films. Some of the degenerative changes of the disk can be indirectly identified on the plain X-rays.

A spinal canal study is required to determine the patency of the central spinal canal and the intervertebral foramina. An MRI or myelogram, followed by a post-myelogram CT scan, provide visualization of these areas. The quality of the MRI studies obtained on the high-resolution machines has significantly improved since the advent of MRI scanning. The ability to obtain multiplanar imaging of the spine and the ability to directly visualize the spinal cord and its relation to surrounding osseoligamentous tissues has made this a very sensitive and specific means of visualizing the cervical spinal canal for evidence of cord and/or nerve root compression. This non-invasive technique has eliminated the need for myelography in a number of cases. Some perform myelogram/CT scanning for delineating the extent of nerve root and spinal cord compression. The AP post-myelo-gram X-ray can enable visualization of the nerve roots as they exit the spinal canal through the proximal aspect of the foramen and outline the foci of compression. Flexion/extension views in a lateral projection can identify dynamic foci of compression of the spinal cord in the central canal.

Detailed study of the osseoligamentous structures of the spine can be obtained using MRI and CT scanning. These two forms of computer-assisted imaging provide complimentary information. The extent of disk desiccation, the presence of reactive changes in the endplates and the accumulation of fluid in the facet joints can be clearly seen on the MRI study. Sclerosing of the vertebral body endplates and accumulation of osteophyte at the disk space or

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