PainJournal.net
Clinical Journal of Pain for
Healthcare Professionals and Patients
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PainJournal.net Clinical Journal of Pain for Healthcare Professionals and Patients
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FDA Registers New MRI Cervical Imaging Device Doctors diagnosing cervical spine injuries have historically relied heavily on x-ray as the standard tool in initial examination. Technological advances such as CT scanning, and later MR!, allowed more definitive imaging of suspected lesions. Unfortunately for patients who continued to complain of neck pain and paraesthesias (such as numbness and/or tingling in the arms and hands), no apparent injury would appear on routine diagnostic imaging.
However "A patient's first x-ray study following a MVA are often performed in an emergency room and may show normal alignment of the vertebrae (Fig. la) (Fig. la)
hypolordosis, indicating no subluxation. (Fig. lb)
Posterior subluxation C3 on extension, represents anterior ligamentous damage. when actually temporary subluxation may have occurred (Fig. 1 b) at the moment of injury and severely damaged the spinal cord." I As shown, biomechanical studies performed in flexion and extension would suggest anterior and posterior ligament injury, but would not reveal those structures.
The next logical step was to reproduce flexion and extension positions utilizing imaging technology,such as MRI,to duplicate the point of impact.This was designed to permit evaluation of soft-tissue injury (suspected but not visualized)on plain-film x-ray.Many medical engineers,radiologists,and similarly interested parties set out to achieve such positioning.Pillows,props,or wedges were placed under the subject ’s cervical spine to attain images in various positions.These efforts met with only limited success, however,in part due to patient motion and breathing difficulties. With a working knowledge of spinal biomechanics and extensive review of those previous attempts,another reason for the limited success becomes apparent.However, when the patient was placed in a position,such as extension,utilizing a support device, the addition of the MRI coil to the positioning device created a spinal stabilization, resulting in a neutral position rather than a true kinematic position.This would not allow for an unstable motor unit to be visualized,since it would be supported rather than accentuated (Fig 2).To address the problem caused by the placement of the coil between the pad and the subject ’s cervical spine,the Rhodes MRI Device was developed to allow visualization of the aberrant motion of the vertebral subluxation complex and to prevent stabilization of the motion from interfering with visualization.
(fig. 2)
(fig. 1C)
Colorized Extension MRI; Same patient as 1A and 1B
The Rhodes Device is designed with a recess which accommodates the cervical MRI coil and still allows a degree of comfort for the subject.In addition,the presence of a coil recess allows for relaxation of the cervical spinal musculature and permits visualization of misaligned structures and resultant ligament and disc lesions previously unseen (Fig 1c).Contraction of musculature may inherently splint such structures,such as in a neutral position MRI (Fig 1d).
(Fig. 1D)
Colorized Neutral MRI; Same patient as 1A, 1B and 1C
Prior positioning devices consisted of the flexion device without the recess.This achieves only a chin-down effect (Fig 3)versus true cervical flexion.Cervical flexion without the recess also results in a supporting effect,preventing visualization of vertebral misalignment,ligament and disc injury.(Fig.4)
(Fig. 4)
The following images demonstrate an MVA patient experiencing radicular complaints and associated neck pain.MRI using only standard neutral protocol would have certainly failed to demonstrate any disc lesion.With execution of the Rhodes Procedure (the established protocol for obtaining Flexion and Extension cervical MRI ’s utilizing the FDA-registered accessory MRI device),a clear,undeniable image of the patient ’s lesions becomes obvious.This is confirmed by the radiology report,which follows the images.(Fig 5a-c) (fig. 5a)
Neutral MRI
(Fig. 5b)
Extension MRI
(Fig. 5C)
Flexion MRI
…Circumferential disk bulge is seen at C4-5.This appears most obvious on the flexion and extension views yet does not appear to be present in the neutral position … …Anterior disk bulges with stretching of the anterior longitudinal ligament is seen at C4-5 and C5-6. A posterior disk bulge is seen at C4-5 noted on the flexion and extension images only. REFERENCE: 1.Clinical Symposia,Volume 32,Number 1,1980,Acute Cervical Spine Injuries.Ralph B.Cloward,M.D.
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