Imaging

Cervical Spondylosis

Preliminary Diagnosis: Cervical Spondylosis

I. What imaging technique is first-line for this diagnosis?

  • Plain radiography of the cervical spin

II. Describe the advantages and disadvantages of this technique for diagnosis of cervical spondylosis.

Advantages

  • Easily available

  • Quickly performed

  • Relatively inexpensive compared with other modalities

Disadvantages

  • Exposure to a small amount of ionizing radiation

III. What are the contraindications for the first-line imaging technique?

No specific contraindications to plain radiography exist.

IV. What alternative imaging techniques are available?

  • Noncontrast extradural protocol MRI of the cervical spine in patients without a history of prior neck surgery and with radicular symptoms

  • In patients with prior neck surgery, one should obtain a contrasted extradural protocol MRI of the cervical spine.

  • CT myelography

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of cervical spondylosis.

MRI of the cervical spine

Advantages

  • The patient is not exposed to ionizing radiation.

  • Contrast MR examinations are able to differentiate granulation tissue from recurrent disc.

Disadvantages

  • Time consuming

  • Requires significant patient cooperation to minimize artifact

  • Expensive

CT myelography

Advantages

  • May be performed in patients with non-MR-compatible hardware

  • May be performed much faster than MR exams

Disadvantages

  • Exposes the patient to ionizing radiation.

  • Invasive procedure

VI. What are the contraindications for the alternative imaging techniques?

MRI of the cervical spine

  • Patients who contain non-MR-compatible hardware

CT myelography

  • Patients allergic to iodinated contrast

  • Patients with significant renal failure

  • Relative contraindication in pregnancy

  • Contraindication in hypocoagulable patients (platelets <50,000, INR >2.0)

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