What is the role of imaging studies in the diagnosis of cervical spondylosis?

Updated: Apr 23, 2020
  • Author: Hassan Ahmad Hassan Al-Shatoury, MD, PhD, MHPE; Chief Editor: Dean H Hommer, MD  more...
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  • Plain cervical radiography is routine in every patient with suspected cervical spondylosis.

    • This examination is valuable in evaluating the uncovertebral and facet joints, the foramen, intervertebral disk spaces, and osteophyte formation.

    • In select circumstances, flexion-extension views may be needed to detect instability.

  • Myelography, with computed tomography (CT) scanning, was previously considered to be the imaging test of choice for assessing spinal and foraminal stenosis. However, with advances in MRI and CT scanning technology, myelography is now performed in selected patients. [14]

    • Because myelography method is invasive, most physicians depend on MRI in diagnosing cervical spondylosis. [14]

    • Myelography adds anatomic information in evaluating spondylosis.

    • Myelography may be especially useful in visualizing the nerve root takeoff.

    • CT scanning, with or without intrathecal dye, can be used to estimate the diameter of the canal.

    • CT scans may demonstrate small, lateral osteophytes and calcific opacities in the middle of the vertebral body.

  • MRI is a considerable advance in the use of imaging to diagnose cervical spondylosis. It offers the following advantages:

    • Direct imaging in multiple planes

    • Better definition of neural elements

    • Increased accuracy in evaluating intrinsic spinal cord diseases

    • Noninvasiveness

    • Myelogramlike images

  • High–signal-intensity lesions can be seen on magnetic resonance images of spinal cord compression; this finding indicates a poor prognosis.

  • False-positive and false-negative MRI results occur frequently in patients with cervical radiculopathy; therefore, MRI results and clinical findings should be used when interpreting root compression. [3]

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