Spine Management Report

Spinal Stenosis Measurements and Bodily Injury

"Central cervical spinal stenosis (CCSS) is a relatively common disorder associated with degenerative spondylosis such as osteophyte formation, herniated intervertebral disks, or ossification of the posterior longitudinal ligament." [pg 1] When a traumatic event occurs and there are pre-existing underlying conditions, it is critical to be able to measure the influence of the NEW injury on the pre-existing condition. This in turn helps us to determine persistent functional loss associated with the NEW injury as well as the clients risk of being injured with less trauma than a healthy spine would require.


"In a recent paper by Lee et al (2020), the authors stated, "The current
modality of choice for radiological assessment of cervical spinal stenosis is
magnetic resonance imaging (MRI). MRI provides a valuable demonstration
of cervical anatomy, extent and etiology of spinal canal narrowing, and
signal change of the cervical cord." [pg 1] This is especially important when a
pre-existing central cervical spinal stenosis is aggravated causing
permanent disability. We need to objectify the changes due to the causally
related event. The only way to do that is by measuring the actual diameter
of the central canal in the spine.


They continue by stating, "Although previous studies have reported various
methods of qualifying or quantifying the degree of cervical stenosis, there is
no commonly accepted system for grading cervical canal stenosis." [pg 1]
They go on by stating, "Kang et al. proposed a novel MRI grading system for
CCSS. They classified CCSS into the following grades based on T2-weighted
sagittal images: grade 0, absence of canal stenosis (subarachnoid space
obliteration<50 %); grade 1, subarachnoid space obliteration>50 %;
grade 2, compressed spinal cord without signal change in the cord; and grade 3, spinal cord compression with signal change. They reported that their system is a reliable method for grading CCSS." [pg 1] Having a reliable and scientific way to objectify changes in clients with pre-existing degenerative changes is critical to the need for surgical intervention as well as in litigation.


The more information we can provide to outline the body's condition prior to the causally related injury and its status after, is the best way to start to be able to care for patient and clients. It is also important that clinicians have training in the most reliable way to measure those changes as well as the science that
supports the accuracy of those measurements.


The authors concluded. "To summarize, the Kang MRI grading system of CCSS based on midsagittal MRI provides objective, reliable, and reproducible assessment regardless of field proficiency of the reader although the reproducibility of the clinician is slightly lower than radiologist and trainee of the radiology department. There was moderate correlation between image interpretation and clinical findings independent of the observerʼs main field of specialization. This study is the first to report that clinicians can easily use the new CCSS grading system in real clinical practice.

Lee, K. H., Park, H. J., Lee, S. Y., Kim, M. S., Lee, Y. T., Kim, Y. B., ... & Youn, I.
(2020). Inter-observer reliability and clinical validity of the MRI grading
system for cervical central stenosis based on sagittal T2-weighted image.
European Journal of Radiology, 108987.

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