Just as you can’t know a person just by their photo, surgeons can’t make clinical decisions based solely on X-Ray or MRI images.  Whether the images look good or bad, they have to consider the whole person. This is especially true when it comes to a degenerative disorder involving the spinal cord called  Cervical Spondylotic Myelopathy (CSM).   Dr. Michael Kaiser from our Spine Center talked about CSM at the annual meeting of the Congress of Neurological Surgeons (CNS) in October and emphasized this point.

The spinal cord runs from head to tail through a bony canal that with age, can become more narrow. In the neck or cervical spine, thickening of ligaments, bulging disks, or bony build up  in places can start to squeeze in on the cord and cause loss of feeling and  function in the arms, difficulty walking,  and even bowel or bladder problems.

Unfortunately, once the cord is damaged, symptoms may be irreversible.   Surgeons can go in and take pressure off the spinal cord by removing part of the bone around it but  this may not change the patients current condition. What it can do though, is keep the problem from getting much worse.

Many of the patients with CSM who come into The Spine Center have been sent because their X-Ray or MRI images look bad, and based on that, they come in thinking they need surgery.  Sometimes they do but that decision is based on much more than the medical images they walk in with.

In his talk at the annual CNS meeting, Dr. Kaiser said that CSM varies substantially from person to person and there is, in fact, a “lack of correlation between severity of symptoms and imaging.”  Meaning that the image alone can’t be used to determine whether the patient needs surgery.  He emphasized a number of other factors that must also be taken into consideration.

A thorough history and neurological examination must be given to determine if and how much the spinal cord is damaged or at risk.  In particular, the patient’s age, intensity and duration of symptoms are important.  Dr. Kaiser says that, “mild to moderate CSM can be stable.”  Meaning it won’t get any worse and may not require surgery.

A set of dynamic images may also be taken; these are like MRI or X-Ray movies that can show if the spinal cord is in more danger when the patient moves.

Ultimately it is the combination of all these factors that help the surgeon make the right choice for his patient.  When that includes surgery, medical images can be invaluable in not only confirming the diagnosis but also as a guide to the surgeon.