Physical examination demonstrated a well-developed 62-year-old female who was in mild distress due to right-sided neck pain and arm pain. Her medical illnesses included diabetes, asthma and hypertension. Four weeks prior to presentation the patient began to experience neck pain with radiation to the right arm and hand. The weakness was progressive and then was accompanied by numbness and tingling of the right hand. She first noted weakness with opening a jar and then it progressed to difficulty with writing. ![]() There was no history of trauma or lifting. The weakness began six months prior to presentation and was initially localized to the right arm. CASE STUDYĪ 62-year-old female presented with the chief complaint of right upper extremity weakness and pain. This article reviews the current trends in the diagnosis and treatment of cervical myelopathy as well as the classification of disability in patients who have treatment. Even with surgery, results are unpredictable and neurologic disability continues. Some patients remain static in their symptoms while others develop progressive disability requiring surgery. Cervical degeneration may lead to cervical stenosis, which can cause progressive neurologic impairment. Degeneration of the disks and vertebral bodies is a common finding MRI detected cervical lesions affect the spinal cord in 26 percent of asymptomatic older patients. In order to stratify eligible patients for decompressive surgery, our findings may help to implement 18F-FDG PET investigations of the cervical spine in clinical routine.Diseases of the spine have become more common because of the aging population. Presence of this metabolic pattern reflects the time frame when decompressive surgery can lead to substantial clinical improvement. “The lesion of the spinal cord seems to be predominantly functional. “A hypermetabolism of the cervical spinal cord at the level of cervical spine stenosis as indicated by a locally increased 18F-FDG uptake seems to be a marker for a potentially reversible phase of a compression-induced cervical myelopathy,” explained Galldiks. In contrast, there was no significant clinical change in patients with inconspicuous 18F-FDG uptake. The overall outcome in myelopathy type 1 patients was favorable, and the patients showed significant improvement on their functional status assessment. Post-operatively, those with myelopathy type 1 had a marked decrease in 18F-FDG uptake, while myelopathy type 2 patients had only a moderate decline in uptake. Researchers observed two significantly different patterns of 18F-FDG uptake among the 20 study participants prior to surgery-approximately half of the patients had increased 18F-FDG uptake at the site of spinal cord compression and were classified as myelopathy type 1, while the other half had inconspicuous 18F-FDG uptake and were classified as myelopathy type 2. Imaging findings were correlated with the clinical outcome.” “To date, experiences with 18F-FDG PET in symptomatic patients with degenerative cervical spine stenosis and consecutive compressive myelopathy are very limited,” said Norbert Galldiks, MD, one of the lead researchers of the study.“In the present study, we present the results of preoperative magnetic resoncance imaging and 18F-FDG PET imaging and postoperative follow-up imaging 12 months after decompressive surgery. In the study “Hypermetabolism in 18F-FDG PET Predicts Favorable Outcome Following Decompressive Surgery in Patients with Degenerative Cervical Myelopathy,” researchers aimed to assess the regional changes of glucose metabolism of the cervical spinal cord using 18F-FDG PET. ![]() This compression can lead to progressive neurologic deficits, such as numbness, weakness or tingling in a leg, foot, arm or hand. While many patients lack symptoms, once symptoms appear, it usually indicates the presence of myelopathy. According to research published in the September issue of The Journal of Nuclear Medicine, patients who exhibited hypermetabolism at the point of compression in their spine experienced improved outcomes after undergoing decompressive surgery.Ĭervical spinal stenosis is a condition in which the spinal canal narrows in the neck. For patients with degenerative cervical myelopathy, imaging with 18F-FDG positron emission tomography (PET) could act as a marker for a potentially reversible phase of the disease in which substantial clinical improvement can be achieved.
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