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Spinal surgeons need to read patients' studies to avoid missing pathology.

Epstein NE, Hollingsworth RD, Silvergleid R - Surg Neurol Int (2015)

Bottom Line: A now 54-year-old male had an original enhanced magnetic resonance imaging (MR) scan of the cervical spine performed in 2012 that was read as showing mild spondylotic changes at multiple levels.In 2015, the patient presented with a severe spastic quadriparesis, right greater than left, which had markedly worsened over the prior 3 months.Following a C4-C6 laminectomy, and a challenging tumor removal, and the patient was neurologically intact.

View Article: PubMed Central - PubMed

Affiliation: Department of Neuroscience, Winthrop University Hospital, 200 Old Country Road, Suite 485, Mineola, NY, USA.

ABSTRACT

Background: Many spine surgeons rely on reports of radiological studies for patients seen routinely in consultation. However, "best practice" should include the spine surgeon's individual assessment of the images themselves to better determine whether the diagnoses rendered were/are correct.

Methods: A now 54-year-old male had an original enhanced magnetic resonance imaging (MR) scan of the cervical spine performed in 2012 that was read as showing mild spondylotic changes at multiple levels.

Results: In 2015, the patient presented with a severe spastic quadriparesis, right greater than left, which had markedly worsened over the prior 3 months. Review of the original enhanced MR from 2012 revealed a right-sided C5-C6 tumor (e.g., likely meningioma) filling the right neural foramen with extension into the spinal canal (7 mm × 8 mm × 11 mm): The tumor was originally "missed". The new 2015 enhanced MR scan documented the tumor had enlarged 6.7 fold (measuring 17 mm × 11 mm × 2.2 cm), and now filled 2/3 of the spinal canal, markedly compressing the cord and right C6 nerve root. Following a C4-C6 laminectomy, and a challenging tumor removal, and the patient was neurologically intact.

Conclusion: This case underscores the need for spine surgeons to carefully review both images and reports of prior diagnostic studies that accompany patients. In this case, the original failure to recognize the tumor led to a 2.5-year delay in surgery that resulted in the patient's severe preoperative quadriparesis, and a much more challenging surgery.

No MeSH data available.


Related in: MedlinePlus

The original October 2012 axial T1 enhanced magnetic resonance imaging (MR) showing smaller right C5–C6. On the original October 2012 axial T1 enhanced MR study. The right-sided C5-6 intradural extramedullary tumor was clearly visualized extending into the right neural foramen where it markedly compressed the right C6 root and the spinal cord
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Figure 1: The original October 2012 axial T1 enhanced magnetic resonance imaging (MR) showing smaller right C5–C6. On the original October 2012 axial T1 enhanced MR study. The right-sided C5-6 intradural extramedullary tumor was clearly visualized extending into the right neural foramen where it markedly compressed the right C6 root and the spinal cord

Mentions: The original report of the enhanced MR from 2012 read; small central/right paracentral disc herniation at C4–C5, and moderate size broad based bony ridge at the C5–C6 level causing mild cord compression/moderate bilateral foraminal stenosis. Review of the original enhanced T1 MR study clearly revealed a right-sided uniformly enhancing intradural extramedullary tumor extending from the C5-C6 neural foramen, into the neural foramen and into the spinal canal (7 mm × 8 mm × 11 mm) contributing to marked C6 root and mild/moderate cord compression [Figures 1 and 2].


Spinal surgeons need to read patients' studies to avoid missing pathology.

Epstein NE, Hollingsworth RD, Silvergleid R - Surg Neurol Int (2015)

The original October 2012 axial T1 enhanced magnetic resonance imaging (MR) showing smaller right C5–C6. On the original October 2012 axial T1 enhanced MR study. The right-sided C5-6 intradural extramedullary tumor was clearly visualized extending into the right neural foramen where it markedly compressed the right C6 root and the spinal cord
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496831&req=5

Figure 1: The original October 2012 axial T1 enhanced magnetic resonance imaging (MR) showing smaller right C5–C6. On the original October 2012 axial T1 enhanced MR study. The right-sided C5-6 intradural extramedullary tumor was clearly visualized extending into the right neural foramen where it markedly compressed the right C6 root and the spinal cord
Mentions: The original report of the enhanced MR from 2012 read; small central/right paracentral disc herniation at C4–C5, and moderate size broad based bony ridge at the C5–C6 level causing mild cord compression/moderate bilateral foraminal stenosis. Review of the original enhanced T1 MR study clearly revealed a right-sided uniformly enhancing intradural extramedullary tumor extending from the C5-C6 neural foramen, into the neural foramen and into the spinal canal (7 mm × 8 mm × 11 mm) contributing to marked C6 root and mild/moderate cord compression [Figures 1 and 2].

Bottom Line: A now 54-year-old male had an original enhanced magnetic resonance imaging (MR) scan of the cervical spine performed in 2012 that was read as showing mild spondylotic changes at multiple levels.In 2015, the patient presented with a severe spastic quadriparesis, right greater than left, which had markedly worsened over the prior 3 months.Following a C4-C6 laminectomy, and a challenging tumor removal, and the patient was neurologically intact.

View Article: PubMed Central - PubMed

Affiliation: Department of Neuroscience, Winthrop University Hospital, 200 Old Country Road, Suite 485, Mineola, NY, USA.

ABSTRACT

Background: Many spine surgeons rely on reports of radiological studies for patients seen routinely in consultation. However, "best practice" should include the spine surgeon's individual assessment of the images themselves to better determine whether the diagnoses rendered were/are correct.

Methods: A now 54-year-old male had an original enhanced magnetic resonance imaging (MR) scan of the cervical spine performed in 2012 that was read as showing mild spondylotic changes at multiple levels.

Results: In 2015, the patient presented with a severe spastic quadriparesis, right greater than left, which had markedly worsened over the prior 3 months. Review of the original enhanced MR from 2012 revealed a right-sided C5-C6 tumor (e.g., likely meningioma) filling the right neural foramen with extension into the spinal canal (7 mm × 8 mm × 11 mm): The tumor was originally "missed". The new 2015 enhanced MR scan documented the tumor had enlarged 6.7 fold (measuring 17 mm × 11 mm × 2.2 cm), and now filled 2/3 of the spinal canal, markedly compressing the cord and right C6 nerve root. Following a C4-C6 laminectomy, and a challenging tumor removal, and the patient was neurologically intact.

Conclusion: This case underscores the need for spine surgeons to carefully review both images and reports of prior diagnostic studies that accompany patients. In this case, the original failure to recognize the tumor led to a 2.5-year delay in surgery that resulted in the patient's severe preoperative quadriparesis, and a much more challenging surgery.

No MeSH data available.


Related in: MedlinePlus