Friday 6 January 2012

Cervical Kyphosis and Cord Atrophy

A 19 yo male with progressive weakness and wasting of hands marked on left side.
MRI Cervical spine Sagittal T2 image show:
Reversal of normal cervical lordotic curvature.
Smooth focal cord thinning extending from C5-6 to C6-7 disc levels, at the apex of kyphosis to be specific.
No obvious cord compression.
No marked abnormal intramedullary signals in cord even on axial T2.
Study repeated with deliberate extension; no curvature correction is seen, same wide posterior epidural space.

Imagingwise diagnosis: Cervical kyphosis with an associated focal cervical cord atrophy.

Spinal Kyphosis causes Demyelination and Neuronal Loss in the Spinal Cord.
Studies performed, using a animal models, to demonstrate an association between the histological changes in cord caused by progressive spinal kyphosis. Results have shown a significant correlation between the kyphosis, the degree of kyphosis and cord atrophy.
Histopathogical changes observed are demyelination of the anterior funiculus, neuronal loss and anterior horn atrophy. Demyelination progresses in an order, anterior funiculus affected first, later extending to the lateral and then the posterior funiculus. Changes are marked at the apex of the kyphosis.
These histopathogical changes result from both continuous mechanical compression and vascular changes in the spinal cord as a decrease in vascular distribution is observed marked on ventral side of the compressed spinal cord on Angiography studies.

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