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Root compression on MRI compared with clinical findings in patients with recent onset cervical radiculopathy

PainSci » bibliography » Kuijper et al 2011
updated
Tags: diagnosis, neurology, neck, head/neck, spine

One article on PainSci cites Kuijper 2011: The Complete Guide to Neck Pain & Cricks

PainSci commentary on Kuijper 2011: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

There is extensive evidence that the symptoms of radiculopathy correlate poorly with MRI evidence of it, and yet clearly there is a relationship. For this study, the authors provided their best guess which nerve root was compressed in 78 patients based only on symptoms, and compared that to the diagnostic guesses of two neuroradiologists who looked only at MRI findings.

In 73% of patients, the clinical and radiological diagnoses synced up. In 45%, MRI showed a compressed nerve root that was not associated with symptoms, with or without compression of a nerve root that was associated with symptoms. In 10% of patients, for instance, the only nerve root compression visible on MRI were asymptomatic roots. And in 14% — 10 patients — there were no signs of any nerve root compression at all.

The authors concluded:

MRI findings in patients with cervical radiculopathy should be interpreted together with the clinical findings, as false-positive and false-negative MRIs occur rather frequently.

See also Kuijper.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVES: To evaluate the occurrence of symptomatic and asymptomatic root compression caused by herniated discs and spondylotic foraminal stenosis by MRI in patients with recent onset cervical radiculopathy.

PARTICIPANTS: 78 patients with symptoms and signs of cervical radiculopathy of less than one month's duration.

METHODS: The authors determined the clinically suspected level of root compression in each patient. Two neuroradiologists independently evaluated MRIs, blinded for the clinical findings. For each patient, the level of root compression on MRI was compared with the clinically affected level. The authors also examined the cause of compression: herniated disc, spondylotic foraminal stenosis or both.

RESULTS: In 73% of patients, the clinically affected root was compressed on MRI. In 45%, MRI showed root compression without clinical substrate together with, or to a lesser extent without, the coexistence of compression of the clinically affected root. MRIs were assessed as normal in 13-15% of cases, and in 9-10% only asymptomatic roots were compressed. Herniated discs without spondylosis were more often responsible for root compressions only at the clinically affected level and spondylotic foraminal stenosis for multiple root compression including compression of clinically unaffected roots.

CONCLUSION: MRI findings in patients with cervical radiculopathy should be interpreted together with the clinical findings, as false-positive and false-negative MRIs occur rather frequently.

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