From the Guidelines
Ventral spinal cord flattening is a significant radiological finding that indicates compression of the spinal cord, often due to degenerative changes in the spine, and requires prompt evaluation and treatment to prevent permanent neurological damage. This condition typically occurs in cervical spondylotic myelopathy, where degenerative changes in the spine cause compression of the spinal cord from the front (ventral aspect) 1. The significance of ventral spinal cord flattening lies in its potential to cause myelopathy, which can lead to severe neurological deficits, including paralysis, numbness, and loss of reflexes.
Key points to consider in the evaluation of ventral spinal cord flattening include:
- The presence of degenerative changes in the spine, such as disc herniations, spinal stenosis, and malalignment 1
- The severity of symptoms and neurological deficits, which can range from mild to severe 1
- The need for prompt evaluation and treatment to prevent permanent neurological damage 1
- The use of MRI imaging to evaluate the spinal cord and surrounding structures, including the osseous and soft-tissue structures 1
Treatment options for ventral spinal cord flattening depend on the severity of symptoms and neurological deficits. For mild cases, conservative management including physical therapy, anti-inflammatory medications (such as ibuprofen 400-800mg three times daily or naproxen 500mg twice daily), and activity modification may be sufficient 1. However, moderate to severe cases with progressive neurological symptoms often require surgical intervention, typically anterior cervical discectomy and fusion (ACDF) or laminoplasty to decompress the spinal cord 1. The urgency of treatment increases with symptom severity, as prolonged cord compression can lead to permanent neurological damage 1.
Regular monitoring with neurological examinations and follow-up imaging is crucial to assess for progression of cord compression and to adjust treatment plans as needed 1. In cases where spinal cord ischemia is suspected, diffusion-weighted imaging should be included in the MRI protocol to show signal alteration in the spinal cord earlier after patient symptom onset 1. Additionally, contrast-enhanced imaging is recommended for initial diagnostic evaluation of demyelinating diseases, such as multiple sclerosis and neuromyelitis optica 1.
From the Research
Significance of Ventral Spinal Cord Flattening
- Ventral spinal cord flattening can be caused by various factors, including vertebral artery compression 2 and idiopathic thoracic spinal cord herniation 3.
- This condition can lead to progressive myelopathy or Brown-Séquard syndrome, resulting in significant disability 3.
- Surgical treatment strategies for ventral spinal cord flattening vary, but a novel approach involving ventral dural repair with a collagen matrix graft has shown promising outcomes 3.
- Decompression, denticulotomy, mobilization of the spinal cord, and craniovertebral canal expansion with duraplasty can also be effective in treating ventral spinal cord compression 2.
- The significance of ventral spinal cord flattening highlights the importance of early diagnosis and treatment to prevent further injury and optimize outcomes 4.
Treatment Options
- Decompressive surgery can be beneficial in selected patients with ventral spinal cord compression, particularly those with poor prognostic factors for radiotherapy 5.
- Radiotherapy and corticosteroids are also commonly used treatments for metastatic epidural spinal cord compression, but their effectiveness and adverse effects vary 5.
- Spinal cord stimulation can be an effective tool in alleviating neuropathic pain, and combining it with pharmacological therapy, such as gabapentin or pregabalin, can enhance its effects 6.