Preliminary Diagnosis: Cervical Spondylosis
I. What imaging technique is first-line for this diagnosis?
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Plain radiography of the cervical spin
II. Describe the advantages and disadvantages of this technique for diagnosis of cervical spondylosis.
Advantages
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Easily available
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Quickly performed
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Relatively inexpensive compared with other modalities
Disadvantages
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Exposure to a small amount of ionizing radiation
III. What are the contraindications for the first-line imaging technique?
No specific contraindications to plain radiography exist.
IV. What alternative imaging techniques are available?
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Noncontrast extradural protocol MRI of the cervical spine in patients without a history of prior neck surgery and with radicular symptoms
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In patients with prior neck surgery, one should obtain a contrasted extradural protocol MRI of the cervical spine.
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CT myelography
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of cervical spondylosis.
MRI of the cervical spine
Advantages
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The patient is not exposed to ionizing radiation.
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Contrast MR examinations are able to differentiate granulation tissue from recurrent disc.
Disadvantages
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Time consuming
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Requires significant patient cooperation to minimize artifact
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Expensive
CT myelography
Advantages
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May be performed in patients with non-MR-compatible hardware
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May be performed much faster than MR exams
Disadvantages
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Exposes the patient to ionizing radiation.
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Invasive procedure
VI. What are the contraindications for the alternative imaging techniques?
MRI of the cervical spine
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Patients who contain non-MR-compatible hardware
CT myelography
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Patients allergic to iodinated contrast
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Patients with significant renal failure
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Relative contraindication in pregnancy
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Contraindication in hypocoagulable patients (platelets <50,000, INR >2.0)
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