Sarah L O'Beirne1,2, J Levi Chazen3, Joshua Cornman-Homonoff3, Bridget T Carey4, Brian D Gelbman5,6. 1. Division of Pulmonary and Critical Care Medicine, New York Presbyterian Hospital/Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA. sao9016@med.cornell.edu. 2. Department of Genetic Medicine, Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10021, USA. sao9016@med.cornell.edu. 3. Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA. 4. Department of Neurology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA. 5. Division of Pulmonary and Critical Care Medicine, New York Presbyterian Hospital/Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA. 6. Division of Pulmonary and Critical Care Medicine, New York Presbyterian Hospital/Weill Cornell Medicine, 635 Madison Avenue, Suite 1101, New York, NY, 10022, USA.
Abstract
PURPOSE: Diaphragmatic paralysis (DP) is an important cause of dyspnea with many underlying etiologies; however, frequently no cause is identified despite extensive investigation. We hypothesized that cervical spondylosis (CS), as manifest by cervical neuroforaminal stenosis on magnetic resonance imaging (MRI), is an underrecognized cause of unilateral DP. METHODS: A retrospective study was performed assessing cervical spine imaging utilization in the investigation of unilateral DP, and the contribution of CS to its pathogenesis. To assess the relationship between CS and DP, comparison was made between severity of ipsilateral and contralateral foraminal stenosis on cervical spine MRI in individuals with idiopathic DP, and to controls with DP of known etiology. RESULTS: Record searches identified 334 individuals with DP who were classified as idiopathic (n = 101) or DP of known etiology (n = 233). Of those with idiopathic DP, only 37% had undergone cervical spine imaging. Cervical spine MRIs, available for 32 individuals from the total cohort identified (n = 15 idiopathic DP, n = 17 DP of known etiology), were reviewed and severity of CS graded (0-2). In idiopathic DP, CS was significantly more severe (grade 2 stenosis) on the side of DP at C3-C4 (73% affected vs 13% unaffected side; p = 0.031) and C4-C5 (60% affected vs 20% unaffected side; p = 0.0039), while no difference was observed in DP of known etiology. Overall severity of CS across all cervical spine levels was significantly worse in idiopathic DP versus those with DP of known etiology. CONCLUSIONS: In unilateral idiopathic DP, severity of CS is associated with DP laterality and is an underrecognized cause of diaphragmatic dysfunction. We propose that evaluation of 'idiopathic' DP should routinely include cervical spine imaging, preferably by MRI.
PURPOSE: Diaphragmatic paralysis (DP) is an important cause of dyspnea with many underlying etiologies; however, frequently no cause is identified despite extensive investigation. We hypothesized that cervical spondylosis (CS), as manifest by cervical neuroforaminal stenosis on magnetic resonance imaging (MRI), is an underrecognized cause of unilateral DP. METHODS: A retrospective study was performed assessing cervical spine imaging utilization in the investigation of unilateral DP, and the contribution of CS to its pathogenesis. To assess the relationship between CS and DP, comparison was made between severity of ipsilateral and contralateral foraminal stenosis on cervical spine MRI in individuals with idiopathic DP, and to controls with DP of known etiology. RESULTS: Record searches identified 334 individuals with DP who were classified as idiopathic (n = 101) or DP of known etiology (n = 233). Of those with idiopathic DP, only 37% had undergone cervical spine imaging. Cervical spine MRIs, available for 32 individuals from the total cohort identified (n = 15 idiopathic DP, n = 17 DP of known etiology), were reviewed and severity of CS graded (0-2). In idiopathic DP, CS was significantly more severe (grade 2 stenosis) on the side of DP at C3-C4 (73% affected vs 13% unaffected side; p = 0.031) and C4-C5 (60% affected vs 20% unaffected side; p = 0.0039), while no difference was observed in DP of known etiology. Overall severity of CS across all cervical spine levels was significantly worse in idiopathic DP versus those with DP of known etiology. CONCLUSIONS: In unilateral idiopathic DP, severity of CS is associated with DP laterality and is an underrecognized cause of diaphragmatic dysfunction. We propose that evaluation of 'idiopathic' DP should routinely include cervical spine imaging, preferably by MRI.
Authors: Christopher M Bono; Gary Ghiselli; Thomas J Gilbert; D Scott Kreiner; Charles Reitman; Jeffrey T Summers; Jamie L Baisden; John Easa; Robert Fernand; Tim Lamer; Paul G Matz; Daniel J Mazanec; Daniel K Resnick; William O Shaffer; Anil K Sharma; Reuben B Timmons; John F Toton Journal: Spine J Date: 2011-01 Impact factor: 4.166
Authors: M C Buszek; T E Szymke; J C Honet; J A Raikes; H H Gass; W Leuchter; S A Bendix Journal: Arch Phys Med Rehabil Date: 1983-12 Impact factor: 3.966