Prevalence of thoracic spine lesions masquerading as cauda equina syndrome: yield of a novel magnetic resonance imaging protocol

• Published in: Internal and emergency medicine 2017-12, Vol.12 (8), p.1259-1264
• Main Authors: Stolper, Katherine, Haug, James Clark, Christensen, Chad Todd, Samsey, Kathleen Michelle, April, Michael David
• Format: Article
• Language: English
• Subjects: Adult; Arthrogryposis - complications; Arthrogryposis - diagnosis; Arthrogryposis - etiology; Cauda Equina Syndrome; Compression; Degeneration; EM - Original; Emergency medical services; Emergency Service, Hospital - organization & administration; Emergency Service, Hospital - statistics & numerical data; Epidural Space - abnormalities; Epidural Space - physiopathology; Evaluation; Female; Hereditary Sensory and Motor Neuropathy - complications; Hereditary Sensory and Motor Neuropathy - diagnosis; Hereditary Sensory and Motor Neuropathy - etiology; Humans; Internal Medicine; Lesions; Low Back Pain - diagnosis; Low Back Pain - etiology; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Myelination; NMR; Nuclear magnetic resonance; Pernicious anemia; Polyradiculopathy - diagnosis; Prevalence; Prospective Studies; Radiology; Resonance; Spinal cord; Spinal Cord Compression; Spine; Spine (lumbar); Spine (thoracic); Surgery; Thoracic Vertebrae - abnormalities; Time Factors
• ISSN: 1828-0447; 1970-9366
• DOI: 10.1007/s11739-016-1565-9

Our objective was to describe the yield of actionable thoracic spine lesions for a novel magnetic resonance imaging (MRI) protocol including evaluation of the thoracic spine among patients presenting to the Emergency Department (ED) with symptoms consistent with epidural compression syndrome. Our ED and Department of Radiology together designed a novel rapid MRI protocol entailing 3D volumetric T2 weighted sequences through both the thoracic and lumbar spine obtained in the sagittal plane to assess for both lumbar and thoracic spine lesions. We recorded study outcomes for all patients undergoing this protocol or conventional lumbar MRI during May 2014–May 2015 to determine the prevalence of actionable thoracic spine lesions. We defined an actionable thoracic lesion as any pathology requiring treatment (e.g., medication, admission, surgery) not otherwise indicated on the basis of lumbar spine findings. During the study period, 112 of 124 (90.3%) of ED patients undergoing MRI evaluation for epidural compression syndrome underwent the novel protocol. The remaining patients underwent evaluation of the lumbar spine using only a conventional MRI protocol. Of the 112 patients undergoing the novel protocol, 6 (5.4%) patients had thoracic spine lesions indicating therapy not otherwise indicated by lumbar spine findings. The etiologies of these six lesions were: neoplasms (2), de-myelination (2), compression fracture (1), and degeneration due to pernicious anemia (1). Emergency providers should strongly consider the routine use of MRI protocols including thoracic spine evaluation in patients presenting to the ED with symptoms consistent with epidural compression syndrome.