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Evaluation of decision criteria for detection of spinal cord compression based on cervical myelography in horses: 38 cases (1981–2001)

Reasons for performing study: Different criteria have been described based on height reduction of the total myelographic contrast column and components of it as tests for compression of the spinal cord due to cervical stenotic myelopathy (CSM). Fifty percent height reduction of the dorsal myelograph...

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Published in:Equine veterinary journal 2004, Vol.36 (1), p.14-20
Main Authors: Biervliet, J. van, Scrivani, P.V, Divers, T.J, Erb, H.N, Lahunta, A. de, Nixon, A
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description Reasons for performing study: Different criteria have been described based on height reduction of the total myelographic contrast column and components of it as tests for compression of the spinal cord due to cervical stenotic myelopathy (CSM). Fifty percent height reduction of the dorsal myelographic column (DMC),
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Fifty percent height reduction of the dorsal myelographic column (DMC), &lt;2 mm empiric height of the DMC and a 40% reduction of the ratio of stenosis calculated based on the height reduction of the entire dural diameter (DD) have been described as decision criteria for considering the test result positive. The reasons for selecting these decision criteria or their accuracies have rarely been reported. Objectives: To evaluate the accuracy of diagnostic criteria based on reduced height of the total myelographic column and components of it for diagnosing extradural spinal cord compression using different decision criteria, and make recommendations for consistent myelographic interpretation in horses suspected of having CSM. Methods: Four measurements were obtained by 2 readers in a retrospective sample population of 38 horses in which both cervical myelography and histopathological examination of the cervical spinal cord were performed. The prevalence of CSM in the sample was 50%. At intervertebral sites, the minimum heights of the DD and DMC were measured. At intravertebral sites, the maximum heights of the entire DD and DMC were obtained. Percent height reductions of the DMC and DD were determined as the ratio of minimum intervertebral height to maximum intravertebral height within the next cranial vertebra. Histological examination was used as the gold standard for determining the actual site of spinal cord compression. Sensitivity and specificity for the diagnostic criteria were estimated at each site in neutral and flexed neck positions using several different decision criteria. Conclusions: At C6-C7, in neutral or flexed neck position and using 20% reduction of DD, the test was highly sensitive and specific for CSM. At other sites, reduced height of the myelographic column generally was not accurate for diagnosing extradural spinal cord compression. Using 20% reduction of DD in neutral position at the mid-cervical sites, the test had only low sensitivity and high specificity. Flexion of the neck appeared to increase detection of spinal cord compression in the mid-cervical region, but also substantially increased the frequency of false-positive diagnoses. Potential relevance: By using the reported sensitivity and specificity estimates, readers may decide on a decision criterion for diagnosis of extradural spinal cord compression due to CSM. However, in planning a surgical correction, it is difficult to define a decision criterion that combines acceptable sensitivity and specificity, especially at the mid-cervical sites.</description><identifier>ISSN: 0425-1644</identifier><identifier>EISSN: 2042-3306</identifier><identifier>DOI: 10.2746/0425164044864642</identifier><identifier>PMID: 14756366</identifier><language>eng</language><publisher>Oxford, UK: British Equine Veterinary Association</publisher><subject>Animals ; Body Height ; cervial stenotic myelopathy ; Cervical Vertebrae - pathology ; Diagnosis, Differential ; diagnostic specificity ; dorsal myelographic column ; dural diameter ; histopathology ; horse ; Horse Diseases - diagnostic imaging ; Horse Diseases - etiology ; Horse Diseases - pathology ; Horses ; myelography ; Myelography - methods ; Myelography - veterinary ; neck ; planning ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity ; spinal cord ; spinal cord compression ; Spinal Cord Compression - diagnostic imaging ; Spinal Cord Compression - etiology ; Spinal Cord Compression - pathology ; Spinal Cord Compression - veterinary ; Spinal Stenosis - complications ; Spinal Stenosis - diagnostic imaging ; Spinal Stenosis - veterinary ; vertebrae</subject><ispartof>Equine veterinary journal, 2004, Vol.36 (1), p.14-20</ispartof><rights>2004 EVJ Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4674-afac6eb24f8c8e01dc6cf9cc684bb72453c19e2e35f3040cb21256362d21ce6a3</citedby><cites>FETCH-LOGICAL-c4674-afac6eb24f8c8e01dc6cf9cc684bb72453c19e2e35f3040cb21256362d21ce6a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,4024,27923,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/14756366$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Biervliet, J. van</creatorcontrib><creatorcontrib>Scrivani, P.V</creatorcontrib><creatorcontrib>Divers, T.J</creatorcontrib><creatorcontrib>Erb, H.N</creatorcontrib><creatorcontrib>Lahunta, A. de</creatorcontrib><creatorcontrib>Nixon, A</creatorcontrib><title>Evaluation of decision criteria for detection of spinal cord compression based on cervical myelography in horses: 38 cases (1981–2001)</title><title>Equine veterinary journal</title><addtitle>Equine Vet J</addtitle><description>Reasons for performing study: Different criteria have been described based on height reduction of the total myelographic contrast column and components of it as tests for compression of the spinal cord due to cervical stenotic myelopathy (CSM). Fifty percent height reduction of the dorsal myelographic column (DMC), &lt;2 mm empiric height of the DMC and a 40% reduction of the ratio of stenosis calculated based on the height reduction of the entire dural diameter (DD) have been described as decision criteria for considering the test result positive. The reasons for selecting these decision criteria or their accuracies have rarely been reported. Objectives: To evaluate the accuracy of diagnostic criteria based on reduced height of the total myelographic column and components of it for diagnosing extradural spinal cord compression using different decision criteria, and make recommendations for consistent myelographic interpretation in horses suspected of having CSM. Methods: Four measurements were obtained by 2 readers in a retrospective sample population of 38 horses in which both cervical myelography and histopathological examination of the cervical spinal cord were performed. The prevalence of CSM in the sample was 50%. At intervertebral sites, the minimum heights of the DD and DMC were measured. At intravertebral sites, the maximum heights of the entire DD and DMC were obtained. Percent height reductions of the DMC and DD were determined as the ratio of minimum intervertebral height to maximum intravertebral height within the next cranial vertebra. Histological examination was used as the gold standard for determining the actual site of spinal cord compression. Sensitivity and specificity for the diagnostic criteria were estimated at each site in neutral and flexed neck positions using several different decision criteria. Conclusions: At C6-C7, in neutral or flexed neck position and using 20% reduction of DD, the test was highly sensitive and specific for CSM. At other sites, reduced height of the myelographic column generally was not accurate for diagnosing extradural spinal cord compression. Using 20% reduction of DD in neutral position at the mid-cervical sites, the test had only low sensitivity and high specificity. Flexion of the neck appeared to increase detection of spinal cord compression in the mid-cervical region, but also substantially increased the frequency of false-positive diagnoses. Potential relevance: By using the reported sensitivity and specificity estimates, readers may decide on a decision criterion for diagnosis of extradural spinal cord compression due to CSM. However, in planning a surgical correction, it is difficult to define a decision criterion that combines acceptable sensitivity and specificity, especially at the mid-cervical sites.</description><subject>Animals</subject><subject>Body Height</subject><subject>cervial stenotic myelopathy</subject><subject>Cervical Vertebrae - pathology</subject><subject>Diagnosis, Differential</subject><subject>diagnostic specificity</subject><subject>dorsal myelographic column</subject><subject>dural diameter</subject><subject>histopathology</subject><subject>horse</subject><subject>Horse Diseases - diagnostic imaging</subject><subject>Horse Diseases - etiology</subject><subject>Horse Diseases - pathology</subject><subject>Horses</subject><subject>myelography</subject><subject>Myelography - methods</subject><subject>Myelography - veterinary</subject><subject>neck</subject><subject>planning</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Sensitivity and Specificity</subject><subject>spinal cord</subject><subject>spinal cord compression</subject><subject>Spinal Cord Compression - diagnostic imaging</subject><subject>Spinal Cord Compression - etiology</subject><subject>Spinal Cord Compression - pathology</subject><subject>Spinal Cord Compression - veterinary</subject><subject>Spinal Stenosis - complications</subject><subject>Spinal Stenosis - diagnostic imaging</subject><subject>Spinal Stenosis - veterinary</subject><subject>vertebrae</subject><issn>0425-1644</issn><issn>2042-3306</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><recordid>eNqFkL2O1DAURi0EYoeFngpcISgC_rl2MtuhZdgBLVCwC6XlODe7hmQc7MzCdJT0vCFPgkMGkGhobOvecz7JHyF3OXssStBPGAjFNTCASoMGcY0sRJ4VUjJ9nSymdZH3cEBupfSBMSkFiJvkgEOptNR6Qb6trmy3taMPGxpa2qDzaXq76EeM3tI2xDwd0f1G0uA3tqMuxCYf_RAx_TJqm7Chk4rxyruM9DvswkW0w-WO-g29DDFhOqKyoi6ziT7ky4r_-PpdMMYf3SY3WtslvLO_D8n589XZ8bo4fXPy4vjpaeFAl1DY1jqNtYC2chUy3jjt2qVzuoK6LgUo6fgSBUrVSgbM1YKL6auiEdyhtvKQPJhzhxg-bTGNpvfJYdfZDYZtMhXjkklgGWQz6GJIKWJrhuh7G3eGMzO1b_5tPyv39tnbusfmr7CvOwNyBj77Dnf_DTSrdy8ryFYxWz6N-OWPZeNHo0tZKvP-9YlZn71aPwMFhmf-_sy3Nhh7EX0y528F4yr3rEAJLX8CooCnDA</recordid><startdate>2004</startdate><enddate>2004</enddate><creator>Biervliet, J. van</creator><creator>Scrivani, P.V</creator><creator>Divers, T.J</creator><creator>Erb, H.N</creator><creator>Lahunta, A. de</creator><creator>Nixon, A</creator><general>British Equine Veterinary Association</general><general>Blackwell Publishing Ltd</general><scope>FBQ</scope><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>2004</creationdate><title>Evaluation of decision criteria for detection of spinal cord compression based on cervical myelography in horses: 38 cases (1981–2001)</title><author>Biervliet, J. van ; 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Fifty percent height reduction of the dorsal myelographic column (DMC), &lt;2 mm empiric height of the DMC and a 40% reduction of the ratio of stenosis calculated based on the height reduction of the entire dural diameter (DD) have been described as decision criteria for considering the test result positive. The reasons for selecting these decision criteria or their accuracies have rarely been reported. Objectives: To evaluate the accuracy of diagnostic criteria based on reduced height of the total myelographic column and components of it for diagnosing extradural spinal cord compression using different decision criteria, and make recommendations for consistent myelographic interpretation in horses suspected of having CSM. Methods: Four measurements were obtained by 2 readers in a retrospective sample population of 38 horses in which both cervical myelography and histopathological examination of the cervical spinal cord were performed. The prevalence of CSM in the sample was 50%. At intervertebral sites, the minimum heights of the DD and DMC were measured. At intravertebral sites, the maximum heights of the entire DD and DMC were obtained. Percent height reductions of the DMC and DD were determined as the ratio of minimum intervertebral height to maximum intravertebral height within the next cranial vertebra. Histological examination was used as the gold standard for determining the actual site of spinal cord compression. Sensitivity and specificity for the diagnostic criteria were estimated at each site in neutral and flexed neck positions using several different decision criteria. Conclusions: At C6-C7, in neutral or flexed neck position and using 20% reduction of DD, the test was highly sensitive and specific for CSM. At other sites, reduced height of the myelographic column generally was not accurate for diagnosing extradural spinal cord compression. Using 20% reduction of DD in neutral position at the mid-cervical sites, the test had only low sensitivity and high specificity. Flexion of the neck appeared to increase detection of spinal cord compression in the mid-cervical region, but also substantially increased the frequency of false-positive diagnoses. Potential relevance: By using the reported sensitivity and specificity estimates, readers may decide on a decision criterion for diagnosis of extradural spinal cord compression due to CSM. However, in planning a surgical correction, it is difficult to define a decision criterion that combines acceptable sensitivity and specificity, especially at the mid-cervical sites.</abstract><cop>Oxford, UK</cop><pub>British Equine Veterinary Association</pub><pmid>14756366</pmid><doi>10.2746/0425164044864642</doi><tpages>7</tpages></addata></record>
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source Wiley-Blackwell Read & Publish Collection
subjects Animals
Body Height
cervial stenotic myelopathy
Cervical Vertebrae - pathology
Diagnosis, Differential
diagnostic specificity
dorsal myelographic column
dural diameter
histopathology
horse
Horse Diseases - diagnostic imaging
Horse Diseases - etiology
Horse Diseases - pathology
Horses
myelography
Myelography - methods
Myelography - veterinary
neck
planning
Reproducibility of Results
Retrospective Studies
Sensitivity and Specificity
spinal cord
spinal cord compression
Spinal Cord Compression - diagnostic imaging
Spinal Cord Compression - etiology
Spinal Cord Compression - pathology
Spinal Cord Compression - veterinary
Spinal Stenosis - complications
Spinal Stenosis - diagnostic imaging
Spinal Stenosis - veterinary
vertebrae
title Evaluation of decision criteria for detection of spinal cord compression based on cervical myelography in horses: 38 cases (1981–2001)
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