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Level of conus medullaris termination in adult population analyzed by kinetic magnetic resonance imaging

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Abstract

Purpose

To investigate the change of conus medullaris termination (CMT) level in neutral, flexion and extension positions and to analyze the effects of age and gender on the CMT level.

Methods

The midline sagittal T2-weighted kinetic magnetic resonance imaging (kMRI) study of 585 patients was retrospectively reviewed to identify the level of CMT. All patients were in an upright position. A straight line perpendicular to the long axis of the cord was drawn from the tip of the cord and then subtended to the adjacent vertebra or disk space. The CMT level was labeled in relation to the upper, middle and lower segments of adjacent vertebra or disk space and assigned values from 0 to 12 [0 = upper third of T12 (T12U), and 12 = upper third of L3 (L3U)]. All parameters were collected for neutral, flexion and extension positions.

Results

The level of CMT had the highest incidence (17.61%) at L1 lower (L1L) in neutral position, 17.44% at L1 upper (L1U) in flexion, and 16.92% at L1 middle (L1M) in extension with no significant differences among three positions (p > 0.05) in weight-bearing status. Moreover, the level of CMT was not correlated with age (p > 0.05). In terms of gender, the level of CMT was lower in women than in men in neutral position, flexion, and extension (p < 0.05). Furthermore, when divided by age in decades, there was a significant difference between females and males in the age group 60–69 years in neutral, flexion and extension position, respectively (p < 0.05).

Conclusions

The level of CMT in the neutral position was in accordance with previous cadaveric and supine-position MRI studies, and it did not change with flexion and extension. Women had lower CMT level than men, especially in the older population. This information can be very valuable when performing spinal anesthesia and spinal punctures.

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Acknowledgements

The study was supported by departmental funds. Authors would like to thank AiM Radiology Medical Group, especially to Yusuf A. Khan, Sameer U. Khan and Aziza Qadir MD for their help on obtaining and uploading kMRI images in the database.

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    Authors and Affiliations

    1. Department of Orthopaedic Surgery, Keck School of Medicine, Elaine Stevely Hoffman Medical Research Center, University of Southern California, HMR 710, 2011 Zonal Ave, Los Angeles, CA, 90033, USA

      An Liu, Kaixiang Yang, Daling Wang, Changqing Li, Zhiwei Ren, Zorica Buser & Jeffrey C. Wang

    2. Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China

      An Liu & Shigui Yan

    3. Department of Orthopedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, 215006, China

      Kaixiang Yang

    4. Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China

      Daling Wang

    5. Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing, 400037, China

      Changqing Li

    6. Department of Orthopaedic Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061, China

      Zhiwei Ren

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    1. An Liu
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    Correspondence to Zorica Buser.

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    Conflict of interest

    None for the current study. Financial disclosures outside of submitted work: Buser Z—Consulting: Xenco Medical, AO Spine; Wang JC—Royalties: Aesculap, Biomet, Amedica, Seaspine, Synthes; Stock Ownership: Fziomed; Private Investments: Promethean Spine, Paradigm spine, Benevenue, NexGen, Vertiflex, electrocore, surgitech, corespine, expanding orthopaedics, osprey, bone biologics, curative biosciences, pearldiver; Board of Directors: North American Spine Society (non-financial, reimbursement for travel for board meetings, courses, etc.), North American Spine Foundation (non-financial), Cervical Spine Research Society (non-financial, reimbursement for travel for board meetings), AO Spine/AO Foundation (honorariums for board position); Fellowship Support: AO Foundation (spine fellowship funding paid to institution).

    Additional information

    A. Liu and K. Yang contributed equally.

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    Liu, A., Yang, K., Wang, D. et al. Level of conus medullaris termination in adult population analyzed by kinetic magnetic resonance imaging. Surg Radiol Anat 39, 759–765 (2017). https://doi.org/10.1007/s00276-017-1813-3

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    • DOI: https://doi.org/10.1007/s00276-017-1813-3

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