Association Between Diaphragmatic Paralysis and Ipsilateral Cervical Spondylosis on MRI
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.
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.
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.
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.
KeywordsDiaphragm Paralysis Phrenic nerve Cervical spondylosis
Informatics for integrating biology and the bedside
Magnetic resonance imaging
Nerve conduction studies
Pulmonary function tests
This study received support from New York-Presbyterian Hospital (NYPH) and Weill Cornell Medical College (WCMC), including the Clinical and Translational Science Center (CTSC) (UL1 TR000457) and Joint Clinical Trials Office (JCTO) who provided access to the i2B2 clinical database search tool and results of the searches performed by SO’B.
SO’B: Conceived study, identified study subjects, collected clinical data, performed data analysis, prepared manuscript. JCH: Reviewed and graded radiology images. JLC: Reviewed and graded radiology images, contributed to preparation manuscript. BTC: Reviewed subject, performed and interpreted EMG and NCS, contributed to manuscript preparation. BDG: Conceived study, identified study subjects, collected clinical data, performed data analysis, prepared manuscript.
This study received support from New York-Presbyterian Hospital and Weill Cornell Medicine, including the Clinical and Translational Science Center (CTSC) (UL1 TR000457) and Joint Clinical Trials Office (JCTO).
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
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