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Association Between Diaphragmatic Paralysis and Ipsilateral Cervical Spondylosis on MRI

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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.

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Abbreviations

CS:

Cervical spondylosis

DP:

Diaphragmatic paralysis

EMG:

Electromyography

i2B2:

Informatics for integrating biology and the bedside

MRI:

Magnetic resonance imaging

NCS:

Nerve conduction studies

PFT:

Pulmonary function tests

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Acknowledgements

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.

Funding

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).

Author information

Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, New York Presbyterian Hospital/Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA

    Sarah L. O’Beirne & Brian D. Gelbman

  2. Department of Genetic Medicine, Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10021, USA

    Sarah L. O’Beirne

  3. Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA

    J. Levi Chazen & Joshua Cornman-Homonoff

  4. Department of Neurology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA

    Bridget T. Carey

  5. Division of Pulmonary and Critical Care Medicine, New York Presbyterian Hospital/Weill Cornell Medicine, 635 Madison Avenue, Suite 1101, New York, NY, 10022, USA

    Brian D. Gelbman

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  1. Sarah L. O’Beirne
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  2. J. Levi Chazen
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Contributions

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.

Corresponding author

Correspondence to Sarah L. O’Beirne.

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Supplemental Figure 1

Consort diagram of the study. Consort diagram of the study showing the total number of subjects identified and screened; numbers included in the study; reasons for study exclusion; causes of diaphragmatic paralysis and investigations performed. Supplemental Figure 2 Severity of cervical foraminal stenosis is idiopathic diaphragmatic paralysis (DP) and DP of known etiology. Proportion of affected/unaffected graphs by each subject group (idiopathic DP, DP of known etiology) and cervical spine level. (A) C2-C3. (B) C3-C4. (C) C4-C5. (D) C5-C6. (E) C6-C7. (F) C7-T1. Side with DP (affected side), side without DP (unaffected side).Supplementary file1 (PPTX 861 kb)

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O’Beirne, S.L., Chazen, J.L., Cornman-Homonoff, J. et al. Association Between Diaphragmatic Paralysis and Ipsilateral Cervical Spondylosis on MRI. Lung 197, 727–733 (2019). https://doi.org/10.1007/s00408-019-00271-y

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  • DOI: https://doi.org/10.1007/s00408-019-00271-y

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