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I recently reached a significant spinal cavernous malformation milestone: #100 resected microsurgically. These are the most common vascular malformation in my practice & teach so much about zones of entry into cord tissue, safe resection techniques, and handling of cord tracts…

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Have disagreements between radiologists on the degree of cervical canal stenosis become a pain in the neck? This month’s AJNR SCANtastic has the latest about Cspine MRI! In the Cspine, we need to think about canal stenosis & the cord. No matter the degree of stenosis, if the cord isn’t happy, the patient won’t be either Here’s how to grade canal stenosis & cord flattening: CANAL STENOSIS Cord swims in CSF, like a fish in water. Like a fish, it needs room to swim. How much room is in the fish bowl determines stenosis 🔸Mild stenosis = fish bowl decorations take up 1 side of the bowl. Not great, but fish can still swim. Either ventral or dorsal CSF is effaced, but the other side of the fish bowl is still empty 🔸Moderate = decorations take up both sides—swimming is very affected. Both ventral and dorsal CSF have been effaced. 🔸Severe = all out w/decorations & there’s no more room for the fish. No room for the cord & it is compressed. CORD FLATTENING It’s like a fight. Cord deformity w/o signal is like someone pushing you to start a fight---you can still walk away. Cord deformity w/signal is a punch to the face—it’s on! 🔸Grade 1: no flattening (just words exchanged, no punches) 🔸Grade 2: flattening but no cord signal (you have been pushed but not bruised, can walk away) 🔸Grade 3: flattening w/cord signal (you have been punched & have a bruise, so you must fight) In this month’s AJNR, Koo et al. found that using a deep learning algorithm produced images in half the time—and the images were non-inferior for evaluation of degenerative chages & canal stenosis Now you know the grading of canal stenosis & cord flattening, for both normal & fast AI imaging! Hopefully, you’ll take to these rating systems like a fish to water!!

Lea Alhilali, MD

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