Diffusion Tensor (Magnetic Resonance) Imaging and Tractography in Herniation of the Cervical Spine

Conventional MRI (magnetic resonance imaging) is used to confirm disc herniation of the
cervical spine. Symptoms of the condition can change before they can be seen by conventional
MR images. Therefore, very little gross change can be seen by conventional MRI even after 6
weeks of treatment, either medical or surgical. This study will investigate whether newer
MRI techniques, diffusion tensor imaging (DTI) and tractography, are useful in demonstrating
gross changes or assessing response to treatment.

Consenting patients referred for clinically indicated cervical spine MRI by their treating
physicians to confirm cervical disc herniation will receive an additional MRI sequence,
diffusion tensor imaging. This will provide a baseline. The DTI sequence will add five
minutes to the procedure. Participants will return at 6 weeks for a follow up MRI of the
cervical spine to include DTI and tractography. Participants will be asked to complete an
anonymized questionnaire at enrollment and at follow up to provide information regarding
their condition.

MRI is a non-invasive diagnostic study of minimal risk which uses magnets instead of
ionizing radiation to acquire images. The images are then assembled by computer. Diffusion
tensor imaging (DTI) uses water diffusion to visualize structures in the brain and nervous
system. Tractography is performed using DTI and computer post-processing to track the fiber
bundles which exist in the brain and spinal cord and visualize them as two and three
dimensional images. Both techniques allow radiologists to detect abnormalities, in this
case, cervical spine disc herniation.

The follow up studies will be compared to the baseline studies to determine which
demonstrates the highest sensitivity and specificity in identifying cervical spine
abnormalities in general and cervical spine herniation in particular.

Inclusion Criteria:

- Patients suspected of having cervical spine herniation.

Exclusion Criteria:

- Patients not suspected of having cervical spine herniation.

- Patients in which MRI is contraindicated (patients with embedded metallic objects,
including pacemakers, surgical clips, spinal cord stimulators, or prosthetic heart
valves.)

- Patients requiring general anesthesia or conscious sedation--sedation would increase
risk to participants.