title: Spinal surgeons need to read patients' studies to avoid missing pathology.
abstract: BACKGROUND
  Many spine surgeons rely on reports of radiological studies for patients seen routinely in consultation. However, "best practice" should include the spine surgeon's individual assessment of the images themselves to better determine whether the diagnoses rendered were/are correct.
  
  
  METHODS
  A now 54-year-old male had an original enhanced magnetic resonance imaging (MR) scan of the cervical spine performed in 2012 that was read as showing mild spondylotic changes at multiple levels.
  
  
  RESULTS
  In 2015, the patient presented with a severe spastic quadriparesis, right greater than left, which had markedly worsened over the prior 3 months. Review of the original enhanced MR from 2012 revealed a right-sided C5-C6 tumor (e.g., likely meningioma) filling the right neural foramen with extension into the spinal canal (7 mm × 8 mm × 11 mm): The tumor was originally "missed". The new 2015 enhanced MR scan documented the tumor had enlarged 6.7 fold (measuring 17 mm × 11 mm × 2.2 cm), and now filled 2/3 of the spinal canal, markedly compressing the cord and right C6 nerve root. Following a C4-C6 laminectomy, and a challenging tumor removal, and the patient was neurologically intact.
  
  
  CONCLUSIONS
  This case underscores the need for spine surgeons to carefully review both images and reports of prior diagnostic studies that accompany patients. In this case, the original failure to recognize the tumor led to a 2.5-year delay in surgery that resulted in the patient's severe preoperative quadriparesis, and a much more challenging surgery.
authors.affiliation: Department of Neuroscience, Winthrop University Hospital, 200 Old Country Road, Suite 485, Mineola, NY, USA.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Epstein
authors.affiliation: Department of Neuroscience, Winthrop University Hospital, 200 Old Country Road, Suite 485, Mineola, NY, USA.
authors.forename: Renee D
authors.initials: RD
authors.lastname: Hollingsworth
authors.affiliation: Department of Radilogy, New York University, Langone Medical Center, New York, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Silvergleid
keywords: Computed tomography; enhanced magnetic resonance imaging; magnetic resonance imaging; meningioma; quadriparesis; radiology; read studies; spinal surgery; surgeon