title: ACR Appropriateness Criteria Myelopathy.
abstract: Patients presenting with myelopathic symptoms may have a number of causative intradural and extradural etiologies, including disc degenerative diseases, spinal masses, infectious or inflammatory processes, vascular compromise, and vertebral fracture. Patients may present acutely or insidiously and may progress toward long-term paralysis if not treated promptly and effectively. Noncontrast CT is the most appropriate first examination in acute trauma cases to diagnose vertebral fracture as the cause of acute myelopathy. In most nontraumatic cases, MRI is the modality of choice to evaluate the location, severity, and causative etiology of spinal cord myelopathy, and predicts which patients may benefit from surgery. Myelopathy from spinal stenosis and spinal osteoarthritis is best confirmed without MRI intravenous contrast. Many other myelopathic conditions are more easily visualized after contrast administration. Imaging performed should be limited to the appropriate spinal levels, based on history, physical examination, and clinical judgment. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals, and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors.affiliation: Duke University Medical Center, Durham, North Carolina. Electronic address: christopher.roth@duke.edu.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Roth
authors.affiliation: Columbia University Medical Center, New York, New York, American Association of Neurological Surgeons/Congress of Neurological Surgeons.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Angevine
authors.affiliation: Vanderbilt University, Nashville, Tennessee.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Aulino
authors.affiliation: Michigan State University, East Lansing, Michigan.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Berger
authors.affiliation: Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Asim F
authors.initials: AF
authors.lastname: Choudhri
authors.affiliation: Bone, Spine and Hand Surgery, Chartered, Brick, New Jersey, American Academy of Orthopaedic Surgeons.
authors.forename: Ian Blair
authors.initials: IB
authors.lastname: Fries
authors.affiliation: University of California Los Angeles, Los Angeles, California, American Association of Neurological Surgeons/Congress of Neurological Surgeons.
authors.forename: Langston T
authors.initials: LT
authors.lastname: Holly
authors.affiliation: Emory University Hospital, Atlanta, Georgia.
authors.forename: Ayse Tuba Karaqulle
authors.initials: AT
authors.lastname: Kendi
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Marcus M
authors.initials: MM
authors.lastname: Kessler
authors.affiliation: The Ohio State University Wexner Medical Center, Columbus, Ohio.
authors.forename: Claudia F
authors.initials: CF
authors.lastname: Kirsch
authors.affiliation: The Ohio State University Wexner Medical Center, Columbus, Ohio.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Luttrull
authors.affiliation: Dent Neurologic Institute, Amherst, New York, American Academy of Neurology.
authors.forename: Laszlo L
authors.initials: LL
authors.lastname: Mechtler
authors.affiliation: Rush University, Chicago, Illinois, American Association of Neurological Surgeons/Congress of Neurological Surgeons.
authors.forename: John E
authors.initials: JE
authors.lastname: O'Toole
authors.affiliation: Mallinckrodt Institute of Radiology, Saint Louis, Missouri.
authors.forename: Aseem
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Saint Louis University Hospital, Saint Louis, Missouri.
authors.forename: Vilaas S
authors.initials: VS
authors.lastname: Shetty
authors.affiliation: University of Texas at Houston, Houston, Texas.
authors.forename: O Clark
authors.initials: OC
authors.lastname: West
authors.affiliation: University of Cincinnati Medical Center, Cincinnati, Ohio.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Cornelius
authors.affiliation: University of California San Diego Health Center, San Diego, California.
authors.forename: Julie
authors.initials: J
authors.lastname: Bykowski
mesh_terms: D003952:Diagnostic Imaging / Q000592:standards*; D019317:Evidence-Based Medicine; D006801:Humans; D011871:Radiology / Q000592:standards*; D013118:Spinal Cord Diseases / Q000175:diagnosis*
keywords: Appropriateness Criteria; myelopathy; spinal stenosis; spine; vertebral fracture