الفهرس 
CERVICAL SPINE ANATOMYOnly 14 pages are availabe for public view
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Abstract
Although the Kang MRI grading system shows substantial reliability and moderate clinical validity, it needs re-visiting in terms of using only sagittal T2 weighted images. We postulate that the additional use of axial T2 weighted images has an impact on the accurate assessment of CCSS grade, warranting further studies comparing between using sagittal images only and using axial and sagittal images.
Also, grade 2 needs re-defining, as we found it to be broad in categorizing a wide array of patients into a single category. We propose the division of the grade into two sub-categories. Grade 2a; including patients with demonstrable spinal cord deformity at the anterior or posterior aspects of the cord only. And grade 2b; including patients with demonstrable spinal cord deformity at both the anterior and posterior aspects of the cord. However, this need further studies on larger patient cohorts to assess its usefulness.
Clinical correlation needs better assessment using more quantified patients’ symptoms, such as utilizing verified clinical scales of the patients’ neurological symptoms, correlating with neurological signs evaluated by experienced clinicians as well as correlating with electromyographic studies. Which was lacking in our study.
Furthermore, we recommend the evaluation of the CCSS grade and its clinical correlation using MRI done in flexion and extension positions in addition to the usual neutral position, to better reflect the reality of central canal stenosis as it is a process influenced by the positional changes of the cervical spine.