Table 3.

Interpretation of magnetic resonance imaging (MRI) tractography before and after the treatment.

Patient no.	MRI tractography interpretation
	Before	After
80776	Vertebral body fractures were found in D5 and D6 with anterior wedging of D6 with anterior, mildly displaced fragment. Myelomalacic change was seen at D5 and D6 vertebral levels. Stabilization of spine with pedicular screws was noted at D4–D5 and D8–D9. Non-visualization of fibers seen at myelomalacia level (D5–D6) and at caudally placed pedicular screws (D8–D9 level) with intervening cord showing some artefactual distortion at its cranial and caudal extent.	D5 and D6 vertebral body fractures were seen with anterior wedging of D6 with mildly displaced anterior fragment. Spine stabilization with pedicular screws at D4–D5 and D8–D9 were noted. Marked myelomalacic change at D5 and D6 vertebral levels was seen. Non-visualization of fibers seen at myelomalacia level (D5–D6) and at caudally placed pedicular screws (D8–D9 level) with intervening cord showing some artefactual distortion at its cranial and caudal extent.
81027	The evidence of pedicular screw spine stabilization at D11–L1 was found to cause distortion of anatomy including spinal canal from magnetic susceptibility artefacts. Mild anterior wedging of D12 vertebral body was noted. T1/T2 hyper-intense signal in anterior D12 vertebral body suggestive of lipid rest/hemangioma was noted. There was near complete transaction of the spinal cord at D12 level with very thin cord tissue seen adherent to the posterior thecal sac. An intradural anterior adhesion was also observed at upper D12 level. Cranial to this at D10 and D11 vertebral levels centromedullary T2 hypersensitivity in the cord suggested syrinx formation. MR tractography showed marked artefactual distortion and non-visualization of tracts in dorsal cords.	Sagittal T2-weighted MRI near complete transaction of the spinal cord at D12 level with very thin cord tissue seen adherent to the posterior thecal sac. An intradural anterior adhesion was also noted at upper D12 level. Cranial to this at D10 and D11 vertebral levels centromedullary T2 hyper-intensity in the cord suggest syrinx formation. MR tractography showed marked artefactual distortion with patchy interrupted and visualization of tracts in dorsal cords with complete non-visualization at D12 level (level of cord transaction) and at D11 vertebral level. There is an artefactual larger gap between the distal conus and the cauda equina compared to the previous tractography.
81078	Fracture dislocation of the spine at C6–C7 with anterior plate stabilization was seen. Minimal anterior displacement of C6 vertebra with disruption of posterior osteoligamentous complex and partial tear of posterior longitudinal ligament were noted. Changes of cystic myelomalacia were seen at lower C5 to C7–D1. No tracts were seen at C6 and C7 vertebral level.	Non-visualization of white matter tracts in the myelomalacic segment. Significant bridging of the previously non-visualized myelomalacic cord segment by the white matter tracts with only a small gap was found.
81191	There was fracture dislocation of spine at C7–D1 with mild anterior displacement of C7 vertebra with bilateral perched facets. At C7–D1, focal cystic myelomalacia was noted. Fracture of posterior spinous process of C7 and minimal C6 anterior subluxation were seen. Cord thinning at C6–C7 was observed along with T2 hyper-intense signal. Interruption of the cord nerve fibers at C6–C7 to C7–D1 level was suggested by MR tractography.	T2 hyper-intense myelomalacic change was seen in the spinal cord at C6–C7 vertebral levels. Focal cystic myelomalacia was present at C7–D1 level. Interruption of fiber tracts in the cord at the level of myelomalacic change with reduction of fractional anisotropy values to less than 0.150, in the MR tractography. Reduced values were seen extending up to mid dorsal level.
81216	D10–D12 laminectomy and old mild anterior wedge compression D11 vertebral body with mild kyphotic angulation of the spine was noted. Myelomalacic changes and focal thinning was observed at lower D10 level in the spinal cord. Cord contour expansion and linear/irregular gliotic scars on the sides along with D11–D12 disc level cystic myelomalacic changes. Ascending and descending white matter tracts were seen cephalic and caudal to the myelomalacic segments with patchy visualization of tracts along the length of the latter.	MRI tractography suggested no significant interval change in the patchy visualization of along the length of the myelomalacic segments with normal visualization of ascending and descending tracts cranial and caudal to it. Myelomalacic changes was observed at lower D10 level in the spinal cord focal thinning.
80957	On the sagittal T2-weighted images prominent magnetic susceptibility artefacts from fixation screws were noted at D8–D10 and D12–L1 level causing distortion of anatomy. Anterior wedging of D11 vertebral was noted with break in superior endplate. Minimal anterior displacement of D11 vertebral body was seen with marked height reduction of D11–D12 disc. There was mild thecal sac indentation from a mild posterior bulge of this disc.	On the sagittal T2-weighted images prominent magnetic susceptibility artefacts from fixation screws were noted at D8–D10 and D12–L1 level. Anterior wedging of D11 vertebral body with break in superior endplate was noted. Minimal anterior displacement of D11 vertebral body was seen with marked height reduction of D11–D12 disc. There was mild thecal sac indentation from a mild posterior bulge of this disc. Cystic myelomalacia was noted caudal to D9–D10 disc level with marked thinning of the cord caudal to lower D10 vertebral level.
80438	MRI tractography showed comminuted fracture of L1 vertebral body with significantly retro-pulsed poster superior fragment. The spinal canal was capacious at this level, post-laminectomy. Spine stabilization surgery with pedicular screws at D11, D12 and L2, L3 levels was noted with resultant magnetic susceptibility artefacts causing marked distortion of the spinal/canal cord at the level of the cranial screws. However, cystic myelomalacia was discerned at D11 and D12 level. Minimal to mild old anterior wedging of D11 and D12 vertebral bodies was noted. There was complete non-visualization of nerve fibers at D9–L3 at cranial normal cord fibers at D9 and D10 level not demonstrated due to presence of metal at adjoining caudal aspect.	MRI tractography showed comminuted fracture of L1 vertebral body with significantly retro-pulsed posterior superior fragment. The spinal canal was capacious at this level, post laminectomy. Spine stabilization surgery with pedicular screws at D11, D12 and L2, L3 levels was noted with resultant magnetic susceptibility artefacts causing marked distortion of the spinal/canal cord at the level of the cranial screws. However, cystic myelomalacia was discerned at D11 and D12 level. The spinal cord cranial to this level was seen normally. There was complete non-visualization of white matter tracts/nerve roots at D9–L3 levels with cranial normal cord at D9 and D10 level and upper cauda equina not seen due to presence of metal adjoining. There was no significant interval change on comparison with the last MRI tractography.
81107	There was distortion of the anatomy and fiber tracts consequent to pedicular fixation screws. On MRI tractography, ascending and descending white matter tracts were seen cephalic and caudal to the injured cord segment and showed thinning, loss of normal contour and myelomalacic changes (D3–D6). No tracts were seen at the level of cord changes.	There was distortion of the anatomy and fiber tracts consequent to pedicular fixation screws. There was no significant interval change on comparison with the last MRI tractography. The non-visualized upper dorsal segment distorted by metallic implants/screws was as before.
81263	Marked glottic scarring and cystic myelomalacic changes were seen in the cord at D1–D3 level. Caudal to this up to conus medullaris, syrinx formation was present with thin preserved peripheral rim of cord parenchyma. Changes of arachnoiditis were also noted in the dorsal and lumbar spine. Magnetic susceptibility artefacts from the metallic screws caused distortion of the anatomy/spinal canal in the upper dorsal spine. At MRI tractography, there was non-visualization of fiber tracts at the level of injury/surgery and susceptibility artefacts. Caudal to this up to the tip of the conus medullaris there was poor patchy interrupted fiber visualization.	Marked glottic scarring and cystic myelomalacic changes were seen in the cord at D1–D3/D4 level. Caudal to this up to conus medullaris, syrinx formation was present with thin preserved peripheral rim of cord parenchyma. Changes of arachnoiditis were also noted. At MRI tractography, there was non-visualization of fiber tracts at the level of injury/surgery and susceptibility artefacts. Compared to previous report there was no significant interval change.
80836	MRI tractography showed evidence of prior spine stabilization surgery with pedicular screws at D9–L3/L4 and multilevel laminectomies at dorsolumbar junction. There was artefactual distortion of the anatomy from the metallic screws. The cauda equina nerve roots were also not well visualized consequent to artefacts.	MRI tractography provided evidence of prior spine stabilization surgery with pedicular screws at D9–L3/L4 and multilevel laminectomies at dorsolumbar junction. There was marked artefactual distortion of the anatomy from the metallic screws. The cauda equina nerve roots were also not well visualized consequent to artefacts.
81193	There was mild thickening of the posterior longitudinal ligament from C4 to D1–D2 level. Mild broad-based posterocentral-right paracentral disc protrusion was seen at C7–D1 level causing thecal sac indentation with minimal impingement of ventral cord surface. Minimal posterior disc bulge was present at C4–C5 and C3–C4 level. Cystic myelomalacic changes were seen in the spinal cord at upper C6 to C7–D1 disc level. An oblique T2-hypointense linear soft tissue intensity was seen in the myelomalacic segment at C7 level, likely post traumatic glial scarring with hemosiderin deposition. Mild centro-medullary T2-hyperintensity was seen at D1–D2. MRI tractography showed artefactual distortion at C6, C7 level with interrupted visualization of nerve fibers/tracts in anterior third. Compared to the previous tractography, there was better visualization of fibers at C6–C7 levels.	There was mild thickening of the posterior longitudinal ligament from C4 to D1–D2 level. Mild broad-based posterocentral-right paracentral disc protrusion was seen at C7–D1 level causing indentation of the thecal sac. Minimal posterior disc bulge was present at C4–C5 and C3–C4 level. Cystic myelomalacic changes were seen in the spinal cord at upper C6 to C7–D1 disc level. An oblique T2-hypointense linear soft tissue intensity was seen in the myelomalacic segment at C7 level suggestive of post-traumatic hemosiderin stained glial scarring. MRI tractography shows artefactual distortion at C6, C7 level with interrupted visualization of nerve fibers/tracts. No continuous bridging of the cranial and caudal ends of the normal cord was seen. Compared to the previous tractography, artefactual distortion was more pronounced. No evident interval change was otherwise discerned.
81160	Mild kyphotic angulation was observed along with the partial collapse with anterior wedging and fusion of D5 and D6 vertebral bodies. Laminectomy was seen at D4, D5 and D6 with small pseudomeningocele at D4–D5 level. Occurrence of myelomalacia was showed by thinning at lower D2 to D6–D7 disc level with abnormal T2 hypersensitivity parenchymal signal. While at MRI tractography level, no white matter tracts/fibers at the level of myelomalacia. Milder cord thinning is present cranially up to C7 level while mild cord expansion was seen at D8–D9 vertebral level with diffused intramedullary T2 hyper intensity.	At MRI tractography, significantly smaller non-visualized cord segment was seen. Mild expansion at D8–D9 vertebral level with diffuse intramedullary T2-hyperintensity was present.
80754	D11–L1 vertebral body fractures with kyphotic angulation were seen. D9 and D11 had artefacts from pedicle screws on left side. Marked myelomalacia caudal to D9/D10 disc level were seen with abrupt cut-off of fibers in spinal cord caudal to their level up to distal conus level as shown by MRI tractography. Intervening segment had interrupted minimal visualization of cord fibers in caudal two-thirds. Focal posterior adhesion of spinal cord was noted proximal to the level of cut-off.	Marked anterior wedge compression of D12 vertebral body and mildly so of D11 body with normal marrow signal was observed. Significant kyphotic angulation of spine was seen. D12–L1 had bone formation at their anterior side along with their fusion. D11–D12 had irregularity of endplates with marked reduction of intervening disc height. Mild reduction of D12–L1 disc height was noted along with wide laminectomy at their level. Pedicular screw artefacts were seen at D9 and D11 levels. Gliotic scarring of the spinal cord at D11–D12 level with post-traumatic syrinx formation cranial to it up to lower D9 level. The spinal cord appears posteriorly adherent to the thecal sac. Non-visualization of cord fibers at D9–D10 and D11–D12 was shown in MRI tractography. FA values cranial to D8.
81289	Sagittal screening of the spine showed marked atrophy of the dorsal cord from D6–D7 disc to lower D11 vertebral body level with normal parenchymal signal. Rest of the spinal cord cranially up to cervicomedullary junction and caudally at D12 level was normal in size, outline and parenchymal signal. The nerve roots of cauda equine were unremarkable. Mild posterocentral-right paracentral disc protrusion was seen at L1–L2 level causing thecal sac indentation. At MRI tractography, there was non-visualization of fiber tracts in the atrophied cord segment with fraction anisotropy values cranial to this segment showing no significant interval change compared to the last tractography. In the atrophied segment values were inconsistent.	Sagittal T2 images of the spine showed marked atrophy of the dorsal cord from D6–D7 disc to lower D11 vertebral body level. The parenchymal signal was normal in the affected segment. Rest of the spinal cord cranially up to cervicomedullary junction and caudally at D12 level was normal in size, outline and parenchymal signal. At MRI tractography, there was non-visualization of fiber tracts in the atrophied cord segment with fraction anisotropy values cranial to this segment showed no significant interval change compared to the last tractography. In the atrophied segment the values were markedly reduced as before.
80985	It showed an evidence of anterior plate and screw fixation of the cervical spine from C3–C7. There was cervical straightening of cervical lordosis. Rightward rotation of the cervical vertebrae was noted with bony fusion of C4–C6 vertebral bodies on the right side. Right ventral thecal sac indentation was noted at these levels. There was marked thinning with deformity of the spinal cord at lower C4 to mid C6 vertebral level with T2-hyperintense myelomalacia cranially at mid-upper C4 level. MRI tractography showed interrupted visualization of the white matter fibers at lower C4–C6 levels with lower segments of discontinuity.	On the sagittal T2 weighted images anterior plate and screw fixation of the cervical spine was noted from C3–C7. There was straightening of cervical lordosis. Right ward rotation of the cervical vertebrae was noted with bony fusion of C4–C6 vertebral bodies on the right side with right ventral thecal sac indentation at these levels. There was marked thinning with deformity of the spinal cord at lower C4 to mid C6 level with T2-hyperintense myelomalacia cranially at mid-upper C4 level. MRI tractography shows interrupted visualization of the white matter fibers at lower C4–C6 levels. Compared to previously there is no significant interval change.

MRI: magnetic resonance imaging.