Background: The association between MRI signal intensity changes and cervical spondylotic myelopathy (CSM) remains controversial. The objectives of the study were to study different patterns of MRI signal intensity changes in CSM, to classify the signal intensity changes before surgery, and to verify whether the classification could reflect clinical features and surgical outcome.

Methods: A total of 110 patients who underwent decompression surgery for cervical spondylotic myelopathy were enrolled in the study. The preoperative MRI of the patients were studied and the pattern of spinal cord signal intensity (SI) changes were classified. Preoperative clinical findings and MRI abnormalities were correlated with outcome using mJOA (modified Japanese Orthopaedic Association) score and recovery rate after surgical intervention before discharge from hospital and in the 3rd month follow up to measure prognostic factors affecting surgery.

Results and Discussion: Majority of the patients (65%) operated for cervical spondylotic myelopathy were having high SI changes in cervical cord on T2WI. Only 16% of the patients showed low SI on T1WI, all of which showed grade 2 high SI on T2WI. Recovery rates were 64.6%, 40%, and 14% in grade 0, grade 1, and grade 2 respectively and 64.3%, 32.4%, and 11% in group A, group B, and group C respectively.

Conclusions: Preoperative MRI signal intensity (SI) changes were correlated with patient age, duration of disease, preoperative and postoperative JOA score, and recovery rate. Preoperative MRI classification based on SI changes on T2Wl as well as MRI classification system that accommodates SI changes on both T1WI and T2WI can be a predictor of surgical outcome.

Keywords: Cervical spondylotic myelopathy; Magnetic Resonance Imaging; Signal intensity changes; Recovery rate.

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Abhilash Babu T.G

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