Title: MRI Signal Intensity Changes in Cervical Spondylotic Myelopathy and Its Role in Assessing the Surgical Prognosis
Authors: Indu Jacob, Abhilash Babu T.G, Alfred Michael, Sajitha K, Nandhini S
DOI: https://dx.doi.org/10.18535/jmscr/v5i9.177
Abstract
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.
References
- Montgomery DM, Browser RS. Cervical myelopathy: clinical syndrome and natural history. Orthop Clin North Am 1992;23:487-493.
- Teresi LM, Lufkin RB, Reicher MA et al. Asymptomatic degenerative dick disease and spondylosis of the cervical spine: MR imaging. Radiology 1987;164(1):83-8.
- Bailey R W, Bagley CE. Stabilization of the cervical spine by anterior fusion. J Bone Joint surg (AM) 1960;42(4):565-594
- McCormack BM, Weinstein PR: cervical spondylosis. An update. West J Med 1996;165(1-2):43-51.
- Clark E, Robinson PK, cervical myelopathy: A complication of cervical spondylosis. Brain 1956;79:483.
- Symon L, Lavender P. The surgical treatment of cervical spondylotic myelopathy. Neurology 1967;17:117-127.
- Scultz KD, McLaughlin MR, Haid RW et al. Single-stage anterior-posterior decomp-ression and stabilisation for complex cervical spine disorders. J Neurosurg. 2000;93 (2 suppl):214-21
- Greenberg’s textbook of Neurosurgery 7th
- Avadhani A et al. Surgical decompression for cervical spondylotic myelopathy: correlation between operative outcomes and MRI of the spinal cord. Orthopedics Journal; Octiber 2004; volume 27. Number 10.
- Aditya Vedantam et al Association of MRI signal changes and outcome prediction after surgery for cervical spondylotic myelopathy J Neurosurg spine 15:660-666, 2011.
- Yasutsugu Yukawa Y, Kato F, Yoshihara H, Yanase M, Ito K, MR T2 image classif-ication in cervical compression yelopathy: prediction of surgical outcomes. Spine (Phila Pa 1976) 2007; 32: 1675-1678