Cervical spondylotic myelopathy due to chronic compression: the role of signal intensity changes in magnetic resonance images

Rota, Juan Jose Fernández de; Meschian, Stephan; Rota, Antonio Fernández de; Urbano, Víctor Manuel Aguilar; Barón, Manuel González

doi:10.3171/spi.2007.6.1.4

Cited by 86 publications

(57 citation statements)

References 21 publications

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“…MR imaging offers an exact morphologic visualization of the stenosis and the cord compression. However, there is no clear correlation between radiologic signs and clinical aspects of cervical myelopathy (3)(4)(5)(6). Patients with severe stenosis and hyperintense signal alterations on T2-weighted MR images can lack any symptoms, and the degree of spinal cord compression correlates neither with the neurologic deficits nor with the recovery after surgical decompression (3)(4)(5)(6).…”

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confidence: 99%

Hypermetabolism in ¹⁸F-FDG PET Predicts Favorable Outcome Following Decompressive Surgery in Patients with Degenerative Cervical Myelopathy

et al. 2013

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The aim of this study was to prospectively assess the regional changes of glucose metabolism of the cervical spinal cord in patients with degenerative cervical spine stenosis and symptomatic cervical myelopathy after decompressive surgery using 18 F-FDG PET. Methods: Twenty patients with symptomatic degenerative monosegmental cervical stenosis with neuroradiologic signs of spinal cord compression underwent decompressive surgery. The clinical course using a functional status score (Japanese Orthopedic Association [JOA] score), 18 F-FDG uptake, and MR imaging were assessed before and at follow-up 12 mo after surgery. Pre-and postoperative changes of 18 F-FDG PET were correlated to the patients' clinical outcome. Results: Ten patients demonstrated preoperatively a focally increased 18 F-FDG uptake at the level of the stenosis. At follow-up, the uptake declined significantly (P 5 0.008), and a significant improvement of JOA scores (P , 0.001) could be observed. The remaining 10 patients were characterized preoperatively by an inconspicuous glucose uptake at the level of cord compression in combination with a poststenotic decrease of 18 F-FDG uptake. At follow-up, both JOA scores and 18 F-FDG uptake changed insignificantly. Conclusion: Focal glucose hypermetabolism at the level of cervical spinal cord compression may predict an improved outcome after surgical decompression. Thus, this finding on 18 F-FDG PET suggests a functional damage in a reversible phase of cervical myelopathy. Compr ession of the cervical spinal cord due to degenerative cervical spine stenosis induces a progressive dysfunction of the myelon with subsequent neurologic deficits (i.e., cervical myelopathy) (1,2). MR imaging offers an exact morphologic visualization of the stenosis and the cord compression. However, there is no clear correlation between radiologic signs and clinical aspects of cervical myelopathy (3-6). Patients with severe stenosis and hyperintense signal alterations on T2-weighted MR images can lack any symptoms, and the degree of spinal cord compression correlates neither with the neurologic deficits nor with the recovery after surgical decompression (3-6). Therefore, mechanical compression of the cervical spinal cord alone seems not to be the essential factor for the development of myelopathy. Other factors such as a compression-induced neuroinflammation have been recently discussed (7-9).Given the limitations of conventional MR imaging in prediction of clinical outcome in patients with cervical myelopathy, 18 F-FDG PET has been used for metabolic assessment of the healthy, noncompressed cervical spinal cord (10-14) as well of the affected spinal cord (13). In a previous publication (15), we reported preliminary results of this prospective study on 18 F-FDG uptake in 20 patients with compression of the cervical spinal cord due to degenerative cervical spine stenosis and cervical myelopathy. In the present work, we report the final results including pre-and postoperative data of MR imaging and 18 F-FDG PET as well as the clinical...

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confidence: 99%

Hypermetabolism in ¹⁸F-FDG PET Predicts Favorable Outcome Following Decompressive Surgery in Patients with Degenerative Cervical Myelopathy

et al. 2013

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“…In a more recent article, Fernandez de Rota and col leagues 8 reported a series of 67 patients with myelopathy who underwent surgery: 43 underwent ACCF, 13 under went ACDF, and 11 underwent laminoplasty. Patients were evaluated at a mean followup of 39 months using mJOA scale scores.…”

Section: Outcome and Spinal Cord Hypointensity On T1-weighted Mr Imagmentioning

confidence: 99%

“…However, singlesegment, preoperative T2 hyperintensity did not predict a poor out come. 8 This study was graded Class III because it was uncertain whether outcome assessment was blinded and whether interrater reliability was performed.…”

Section: Outcome and Spinal Cord Hypointensity On T1-weighted Mr Imagmentioning

confidence: 99%

Preoperative patient selection with magnetic resonance imaging, computed tomography, and electroencephalography: does the test predict outcome after cervical surgery?

Mummaneni

Kaiser

Matz

et al. 2009

SPI

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Object The objective of this systematic review was to use evidence-based medicine to assess whether preoperative imaging or electromyography (EMG) predicts surgical outcomes in patients undergoing cervical surgery. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to the preoperative imaging and EMG. Abstracts were reviewed after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Preoperative MR imaging and CT myelography are successful in confirming clinical radiculopathy (Class II). Multilevel T2 hyperintensity, T1 focal hypointensity combined with T2 focal hyperintensity, and spinal cord atrophy each convey a poor prognosis (Class III). There is conflicting data concerning whether focal T2 hyperintensity or cervical stenosis are associated with a worse outcome. Electromyography has mixed utility in predicting outcome (Class III). Conclusions Magnetic resonance imaging or CT myelography are important for preoperative assessment. Magnetic resonance imaging may be helpful in assessing prognosis, whereas EMG has mixed utility in assessing outcome.

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“…Extensive T2-weighted ISI changes spanning multiple segments predict poor outcomes, 5,10 and regression of the ISI postoperatively appears to herald better neurological recovery.…”

Section: Regression Of T2-weighted Isimentioning

confidence: 99%

“…This disparity between clinical and radiological parameters may be related to factors independent of radiology, such as preoperative functional status, symptom duration, and concurrent lumbar spine or peripheral nerve disease as well as parameters that are difficult to quantify, such as patient motivation and expectation, glycemic control, and nicotine dependence. 2,8,12,23,36 The presence of a T1-weighted hypointensity is probably the single best predictor of outcome on preoperative imaging, 3,6,10,22,32,33 but these changes are relatively uncommon. The exact prognostic relevance of the quality of T2-weighted ISI changes in the absence of T1-weighted changes remains elusive.…”

Section: Prognostic Relevance Of T2-weighted Isimentioning

confidence: 99%

The evolution of T2-weighted intramedullary signal changes following ventral decompressive surgery for cervical spondylotic myelopathy

Sarkar¹,

Turel²,

Jacob

et al. 2014

SPI

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Object T2-weighted intramedullary increased signal intensity (ISI) on MRI in patients with cervical spondylotic myelopathy (CSM) appears to represent a wide spectrum of pathological changes that determine reversibility of cord damage. Although sharp T2-weighted ISI on preoperative imaging may correlate with poorer surgical outcomes, there are limited data on how these changes progress following surgery. In this study, the authors characterized pre-and postoperative ISI changes in patients undergoing surgery for CSM and studied their postoperative evolution in an attempt to quantify their clinical significance. Methods The preoperative and postoperative MR images obtained in 56 patients who underwent oblique cervical corpectomy for CSM were reviewed, and the ISI was classified into 4 subtypes based on margins and intensity: Type 0 (none), Type 1 (“fuzzy”), Type 2 (“sharp”), and Type 3 (“mixed”). The locations of the ISI were further classified as focal if they represented single discrete lesions, multifocal if there were multiple lesions with intervening normal cord, and multisegmental if the lesions were continuous over more than 1 segment. The maximum craniocaudal length of the ISI was measured on each midsagittal MR image. The Nurick grade and Japanese Orthopaedic Association (JOA) score were used to assess clinical status. The mean duration of follow-up was 28 months. Results T2-weighted ISI changes were noted preoperatively in 54 patients (96%). Most preoperative ISI changes were Type 1 (41%) or Type 3 (34%), with a significant trend toward Type 2 (71%) changes at follow-up. Multi-segmental and Type 3 lesions tended to regress significantly after surgery (p = 0.000), reducing to Type 2 changes at follow-up. Clinical outcomes did not correlate with ISI subtype; however, there was a statistically significant trend toward improvement in postoperative Nurick Grade in patients with a > 50% regression in ISI size. In addition, patients with more than 18 months of follow-up showed significant regression in ISI size compared with patients imaged earlier. On logistic regression analysis, preoperative Nurick grade and duration of follow-up were the only significant predictors of postoperative improvement in functional status (OR 4.136, p = 0.003, 95% CI 1.623–10.539 and OR 6.402, p = 0.033, 95% CI 1.165–35.176, respectively). Conclusions There is a distinct group of patients with multisegmental Type 3 intramedullary changes who show remarkable radiological regression after surgery but demonstrate a residual sharp focal ISI at follow-up. A regression of the ISI by > 50% predicts better functional outcomes. Patients with a good preoperative functional status remain the most likely to show improvement, and the improvement continues to occur even at remote follow-up. The clinical relevance of the quality of the T2-weighted ISI changes in patients with CSM remains uncertain; however, postoperative regression of the ISI change is possibly a more important correlate of patient outcome than the quality of the ISI change alone.

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Cervical spondylotic myelopathy due to chronic compression: the role of signal intensity changes in magnetic resonance images

Abstract: Multisegmental high-intensity change on T2-weighted MR imaging is a more sensitive indicator of outcomes than T1-weighted signal changes because of its higher frequency in patients with advanced myelopathy.

Cited by 86 publications

References 21 publications

Hypermetabolism in ¹⁸F-FDG PET Predicts Favorable Outcome Following Decompressive Surgery in Patients with Degenerative Cervical Myelopathy

Hypermetabolism in ¹⁸F-FDG PET Predicts Favorable Outcome Following Decompressive Surgery in Patients with Degenerative Cervical Myelopathy

Preoperative patient selection with magnetic resonance imaging, computed tomography, and electroencephalography: does the test predict outcome after cervical surgery?

The evolution of T2-weighted intramedullary signal changes following ventral decompressive surgery for cervical spondylotic myelopathy

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Cervical spondylotic myelopathy due to chronic compression: the role of signal intensity changes in magnetic resonance images

Abstract: Multisegmental high-intensity change on T2-weighted MR imaging is a more sensitive indicator of outcomes than T1-weighted signal changes because of its higher frequency in patients with advanced myelopathy.

Cited by 86 publications

References 21 publications

Hypermetabolism in 18F-FDG PET Predicts Favorable Outcome Following Decompressive Surgery in Patients with Degenerative Cervical Myelopathy

Hypermetabolism in 18F-FDG PET Predicts Favorable Outcome Following Decompressive Surgery in Patients with Degenerative Cervical Myelopathy

Preoperative patient selection with magnetic resonance imaging, computed tomography, and electroencephalography: does the test predict outcome after cervical surgery?

The evolution of T2-weighted intramedullary signal changes following ventral decompressive surgery for cervical spondylotic myelopathy

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Hypermetabolism in ¹⁸F-FDG PET Predicts Favorable Outcome Following Decompressive Surgery in Patients with Degenerative Cervical Myelopathy

Hypermetabolism in ¹⁸F-FDG PET Predicts Favorable Outcome Following Decompressive Surgery in Patients with Degenerative Cervical Myelopathy