Clinico-Radiological Spectrum of Non-Compressive Myelopathies

Abstract

Objective: To study the etiology and clinico-radiological profile of non-compressive myelopathies. Methods: 40 consecutive admissions of non-compressive myelopathy were studied for clinical and radiological profile. Statistical methods: Descriptive statistics, linear regression and independent t-test using SPSS 20. Results: Age of the studied population ranged from 2 years to 55 years with a median age of 32.35 years and male:female ratio of 2:1. 87.5% of cases had an acute to subacute presentation. Complete cord syndrome was the most common presentation followed by anterior cord syndrome, central cord syndrome and mixed pattern. LETM was seen in nearly two-thirds of cases. Lesions involving more than two-thirds of the cross section of spinal cord were seen in more than 60% of cases, thereby accounting for significant disability at onset. Most of the lesions were hyperintense on T2 and STIR images and isointense on T1 with only 18.91% showing contrast enhancement. Optic neuritis was recorded with an overall prevalence of 28.26%. EDSS at presentation varied among the subgroups with ADEM, NMOSD and LETM form of ITM having EDSS scores of 9.5,8.0 and 7.5 respectively whereas in MS and Non-LETM form of ITM, EDSS score was 4.0 and 2.5 respectively. Conclusion: Demyelinating disorders contribute to nearly 80% cases of non-compressive myelopathies with NMOSD being the most common pathology. CSF cell count, cross-sectional involvement of spinal cord, pattern of myelitis and aquaporin-4 seropositivity were found to be predictive of the severity at onset i.e., EDSS at presentation with the initial 3 factors also showing predictability of EDSS at last visit.