Correlation Between Operative Outcomes of Cervical Compression Myelopathy and MRI of the Spinal Cord

Morio, Yasuo; Teshima, Ryota; Nagashima, Hideki; Nawata, Kouji; Yamasaki, Daisuke; Nanjo, Yoshirou

doi:10.1097/00007632-200106010-00012

Cited by 243 publications

(148 citation statements)

References 29 publications

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“…4 Correlation of SI with spinal cord compression There were researches suggesting that axial sections based on T2-weighted MRI parameters were more reliable in assessing the degree of cervical spinal cord compression than T1-weighted sequences, and TA was reliable and versatile in assessing spinal cord compression. 5 Consistent with consensus that most studies have reported, 8 data from our study support the fact that TA closely correlates with baseline JOA score and surgical outcome. Trying to correlate TA and GSI on MRI, one would expect TA to be larger in patients with lower GSI on MRI.…”

Section: Discusionsupporting

confidence: 91%

“…MRI can show not only the etiology of myelopathy but also the intramedullary state of the spinal cord in detail, 6,7 thereby helping in both the diagnosis and prognosis of CSM. 8,9 To date, postoperative MRI has not yet been fully studied in relation to the correlation of morphology or signal change of cervical cord and longer-term prognosis in CSM patients. In our study, we have focused on quantitative analysis of signal intensity (SI) and transverse area (TA) of the spinal cord on T2-weighted MRI preoperatively and postoperatively.…”

Section: Introductionmentioning

confidence: 99%

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Quantitative magnetic resonance imaging analysis correlates with surgical outcome of cervical spondylotic myelopathy

Wang

et al. 2014

Spinal Cord

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Study design: Prospective study. Objectives: To investigate whether preoperative and postoperative changes of signal intensity (SI) and transverse area (TA) of the spinal cord reflect the surgical outcome in patients with cervical spondylotic myelopathy (CSM). Setting: The Second Hospital of Tangshan, Tangshan, Hebei, China. Methods: In 45 consecutive prospective patients, magnetic resonance imaging (MRI) was performed preoperatively and 3 months postoperatively. The Japanese Orthopedic Association (JOA) scale was used to quantify the neurological status at admission and of at least 12-month follow-up. Preoperative and postoperative TA of the spinal cord at the site of maximal compression and grayscale of signal intensity (GSI) were measured using the image analysis software. Ratio of transverse area (RTA) and ratio of grayscale of signal intensity (RGSI) were used to assess the extent of spinal cord re-expansion and extent of SI regression. Preoperative status and postoperative recovery were assessed in relation to MRI parameters preoperatively and postoperatively using univariate and multivariate analysis. Results: Higher baseline JOA scores were associated with larger TA. Greater recovery rate was associated with larger preoperative and postoperative TA, along with greater RTA. Recovery rate negatively correlated with RGSI and age. Higher baseline JOA score was associated with greater recovery rate. RGSI negatively correlated with RTA. Multivariate stepwise regression analysis showed that the optimal combination of surgical outcome predictors included age, postoperative TA and RGSI. 1 The natural history of CSM is progressive neurological deterioration in the majority of patients. The surgical intervention have been advocated to alter the natural history and improve the prognosis of patients with CSM. How to predict neurological outcomes after surgery is of great importance for the management of CSM patients. Various factors that may influence the surgical outcome include the patient's age, duration of myelopathic symptoms, baseline neurological status, preoperative signal changes on magnetic resonance images and TA of the spinal cord. [2][3][4][5] There is no doubt that magnetic resonance imaging (MRI) is the best radiological modality for examination and evaluation of patients with CSM. MRI can show not only the etiology of myelopathy but also the intramedullary state of the spinal cord in detail, 6,7 thereby helping in both the diagnosis and prognosis of CSM. 8,9 To date, postoperative MRI has not yet been fully studied in relation to the correlation of morphology or signal change of cervical cord and longer-term prognosis in CSM patients. In our study, we have focused on quantitative analysis of signal intensity (SI) and transverse area (TA) of the spinal cord on T2-weighted MRI preoperatively and postoperatively. The purpose of the present study was to investigate

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Section: Discusionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Quantitative magnetic resonance imaging analysis correlates with surgical outcome of cervical spondylotic myelopathy

Wang

et al. 2014

Spinal Cord

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“…The involved level of the spinal cord was determined using magnetic resonance imaging (MRI) by ascertaining signal intensity changes [18]. If the spinal cord showed signal intensity changes at more than one level, the level showing the most severe compression of the spinal cord was identified as the involved level.…”

Section: Methodsmentioning

confidence: 99%

Clinical features and surgical outcomes of cervical spondylotic myelopathy in patients aged 80 years or older: a multi-center retrospective study

et al. 2011

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With the aging of the population in developed countries, spine surgeons have recently been more likely to encounter elderly patients in need of treatment. This study investigated whether decompression surgery for cervical spondylotic myelopathy (CSM) in elderly patients aged 80 years or older would likely be a reasonable treatment. We retrospectively reviewed 605 consecutive patients with cervical myelopathy who underwent decompression surgery between 2004 and 2008. Patients with other conditions that could affect functional status or compression factors other than spondylosis were excluded from this study. Of the remaining 189 patients, 161 with CSM whose condition could be evaluated 6 months after surgery were analyzed. The patients were divided into two age groups: 80 years or older (Group A, 37 patients) and younger than 80 years of age (Group B, 124 patients). We evaluated the differences in symptom duration, clinical data, involved levels, surgical outcome, comorbidities, and postoperative complications between the two groups. The symptom duration was significantly shorter in Group A. The average JOA scores preoperatively and 6 months postoperatively were significantly lower in Group A; however, there was no significant difference in the recovery ratio. There were no significant differences in the percentages of patients with comorbidities or those with postoperative complications. Elderly patients aged 80 years or older regained approximately 40% of their function postoperatively, and the incidence of postoperative complication was similar to that in younger patients. Since this age group shows a rapid deterioration after onset, prompt decompression surgery is required.

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“…Morio et al 16 reported that low-signal intensity changes on T1-weighted sequences indicated a poor prognosis. They speculated that high-signal intensity changes on T2-weighted images indicated a broad spectrum of compressive myelomalacic pathologies and reflected a broad spectrum of spinal cord recuperative potentials.…”

Section: Discussionmentioning

confidence: 99%

Outcome of late surgical treatment in patients with incomplete paraplegia due to spinal degenerative diseases

et al. 2004

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Study design: Retrospective analysis. Objective: To assess the outcome of late surgical intervention in patients with incomplete paraplegia due to spinal degenerative diseases. Setting: Three men and four women with cervical or thoracic spinal degenerative diseases, who preoperatively were unable to walk for more than 6 months in Mie prefecture, Japan. Methods: Review of clinical records and questionnaire survey regarding the walking ability of patients 2 years after surgery. Results: All seven patients were unable to walk postoperatively. Conclusion: A late surgical intervention may not lead to functional recovery in patients with spinal degenerative disease who were unable to walk for at least 6 months.

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Correlation Between Operative Outcomes of Cervical Compression Myelopathy and MRI of the Spinal Cord

Cited by 243 publications

References 29 publications

Quantitative magnetic resonance imaging analysis correlates with surgical outcome of cervical spondylotic myelopathy

Quantitative magnetic resonance imaging analysis correlates with surgical outcome of cervical spondylotic myelopathy

Clinical features and surgical outcomes of cervical spondylotic myelopathy in patients aged 80 years or older: a multi-center retrospective study

Outcome of late surgical treatment in patients with incomplete paraplegia due to spinal degenerative diseases

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