Effect of intramedullary signal changes on the surgical outcome of patients with cervical spondylotic myelopathy

Suri, Ashish; Chabbra, Ravinder Pal Singh; Mehta, Veer Singh; Gaikwad, Shailesh; Pandey, Ram Mohan

doi:10.1016/s1529-9430(02)00448-5

Cited by 228 publications

(155 citation statements)

References 31 publications

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“…Yukawa et al [25] reported that MRI outcomes associated with intramedullary high SI are indicators of poor prognosis. According to several other studies, the signal changes on preoperative MR images have been observed variously range from 28.7 to 83% [16,24]. In this study, we found that preoperative intramedullary signal changes were present in 67.6% of patients enrolled in this study.…”

Section: Discussionsupporting

confidence: 64%

“…The regression of intramedullary signal changes in patients with hyperintensity T2WI can be regarded as a predictor of improved outcome following surgery. Several studies have reported that patients whose SI decreased following surgery had better neurological outcomes postoperatively than patients whose SI did not decrease [16,24]. However, other studies have reported that postoperative alterations in SI were uncorrelated with postoperative outcomes [22].…”

Section: Discussionmentioning

confidence: 99%

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The relevance of intramedullary high signal intensity and gadolinium (Gd-DTPA) enhancement to the clinical outcome in cervical compressive myelopathy

Cho

Shin

et al. 2011

Eur Spine J

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Purpose We prospectively investigated whether high intramedullary SI and contrast [gadolinium-diethylenetriamine-pentaacetic acid (Gd-DTPA)] enhancement in magnetic resonance imaging (MRI) are associated with postoperative prognosis in cervical compressive myelopathy (CCM) patients. Methods Seventy-four patients with ventral cord compression at one or two levels underwent anterior cervical discectomy and fusion (ACDF) for CCM between March 2006 and June 2009. The mean follow-up period was 39.7 months (range, 12.7-55.7 months). The cervical cord compression ratio and clinical outcomes were measured using Japanese Orthopedic Association (JOA) scores for cervical myelopathy. Patients were classified into three groups based on the SI change in T2WI, T1-weighted images (T1WI), and contrast (Gd-DTPA) enhancement. Results The mean preoperative and postoperative JOA scores were 10.5 ± 2.9 and 15.0 ± 2.1 (P \ 0.05), respectively. The mean recovery ratio of the JOA score was 70.9 ± 20.2%. There were statistically significant differences in postoperative JOA and recovery ratio among three groups. However, post-surgical neurological outcomes were not associated with age, symptom duration, preoperative JOA, and cord compression. Conclusions We found that intramedullary SI change is a poor prognostic factor and the intramedullary contrast (Gd-DTPA) enhancement on preoperative MRI should be viewed as the worst predictor of surgical outcomes in cervical myelopathy. Contrast (Gd-DTPA) enhancement and postoperative MRI are useful for identifying the prognosis of patients with poor neurological recovery.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

The relevance of intramedullary high signal intensity and gadolinium (Gd-DTPA) enhancement to the clinical outcome in cervical compressive myelopathy

Cho

Shin

et al. 2011

Eur Spine J

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“…Regarding intramedullary signal intensity changes, Suri et al 15 showed that the presence of intramedullary signal changes on T1-as well as T2-weighted sequences on MRI in patients with cervical spondylotic myelopathy indicated a poor prognosis. Morio et al 16 reported that low-signal intensity changes on T1-weighted sequences indicated a poor prognosis.…”

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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“…However, based on the cervical myelopathy literature, patients with signal changes on both T1-and T2-weighted images have a worse chance of recovery compared to patients who only have signal changes on T2-weighted images. 61,76 Serial MR imaging examinations can be performed to assess potential improvement in the cord signal changes.…”

Section: Long-term Care Of Patients With Poscismentioning

confidence: 99%

Prevention, identification, and treatment of perioperative spinal cord injury

Ahn¹,

Fehlings

2008

FOC

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Object In this report, the authors suggest evidence-based approaches to minimize the chance of perioperative spinal cord injury (POSCI) and optimize outcome in the event of a POSCI. Methods A systematic review of the basic science and clinical literature is presented. Results Authors of clinical studies have assessed intraoperative monitoring to minimize the chance of POSCI. Furthermore, preoperative factors and intraoperative issues that place patients at increased risk of POSCI have been identified, including developmental stenosis, ankylosing spondylitis, preexisting myelopathy, and severe deformity with spinal cord compromise. However, no studies have assessed methods to optimize outcomes specifically after POSCIs. There are a number of studies focussed on the pathophysiology of SCI and the minimization of secondary damage. These basic science and clinical studies are reviewed, and treatment options outlined in this article. Conclusions There are a number of treatment options, including maintenance of mean arterial blood pressure > 80 mm Hg, starting methylprednisolone treatment preoperatively, and multimodality monitoring to help prevent POSCI occurrence, minimize secondary damage, and potentially improve the clinical outcome of after a POSCI. Further prospective cohort studies are needed to delineate incidence rate, current practice patterns for preventing injury and minimizing the clinical consequences of POSCI, factors that may increase the risk of POSCI, and determinants of clinical outcome in the event of a POSCI.

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Effect of intramedullary signal changes on the surgical outcome of patients with cervical spondylotic myelopathy

Cited by 228 publications

References 31 publications

The relevance of intramedullary high signal intensity and gadolinium (Gd-DTPA) enhancement to the clinical outcome in cervical compressive myelopathy

The relevance of intramedullary high signal intensity and gadolinium (Gd-DTPA) enhancement to the clinical outcome in cervical compressive myelopathy

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

Prevention, identification, and treatment of perioperative spinal cord injury

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