Effect of spinal cord signal intensity changes on clinical outcome after surgery for cervical spondylotic myelopathy

Chatley, Anooj; Kumar, Raj; Jain, Vibha; Behari, Sanjay; Sahu, Rabi Narayan

doi:10.3171/2009.6.spine091

Cited by 57 publications

(60 citation statements)

References 33 publications

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“…Many authors demonstrated that the surgical outcomes of cervical myelopathy have been reported variously depending on affected level number, treatment modality, and surgical options including anterior cervical fusion, posterior fusion, or cervical laminoplasty [5,20]. There has been no study to compare the clinical outcome of none SI change and intramedullary increased SI change to that of contrast (Gd-DTPA) enhancement.…”

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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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: 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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“…6,16,25,30,36,37 The physiological mechanisms underlying the recovery of motor function after CSM surgery are poorly understood.…”

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confidence: 99%

Functional cortical reorganization in cases of cervical spondylotic myelopathy and changes associated with surgery

Bhagavatula¹,

Shukla²,

Sadashiva³

et al. 2016

FOC

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OBJECTIVE The physiological mechanisms underlying the recovery of motor function after cervical spondylotic myelopathy (CSM) surgery are poorly understood. Neuronal plasticity allows neurons to compensate for injury and disease and to adjust their activities in response to new situations or changes in their environment. Cortical reorganization as well as improvement in corticospinal conduction happens during motor recovery after stroke and spinal cord injury. In this study the authors aimed to understand the cortical changes that occur due to CSM and following CSM surgery and to correlate these changes with functional recovery by using blood oxygen level–dependent (BOLD) functional MRI (fMRI). METHODS Twenty-two patients having symptoms related to cervical cord compression due to spondylotic changes along with 12 age- and sex-matched healthy controls were included in this study. Patients underwent cervical spine MRI and BOLD fMRI at 1 month before surgery (baseline) and 6 months after surgery. RESULTS Five patients were excluded from analysis because of technical problems; thus, 17 patients made up the study cohort. The mean overall modified Japanese Orthopaedic Association score improved in patients following surgery. Mean upper-extremity, lower-extremity, and sensory scores improved significantly. In the preoperative patient group the volume of activation (VOA) was significantly higher than that in controls. The VOA after surgery was reduced as compared with that before surgery, although it remained higher than that in the control group. In the preoperative patient group, activations were noted only in the left precentral gyrus (PrCG). In the postoperative group, activations were seen in the left postcentral gyrus (PoCG), as well as the PrCG and premotor and supplementary motor cortices. In postoperative group, the VOA was higher in both the PrCG and PoCG as compared with those in the control group. CONCLUSIONS There is over-recruitment of sensorimotor cortices during nondexterous relative to dexterous movements before surgery. After surgery, there was recruitment of other cortical areas such as the PoCG and premotor and supplementary motor cortices, which correlated with improvement in dexterity, but activation in these areas was greater than that found in controls. The results show that improvement in dexterity and finer movements of the upper limbs is associated with recruitment areas other than the premotor cortex to compensate for the damage in the cervical spinal cord.

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“…Chatley et al 12 found that in their series of 67 patients with CSM the mean age was 47.1years with a range of 22 to 65 years. In this study, the mean age was 53.11 years with SD of ±10.71 years.…”

Section: Discussionmentioning

confidence: 99%

“…The respondents have multiple responses, like if one patient had weakness in upper limbs, the patient may also have had neck pain or numbness & tingling sensation. Chatley et al 12 shows the presenting complaints in their study as gait dysfunction (86.0%), limb weakness (78.1%), numbness & tingling (51.6%) and neck pain (39.1%). In this present study, there were 5 motor myelopathic signs being present in the respondents named hyperreflexia, Hoffmann's sign, IBR (Inverted brachioradialis reflex), ankle clonus and Babinski sign.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Signal Intensity Change of the Spinal Cord on MRI and Motor Myelopathic Severity in Patients with Cervical Spondylotic Myelopathy

Zahan

Hossain

Barua

et al. 2017

J. Natl Inst. Neurosci Bangladesh

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Background: Diagnosis of cervical spondylotic myelopathy (CSM) can be challenging due to subtle symptoms and insidious onset; however, there is a relationship between signal intensity change of the spinal cord on MRI and cervical spondylotic myelopathy. Objective: The purpose of this present study was to find out the relationship between signal intensity change of the spinal cord on MRI and motor myelopathic severity in patients with CSM. Methodology: This cross-sectional study was carried out in the Department of Neurosurgery at Banghabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from October, 2011 to March, 2013 for a period of one and half year. All patients presented with cervical spondylotic myelopathy were included in this study. MRI of cervical spine was performed to all patients. Results: A total number of 36 patients with cervical spondylotic myelopathy were included in this study. Among the 36 study patients, all had normal intensity in the spinal cord on sagittal T 1 WI of MRI; however, there was variable intensity on sagittal T2WI of MRI. Low Nurick score was found in 24(66.6%) patients who had type 0 signal intensity on (T 2 WI) MRI. High Nurick score was found in 3(8.3%) patients who had type 0 signal intensity on (T 2 WI) MRI. Low Nurick score was found in 2(5.5%) patients who had type 1 signal intensity on (T2WI) MRI. High Nurick score was found in 6(16.6%) patients who had type 1 signal intensity on (T 2 WI) MRI. Only 1 patient (2.7%) having high Nurick score (3-5) had type-2 signal intensity on (T 2 WI) MRI (p<0.001). Conclusion: There is a direct relationship between signal intensity change of the spinal cord on MRI and motor myelopathic severity in patients with cervical spondylotic myelopathy. [Journal of National Institute of Neurosciences Bangladesh, 2015;1(2): [37][38][39][40]

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Effect of spinal cord signal intensity changes on clinical outcome after surgery for cervical spondylotic myelopathy

Cited by 57 publications

References 33 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

Functional cortical reorganization in cases of cervical spondylotic myelopathy and changes associated with surgery

Relationship between Signal Intensity Change of the Spinal Cord on MRI and Motor Myelopathic Severity in Patients with Cervical Spondylotic Myelopathy

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