Magnetic Resonance Imaging Study on the Results of Surgery for Cervical Compression Myelopathy

Okada, Yuji; Ikata, Takaaki; Yamada, Hidehiro; Sakamoto, Rintaro; Katoh, Shinsuke

doi:10.1097/00007632-199310001-00016

Cited by 219 publications

(107 citation statements)

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“…3,4,5,11,18 The current results showed no significant correlations between the preoperative GSI with baseline JOA and recovery rate. However, there was a tendency toward negative correlation.…”

Section: Predictors Of Surgical Outcomescontrasting

confidence: 73%

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: Predictors Of Surgical Outcomescontrasting

confidence: 73%

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

Wang

et al. 2014

Spinal Cord

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“…This term may be the same as 'fried-egg appearance' demonstrated by computed-tomographic myelography by Iwasaki et al 9 Some authors suggested that SEA is an irreversible change in the spinal cord, like cystic necrosis. 3,7,8,10 Others suggested that it is a reversible change, similar to edema. 3,6,8 This confusion arises from a lack of precise pathological correlation of the compressed spinal cord with SEA.…”

Section: Discussionmentioning

confidence: 99%

Postmortem study of the spinal cord showing snake-eyes appearance due to damage by ossification of the posterior longitudinal ligament and kyphotic deformity

et al. 2005

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Clinical design: A case report. Objectives: To elucidate the clinical role of snake-eyes appearance in this case, correlation between radiological, clinical and postmortem study was performed. Setting: Aichi, Japan. Case report: A 73-year-old man developed weakness and pain in the upper limbs due to kyphotic deformity secondary to laminectomy for cervical ossification of the posterior longitudinal ligament. Axial magnetic resonance imaging revealed snake-eyes appearance from C4 to C6. He died of acute myocardial infarction 3 months after anterior decompressive surgery. Results: A postmortem examination of the cervical spinal cord showed small cystic six necrotic areas at the junction of the central gray matter and the ventrolateral posterior column, one in the right and one in the left, in association with neuronal loss in the anterior horn. Conclusions: Bilateral small intramedullary high-signal areas known as 'snake-eyes appearance' located around the central gray matter and the ventrolateral posterior column, are associated with neuronal loss in the compressed anterior horn that played an important role in worsening weakness of the upper limbs.

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“…Bu çalışmanın bize göre en çarpıcı yanı, hafif dereceli miyelopati olgularında konservatif tedaviye karar verirken, sadece MRG'de saptanan miyelomalazik sinyal değişikliğine göre değil, nörolojik defisitin dinamik süreci, semptom süresi, mJOA skoru, spinal kordun kompresyon seviyesi ve derecesi ve elektrofizyolojik bulguların da değerlendirilmesi gerektiğini vurgulamasıdır (14,15). Derlemede sözü geçen önerileri üç başlık altında toparlamak gerekirse (16,17)…”

Section: Discussionunclassified

Subklinik Servikal Miyelopatiye Yaklaşım: Olgu Sunumu

...

2012

Tftr

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ÖzetSık görülmesine ve en az 50 yıldır bilinmesine rağmen, servikal miyelopatinin doğal seyri, patogenezi, semptom ve bulguların düzelmesinde konservatif ve cerrahi tedavilerin etkinliği halen tartışmalıdır. Özellikle klinikte ara sıra karşımıza çıkan, radyolojik olarak miyelomalazik sinyal değişikliği olup, belirgin semptom veya bulgu saptamadığımız ve literatürde "subklinik" ya da "pre-semptomatik" olarak adlandırılan hasta grubunda tedavi ile ilgili çelişkili veriler yer almaktadır. Manyetik rezonans görüntülemede spinal korddaki sinyal değişikliği klinisyenleri hızla miyelopati tanısını koymaya yönlendirse de, son yıllarda yapılan araştırmalar optimal tedavi seçiminin ve prognoz tayininin sadece görüntüleme ile yapılamayacağını göstermektedir. Hastaya özel tedavi şeklinin belirlenmesinde, semptomların süresi, detaylı ve belli aralıklarla yapılan nörolojik değerlendirmeler, elektrofizyolojik bulgular, Japon Ortopedi Derneği Miyelopati skoru gibi bir takım klinik skorlama yöntemlerinin de son derece önemli olduğu vurgulanmış ve bu verilerin tümünün birlikte değerlendirilmesi durumunda tedavi için doğru karar verilebileceği üzerinde durulmuştur. Bu bilgilerin ışığında; kliniğimizde tanı koyup izlenmekte olan, radyolojik olarak miyelopati bulgusu olup; ancak klinikte belirgin nörolojik bulgu saptanmayan bir olgunun sunulması ve bu tip hastalara yaklaşımın literatür eşliğinde tartışılması amaçlanmıştır. Türk Fiz T›p Re hab Derg 2012;58:335-9. Anah tar Ke li me ler: Miyelopati; servikal miyelopati; subklinik miyelopati; miyelomalazi Sum maryCervical myelopathy is a spinal cord lesion caused by cervical stenosis compressing the spinal cord and vascular structures. Despite the common occurrence and large amount of information has been published about cervical myelopathy for at least 50 years, the effectiveness of the conservative and surgical treatments on the natural history, pathogenesis and especially the prognosis of the disease is still controversial. As a result of this controversy, in everyday clinical practice many doctors are still hesitant to commit themselves to a treatment regimen and are unable to predict the natural course of the disease. Although cervical cord compression is prerequisite for the clinical diagnosis and detected easily by myelomalacic signal changes on MRI, previous studies have demonstrated the existence of asymptomatic spinal cord compression detected by MRI. Little is known about the spontaneous course and prognosis of clinically "silent" or "subclinical" cervical cord myelomalasia. In addition, conflicting data on the prognosis and the treatment of this subclinical patient group exist in the literature. In order to determine the prognosis and patient-specific treatment modality; duration of symptoms, detailed neurological assessment made at regular intervals, electrophysiological findings, clinical myelopathy scoring methods such as the Japanese Orthopaedic Association Score as well as myelomalacic changes should be taken into consideration and decisionmaking must then be based on t...

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Magnetic Resonance Imaging Study on the Results of Surgery for Cervical Compression Myelopathy

Cited by 219 publications

References 0 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

Postmortem study of the spinal cord showing snake-eyes appearance due to damage by ossification of the posterior longitudinal ligament and kyphotic deformity

Subklinik Servikal Miyelopatiye Yaklaşım: Olgu Sunumu

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