Magnetic Resonance T2 Image Signal Intensity Ratio and Clinical Manifestation Predict Prognosis After Surgical Intervention for Cervical Spondylotic Myelopathy

Zhang, Yingze; Shen, Yong; Wang, Linfeng; Ding, Wenyuan; Xu, Jiaxin; He, Jian

doi:10.1097/brs.0b013e3181c6dbc4

Cited by 75 publications

(59 citation statements)

References 18 publications

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“…Sagittal MRI has been commonly used in humans with SCI as a means to recognize T2-hyperintense spinal cord lesions, semiquantitatively evaluate lesion size via sagittal ratios and predict long-term functional outcome. 2,15 Data from this study suggest that axial T2-weighted MRI is superior to sagittal images with respect to lesion recognition and associations with measures of initial SCI severity and long-term motor recovery. We believe that this finding is likely generalizable across species as injury characteristics are similar between dogs with IVDH-associated SCI and humans.…”

Section: Discussionmentioning

confidence: 83%

Quantitative magnetic resonance imaging in a naturally occurring canine model of spinal cord injury

Griffin

Davis

et al. 2015

Spinal Cord

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Study design: Retrospective cohort study. Objectives: To analyze magnetic resonance imaging (MRI) evaluator agreement in dogs with spinal cord injury (SCI) caused by intervertebral disk herniation (IVDH) using semiautomated and manual lesion segmentation and to analyze the associations between MRI and functional outcome. Setting: United States of America. Methods: T2-weighted MRIs from dogs with SCI resulting from thoracolumbar IVDH were identified from a database. Evaluators categorized MRIs on the basis of the presence or absence of a T2-hyperintense spinal cord lesion in axial and sagittal images. A semiautomated segmentation algorithm was developed and used to estimate the lesion volume. Agreement between evaluators and between semiautomated and manual segmentation was analyzed. The relationships of qualitative and quantitative MRIs with behavioral functional outcome were analyzed. Results: Axial images more commonly depicted lesions compared with sagittal images. Lesions in axial images had more consistent associations with functional outcome compared with sagittal images. There was imperfect qualitative agreement, and lesion volume estimation was imprecise. However, there was improved precision using semiautomated segmentation compared with manual segmentation. Conclusion: Lesion volume estimation in dogs with naturally occurring SCI caused by IVDH is challenging, and axial images have important advantages compared with sagittal images. The semiautomated segmentation algorithm described herein shows promise but may require further refinement. INTRODUCTIONSpinal cord injury (SCI) is a devastating disease process that results in disability, loss of quality of life and cost to the health-care system. Currently, there are no therapies that robustly improve functional outcomes. 1 Magnetic resonance imaging (MRI) has been used in humans to diagnose SCI for three decades and has been proposed as a viable in vivo biomarker. 2-4 High T2 signal intensity within the spinal cord following injury is correlated with identifiable edema, necrosis, cellular infiltrates and hemorrhage. 5,6 The presence of such lesions has been associated with slowed recovery across a number of model systems and in humans. 2,7,8 More recently, spinal cord lesion volume as measured by MRI has been used to quantitatively characterize SCI following clinical interventions. 9 Canine intervertebral disk herniation (IVDH) is a common, naturally occurring SCI that is seen in pet dogs. 10,11 Canine IVDH shares many features with human SCI including lesion histopathology, presence of compressive/contusive facets of injury and use of surgical/ rehabilitative treatment modalities. 10,11 As is the case in humans, data from dogs with IVDH suggest that T2-hyperintense lesions within the spinal cord are correlated with behaviorally severe injuries and poorer long-term motor recovery. 11

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Section: Discussionmentioning

confidence: 83%

Quantitative magnetic resonance imaging in a naturally occurring canine model of spinal cord injury

Griffin

Davis

et al. 2015

Spinal Cord

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“…All three equations included age as a predictor. [35][36][37] In contrast, four studies could not identify a significant association between age and JOA recovery rate. [38][39][40][41] Postoperative mJOA/JOA score Seven studies used postoperative mJOA or JOA as the primary outcome measure.…”

Section: Joa Recovery Ratementioning

confidence: 80%

Does Age Affect Surgical Outcomes in Patients with Degenerative Cervical Myelopathy? Results from the Prospective, Multicenter AOSpine International Study on 479 Patients

et al. 2015

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BackgroundIn general, older patients with degenerative cervical myelopathy (DCM) are felt to have lower recovery potential following surgery due to increased degenerative pathology, comorbidities, reduced physiological reserves and age-related changes to the spinal cord. This study aims to determine whether age truly is an independent predictor of surgical outcome and to provide evidence to guide practice and decisionmaking. Methods A total of 479 patients with DCM were prospectively enrolled in the CSM-International study at 16 centres. Our sample was divided into a younger group (<65 years) and an elderly (≥65 years) group. A mixed model analytic approach was used to evaluate differences in the modified Japanese Orthopaedic Association (mJOA), Nurick, Short Form-36 (SF-36) and Neck Disability Index (NDI) scores between groups. We first created an unadjusted model between age and surgical outcome and then developed two adjusted models that accounted for variations in (1) baseline characteristics and (2) both baseline and surgical factors. Results Of the 479 patients, 360 (75.16%) were <65 years and 119 (24.84%) were ≥65 years. Elderly patients had a worse preoperative health status ( p<0.0001) and were functionally more severe ( p<0.0001). The majority of younger patients (64.96%) underwent anterior surgery, whereas the preferred approach in the elderly group was posterior (58.62%, p<0.0001). Elderly patients had a greater number of decompressed levels than younger patients ( p<0.0001). At 24 months after surgery, younger patients achieved a higher postoperative mJOA ( p<0.0001) and a lower Nurick score ( p<0.0001) than elderly patients. After adjustments for patient and surgical characteristics, these differences in postoperative outcome scores decreased but remained significant. Conclusions Older age is an independent predictor of functional status in patients with DCM. However, patients over 65 with DCM still achieve functionally significant improvement after surgical decompression.

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“…Furthermore, a pronounced myelopathy signal on MR imaging around an SCCM appears to predict an unfavorable outcome comparable to the myelopathy signal in cervical spondylosis. 25 With regard to the importance of adjacent spinal cord hemosiderosis, no data are available. 5 In this series, one patient had a large cavernoma and pronounced adjacent hemosiderosis.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for the outcome of surgical and conservative treatment of symptomatic spinal cord cavernous malformations: a review of a series of 20 patients

Steiger¹,

Turowski

Hänggi³

2010

FOC

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Object In this study, the authors present a review of a series of 20 intramedullary spinal cord cavernous malformations (SCCMs) with particular focus on MR imaging and prognostic factors. Methods Between 1994 and 2009, 20 patients with SCCM were treated under the care of the senior author. The diagnosis was made in all patients after the onset of clinical symptoms. The age of the 9 men and 11 women ranged between 26 and 71 years (median 38.5 years). The duration of symptoms prior to referral ranged from 1 week to 9 years (median 6.5 months). At the time of referral, 4 patients had no significant neurological deficits, 10 patients suffered significant functional restrictions, and 6 patients presented with severe paraparesis and loss of functional strength. None of the patients had complete paraplegia. Seventeen patients underwent microsurgical removal, while 3 patients opted for conservative therapy. For the present analysis, the medical records and MR images and/or reports were reviewed. Classification of length of history, pretreatment status, MR imaging pattern, and treatment modality was done and correlated with outcome. Results The cavernoma was located at the cervical level in 8 patients and between T-1 and L-1 in 12 patients. The cavernoma appeared as mainly T2 hyperintense on MR images in 7 patients, mainly T2 hypointense in 2 patients, and mixed in the remaining 10 patients. The craniocaudal extension of the core varied between 5 and 45 mm. In 2 patients with cervical cavernomas, a distinct T2 signal of the spinal cord cranial and distal to the cavernoma was seen, and in a patient with a large thoracic cavernoma, T2 extinction cranial and caudal to the cavernoma was seen as a sign of hemosiderosis. Neurological deficits improved postoperatively in 12 of the surgically treated patients, remained stable in 2, and deteriorated in 3. The 3 patients who were conservatively treated remained stable over a follow-up of 3–9 years. Postoperative improvement was seen in 5 of 7 surgical patients with a history of symptoms of 2 months or less, 5 of 6 patients with a history of 2–24 months, and in 2 of 4 patients with a history of more than 2 years. Two of the 3 patients with postoperative deterioration had a history of more than 2 years and the third a short history of 1 month. Conclusions Although a satisfactory outcome can be achieved through surgical treatment of SCCMs, some patients worsen after surgery or during the postoperative course. Long-term stability is possible in oligosymptomatic conservatively treated patients. The prevalence and pathophysiological importance of segmental spinal cord edema and hemosiderosis is incompletely understood at the present time.

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Magnetic Resonance T2 Image Signal Intensity Ratio and Clinical Manifestation Predict Prognosis After Surgical Intervention for Cervical Spondylotic Myelopathy

Cited by 75 publications

References 18 publications

Quantitative magnetic resonance imaging in a naturally occurring canine model of spinal cord injury

Quantitative magnetic resonance imaging in a naturally occurring canine model of spinal cord injury

Does Age Affect Surgical Outcomes in Patients with Degenerative Cervical Myelopathy? Results from the Prospective, Multicenter AOSpine International Study on 479 Patients

Prognostic factors for the outcome of surgical and conservative treatment of symptomatic spinal cord cavernous malformations: a review of a series of 20 patients

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