Preoperative Computed Tomography Myelography Parameters as Predictors of Outcome in Patients With Degenerative Cervical Myelopathy: Results of a Systematic Review

Abstract

Study Design:Systematic review.Objectives:To determine the preoperative computed tomography (CT) myelogram imaging parameters in patients diagnosed with degenerative cervical myelopathy (DCM) that correlate with severity of DCM and predict postoperative patients’ functional outcome.Methods:An electronic database search was performed using Ovid Medline and Embase. CT myelogram studies investigating the correlation between imaging characteristics and DCM severity or postoperative outcomes were included. Two independent reviewers performed citation screening, selection, qualitative assessment, and data extraction using an objective and blinded protocol.Results:A total of 5 studies (402 patients) were included in this review and investigated the role of preoperative CT myelogram parameters in predicting the functional outcome after surgical treatment of DCM. All studies were retrospective cohort studies. CT myelogram characteristics included the transverse area of the spinal cord at maximum level of compression, spinal canal narrowing, number of blocks, spinal canal diameter, and flattening ratio. There is low evidence suggesting that patients with a preoperative transverse area of the spinal cord >30 mm2 at the level of maximum compression have better postoperative recovery and outcome. We found no studies investigating the correlation between preoperative CT myelogram parameters and DCM severity.Conclusions:Patients with greater transverse area of spinal cord at the level of maximum compression on the preoperative CT myelogram are more likely to have better neurological outcome after surgery. There is insufficient evidence to suggest that any of the other CT myelogram parameters investigated are predictors of postoperative outcomes in patients with DCM.

The clinical usefulness of preoperative imaging studies to select pathologic level in cervical spondylotic myelopathy: comparative analysis of three-position MRI and post-myelographic CT

“…CT-imaging after intrathecal injection of contrast agents, so called PMCT, not only provides reliable information of bony structures (commonly accepted as the gold standard), but also comprehensive images of the dural sac and adjacent spinal nerve roots (3,8,11,14,18). Due to these valuable merits, PMCT is still routinely performed in many spine centers, despite its invasiveness and possible complications such as low pressure symptoms, meningitis and nerve root injury (18,21,31,32). To minimize the adverse events of intrathecal contrast injection, our institute has established a routine set-up system in the fluoroscopy room, CT suite and day care center.…”

Degenerative Cervical Myelopathy: Natural History, Clinical Presentation, Current Diagnosis and Treatment Review

“…Besides, dynamic examination with flexion and extension x-rays can provide important information about segmental instability, usually adjacent to hypomobile segments [61] . CT allows visualization of details of bone anatomy, evaluation of spondylosis, OPLL, ossification of the ligament flavum, bone compression and it is also useful for surgical instrumentation planning, and 3D reconstruction [62] . However, it is limited to soft tissue analysis [63] .…”

Cervical Spondylotic Myelopathy: Natural Course and the Value of Diagnostic Techniques –WFNS Spine Committee Recommendations

“…CSA on MRI correlates with recovery ratio, but not with postoperative functional score assessed by JOA/mJOA Scores (Level of evidence: 2) [77]. A more recent systematic review reported that patients with greater CSA had better neurological outcomes after surgery [80].…”