Prognostic relevance of the postoperative evolution of intramedullary spinal cord changes in signal intensity on magnetic resonance imaging after anterior decompression for cervical spondylotic myelopathy

Mastronardi, Luciano; Elsawaf, A.; Roperto, Raffaelino; Bozzao, Alessandro; Caroli, Manuela; Ferrante, Mauro; Ferrante, Luigi

doi:10.3171/spi.2007.7.6.615

Cited by 15 publications

(18 citation statements)

References 25 publications

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“…Furthermore, they could provide information on prognosis of the problem, which in turn may have an impact on the choice of therapeutic method. In humans affected by cervical spondylomyelopathy, it has been reported that specific alterations in the intra-medullary spinal cord signal intensity observed in magnetic resonance imaging results indicate irreversible damage and a poor prognosis (Mastronardi, 2007). Similar results in dogs affected by cervical spondylomyelopathy would render surgical intervention not a rational option.…”

Section: Myelographysupporting

confidence: 66%

Cervical spondylomyelopathy in dogs

Μουζακιτησ)

Kazakos

Patsikas

et al. 2017

J Hellenic Vet Med Soc

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ABSTRACT. Cervical spondylomyelopathy (CSM) is the most common disease of the cervical spine in large and giant breed dogs. Its exact aetiology is not known and the relevant pathophysiology is not clear; two clinical entities are currently recognised: disc-associated and osseous-associated spinal cord compression. History and clinical signs are indicative of cervical spondylomyelopathy, although its neurologic manifestation can vary from cervical pain only to tetraparesis and respiratory compromise. Imaging of the spine is fundamental for definitive diagnosis and includes radiography, myelography, computed tomography and magnetic resonance imaging. It is also the cornerstone of surgical planning. This is usually based on the subjective concept of dynamic or static compressive lesions. Among the advanced imaging techniques, magnetic resonance imaging is superior to myelography for diagnosis of cervical spondylomyelopathy, although, at present, these techniques can be considered complementary. Furthermore, attention is drawn to the false positive interpretations of magnetic resonance findings, which are related to clinically irrelevant spinal cord compression. Hence, the degree of agreement between neuroanatomic localization and neuroimaging is of the outmost importance. Conservative treatment consists of strict restriction of the animal and the use of steroid or non-steroid anti-inflammatory drugs. Objective of surgical treatment is to decompress the spinal cord. However, the decision-making process of surgical treatment is more complicated, because a large number of different surgical techniques have been proposed. Adjacent segment disease is a controversial complication of the surgical treatment of disk-associated cervical spondylomyelopathy and recently introduced motion-preserving techniques are targeted on reducing its occurrence. Significant prognostic information for focal parenchymal damage may derive from magnetic resonance imaging studies, but this remains to be further clarified.

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Section: Myelographysupporting

confidence: 66%

Cervical spondylomyelopathy in dogs

Μουζακιτησ)

Kazakos

Patsikas

et al. 2017

J Hellenic Vet Med Soc

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“…9 Intramedullary intensity changes on MRI have been reported to reflect irreversible changes in the spinal cord, to be related to pyramidal signs, and to be indicative of the prognosis, although this remains controversial. [10][11][12][13] However, the extent of spinal cord compression, even with intramedullary intensity changes on MRI, does not necessarily correlate with that of clinical symptoms.…”

Section: Discussionmentioning

confidence: 99%

Rapid progressive clinical deterioration of cervical spondylotic myelopathy

et al. 2014

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Study Design: Retrospective clinical study. Objective: To elucidate the pathophysiology of rapid progressive clinical deterioration following the onset of cervical myelopathy. Setting: Spinal Injuries Center, Fukuoka, Japan. Methods: A total of 43 cervical spondylotic myelopathy (CSM) patients were treated surgically by a senior surgeon. All patients showed intramedullary intensity changes on magnetic resonance (MR) imaging. Overall, eight patients suffered rapid progressive clinical deterioration; four of them had obvious anamnesis of minor trauma. We assessed the responsible injured segment by MR T2-weighted images. Clinical instabilities at the focal segment were evaluated using functional sagittal plain radiographs. Neurological evaluations were performed preoperatively and at 12 months postoperatively using American Spinal Injury Association (ASIA) motor scores and Japanese Orthopaedic Association (JOA) scores for cervical myelopathy. Intraoperatively, we evaluated the presence of adhesive scar tissue on the dura mater at the focal segment. Results: The responsible injured segment was C3-4 in 75% of the rapid progressive (rp)-CSM and in 28.57% of the conventional CSM subjects. One with rp-CSM showed sagittal translational segmental instability. Preoperative ASIA motor scores and JOA scores in the rp-CSM were significantly lower than those in the conventional CSM subjects. Postoperative ASIA motor scores between the subjects showed no significant differences; however, postoperative JOA scores in the rp-CSM subjects were significantly lower. Moreover, an epidural membrane was observed in 62.5% of rp-CSM and 11.4% of conventional CSM subjects. Conclusions: We hypothesized that the pathophysiology of rp-CSM might be additional cervical cord disorder following the onset of cervical myelopathy. Early decompression surgery is recommended in such patients. INTRODUCTIONThe etiologies of cervical spondylotic myelopathy (CSM) include spinal cord compression, dynamic factors and ischemia of the spinal cord. Several anatomical structures in the cervical motion segment can be involved in cervical spinal cord compression. The spondylotic changes in anterior structures, such as bulging, ossified or herniated discs, as well as anterior osteophytic spurs are generally responsible for cord compression in CSM. Disorders in posterior structures, such as hypertrophy, or rarely, ossification/calcification of the ligamentum flavum (CLF) or facet joints may also contribute to cord compression. Compression of the spinal cord within a narrow spinal canal is believed to cause neural injury and ischemia. The cord and its vascular supply have the ability to adapt to a chronic, slowly progressing compression; therefore, dynamic compression may be more important than static compression in the development of myelopathy symptoms. Patients with canal stenosis also have limited cord excursion, and spinal column motion may increase the strain and shear forces on the spinal cord. 1 CSM is a relatively slowly progressive disorder. However, we r...

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“…MR imaging offers an exact morphologic visualization of the stenosis and the cord compression. However, there is no clear correlation between radiologic signs and clinical aspects of cervical myelopathy (3)(4)(5)(6). Patients with severe stenosis and hyperintense signal alterations on T2-weighted MR images can lack any symptoms, and the degree of spinal cord compression correlates neither with the neurologic deficits nor with the recovery after surgical decompression (3)(4)(5)(6).…”

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confidence: 99%

Hypermetabolism in ¹⁸F-FDG PET Predicts Favorable Outcome Following Decompressive Surgery in Patients with Degenerative Cervical Myelopathy

et al. 2013

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The aim of this study was to prospectively assess the regional changes of glucose metabolism of the cervical spinal cord in patients with degenerative cervical spine stenosis and symptomatic cervical myelopathy after decompressive surgery using 18 F-FDG PET. Methods: Twenty patients with symptomatic degenerative monosegmental cervical stenosis with neuroradiologic signs of spinal cord compression underwent decompressive surgery. The clinical course using a functional status score (Japanese Orthopedic Association [JOA] score), 18 F-FDG uptake, and MR imaging were assessed before and at follow-up 12 mo after surgery. Pre-and postoperative changes of 18 F-FDG PET were correlated to the patients' clinical outcome. Results: Ten patients demonstrated preoperatively a focally increased 18 F-FDG uptake at the level of the stenosis. At follow-up, the uptake declined significantly (P 5 0.008), and a significant improvement of JOA scores (P , 0.001) could be observed. The remaining 10 patients were characterized preoperatively by an inconspicuous glucose uptake at the level of cord compression in combination with a poststenotic decrease of 18 F-FDG uptake. At follow-up, both JOA scores and 18 F-FDG uptake changed insignificantly. Conclusion: Focal glucose hypermetabolism at the level of cervical spinal cord compression may predict an improved outcome after surgical decompression. Thus, this finding on 18 F-FDG PET suggests a functional damage in a reversible phase of cervical myelopathy. Compr ession of the cervical spinal cord due to degenerative cervical spine stenosis induces a progressive dysfunction of the myelon with subsequent neurologic deficits (i.e., cervical myelopathy) (1,2). MR imaging offers an exact morphologic visualization of the stenosis and the cord compression. However, there is no clear correlation between radiologic signs and clinical aspects of cervical myelopathy (3-6). Patients with severe stenosis and hyperintense signal alterations on T2-weighted MR images can lack any symptoms, and the degree of spinal cord compression correlates neither with the neurologic deficits nor with the recovery after surgical decompression (3-6). Therefore, mechanical compression of the cervical spinal cord alone seems not to be the essential factor for the development of myelopathy. Other factors such as a compression-induced neuroinflammation have been recently discussed (7-9).Given the limitations of conventional MR imaging in prediction of clinical outcome in patients with cervical myelopathy, 18 F-FDG PET has been used for metabolic assessment of the healthy, noncompressed cervical spinal cord (10-14) as well of the affected spinal cord (13). In a previous publication (15), we reported preliminary results of this prospective study on 18 F-FDG uptake in 20 patients with compression of the cervical spinal cord due to degenerative cervical spine stenosis and cervical myelopathy. In the present work, we report the final results including pre-and postoperative data of MR imaging and 18 F-FDG PET as well as the clinical...

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Prognostic relevance of the postoperative evolution of intramedullary spinal cord changes in signal intensity on magnetic resonance imaging after anterior decompression for cervical spondylotic myelopathy

Cited by 15 publications

References 25 publications

Cervical spondylomyelopathy in dogs

Cervical spondylomyelopathy in dogs

Rapid progressive clinical deterioration of cervical spondylotic myelopathy

Hypermetabolism in ¹⁸F-FDG PET Predicts Favorable Outcome Following Decompressive Surgery in Patients with Degenerative Cervical Myelopathy

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Prognostic relevance of the postoperative evolution of intramedullary spinal cord changes in signal intensity on magnetic resonance imaging after anterior decompression for cervical spondylotic myelopathy

Cited by 15 publications

References 25 publications

Cervical spondylomyelopathy in dogs

Cervical spondylomyelopathy in dogs

Rapid progressive clinical deterioration of cervical spondylotic myelopathy

Hypermetabolism in 18F-FDG PET Predicts Favorable Outcome Following Decompressive Surgery in Patients with Degenerative Cervical Myelopathy

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Hypermetabolism in ¹⁸F-FDG PET Predicts Favorable Outcome Following Decompressive Surgery in Patients with Degenerative Cervical Myelopathy