The value of dynamic MRI in the treatment of cervical spondylotic myelopathy: a protocol for a prospective randomized clinical trial

Abstract

Background Cervical spondylotic myelopathy (CSM) is the most severe type of cervical spondylosis and the most common cause of spinal cord dysfunction among adults over 55 years old. MRI plays an important role in the diagnosis and evaluation of CSM, which can directly demonstrate the correlation between disc, spinal cord, posterior structures and abnormal signal in spinal cord. Static MRI can only show the static and neutral position of spinal cord, which is not enough to understand the pathogenesis of CSM. Dynamic MRI demonstrating the extension and flexion position of spinal cord can be a better tool for the treatment of CSM, especially the surgical decision making. Method A total of 180 CSM patients who have indications for surgery will be recruited in outpatient of Peking University Third Hospital and assigned to three groups (Group A, B and C) based on their static MRI after consent. Group A (incomplete dura compression) means the signal of cerebral spinal fluid (CSF) is still visible. Group B (complete dura compression) means no CSF signal and no shape change of spinal cord. Group C (spinal cord compression) means shape change of spinal cord. Two surgical plans will be made for each participant by one professional surgeon according to the static MRI and dynamic MRI respectively and we will randomly choose one to perform via a random number system. Follow-up will be maintained at 3, 6, and 12 months after surgery through outpatient or telephone interview, including mJOA score, 10-s G&R (grip and release) and 10-s step test, SF-36 score, radiographic examination and complications. Finally, data collection and statistical analysis will be finished by researchers who are blinded to recruitment and treatment. Discussion This study will help us to explore the indication of dynamic MRI and the value of dynamic MRI in the treatment of CSM, especially the surgical decision making. Dynamic MRI can be a useful tool in the treatment of CSM patients. Trial registration ChiCTR1900023014. Registered on May 7th, 2019.

The value of dynamic MRI in cervical spondylotic myelopathy: About 24 cases

“…Elderly age was shown to predict increased stenosis in extension. With utilization of dynamic scans, clinician agreement and consensus in interpretation improved [ 1 , 3 , 5 , 11 ]. In the present study, we showed that the number of compression levels was increased by 17 levels in extension MR images in 12 or 50% of our patient.…”

Mielopatía espondilótica cervical: lo que el médico en el servicio de urgencias debe saber

“…Los estudios electrofisiológicos no se usan de manera habitual para diagnosticar la mielopatía cervical, pero pueden ser útiles para descartar otras afecciones, como el síndrome del túnel carpiano, la esclerosis múltiple, la esclerosis lateral amiotrófica, la degeneración combinada subaguda y otras enfermedades neurológicas que muestran patrones electromiográficos característicos 25 .…”

New Imaging Modalities for Degenerative Cervical Myelopathy

“…38 Although comprehensive comparative studies are still outstanding, retrospective studies have shown extension-MRI views to more consistently identify canal stenosis that was absent on flexion or neutral MRIs up to 22.5% of the time 39,40. Randomized controlled trials aimed at studying the value of dynamic MRI in the diagnostics of DCM are currently underway 41…”

“…39,40 Randomized controlled trials aimed at studying the value of dynamic MRI in the diagnostics of DCM are currently underway. 41…”