Magnetic resonance imaging predictors of outcome after surgical intervention for cervical spondylotic myelopathy

Authors

  • Sushil Bhogawar Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
  • Prasanth Asher Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India http://orcid.org/0000-0001-9784-5808
  • Sunilkumar Balakrishnan Sreemathyamma Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
  • Anilkumar Peethambaran Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India

DOI:

https://doi.org/10.18203/2349-2902.isj20203992

Keywords:

MRI, MRI A (N/N), MRI B (N/Hi), MRI C (Lo/Hi), Cervical spondylotic myelopathy

Abstract

Background: Cervical spondylotic myelopathy (CSM) is a commonly seen spinal cord disease. There are no well-defined indications and optimal timing for surgical intervention. Therefore, defining predictors for outcome after surgical intervention will have great advantage in taking decisions for interventions.

Methods: A consecutive series of all patients having signs and symptoms of cervical spondylotic myelopathy admitted to Department of Neurosurgery, Medical College, Thiruvananthapuram who underwent decompressive surgery with or without stabilization in one year were studied. Pre-operative magnetic resonance imaging (MRI) findings were correlated with post-operative surgical outcomes (Nurick grade) after 3 months of follow up. The pattern of spinal cord signal intensity was classified as: group A (MRI N/N) - no SI T1WI or T2WI, group B (MRI N/Hi) - no SI T1WI and high SI on T2WI and, group C (MRI Lo/Hi) - low SI T1WI and high SI on T2WI. CSM clinical outcomes were evaluated using Nurick grading system, which was used pre- and post-operatively (pre op and post op).

Results: Post operatively improvement was seen in 75% of group A and 61.35 % of group B patients, but among group C only 25% patient improved according to Nurick grading pre op and post op.

Conclusions: Patients with high intramedullary signal intensity on T2WI may experience a good surgical outcome. A less favorable surgical outcome is predicted by the presence of low intramedullary signal on T1WI.

Author Biography

Prasanth Asher, Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India

Associate Professor

Department of Neurosurgery

Government Medical College Thiruvananthapuram

References

Rao RD, Gourab K, David KS. Operative treatment of cervical spondylotic myelopathy. J Bone Joint Surg Am. 2006;88:1619-40.

Emery S. Cervical spondylotic myelopathy: diagnosis and treatment. J Am Acad Orthop Surg. 2001;9(6):376-85.

Nurick S. The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain. 1972;95:87-100.

Alafifi T, Kern R, Fehlings M. Clinical and MRI Predictors of Outcome After Surgical Intervention for Cervical Spondylotic Myelopathy. J Neuroimaging. 2007;7:315-22.

Chikhale CB, Khurjekar KS, Shyam AK, Sancheti PK. Correlation between Preoperative Magnetic Resonance Imaging Signal Intensity Changes and Clinical Outcomes in Patients Surgically Treated for Cervical Myeloradiculopathy. Asian Spine J. 2017;11(2):174-80.

Avadhani A, Rajasekaran S, Shetty AP. Comparison of prognostic value of different MRI classifications of signal intensity change in cervical spondylotic myelopathy. Spine J. 2010;10(6):475-85.

Arvin B, Kalsi-Ryan S, Mercier D, Furlan JC, Massicotte EM, Fehlings MG. Preoperative Magnetic Resonance Imaging Is Associated With Baseline Neurological Status and Can Predict Postoperative Recovery in Patients With Cervical Spondylotic Myelopathy. Spine. 2013;38(14):1170-6.

Mehalic TF, Pezzuti RT, Applebaum BI. Magnetic resonance imaging and cervical spondylotic myelopathy. Neurosurg. 1990;26:217-26.

Yukawa Y, Kato F, Yoshihara H, Yanase M, Ito K. MR T2 image classification in cervical compression myelopathy: predictor of surgical outcomes. Spine. 2007;32(15):1675-8.

Suri A, Chabbra RP, Mehta VS, Gaikwad S, Pandey RM. Effect of intramedullary signal changes on the surgical outcome of patients with cervical spondylotic myelopathy. Spine J. 2003;3(1):33-45.

Morio Y, Teshima R, Nagashima H, Nawata K, Yamasaki D, Nanjo Y. Correlation between operative outcomes of cervical compression myelopathy and mri of the spinal cord. Spine (Phila Pa 1976). 2001;26(11):1238-45.

Ohshio I, Hatayama A, Kaneda K, Takahara M, Nagashima K. Correlation between histopathologic features and magnetic resonance images of spinal cord lesions. Spine (Phila Pa 1976). 1993;18(9):1140-9.

Mummaneni PV, Kaiser MG, Matz PG, Anderson PA, Groff M, Heary R, et al. Preoperative patient selection with magnetic resonance imaging, computed tomography, and electroencephalography: does the test predict outcome after cervical surgery?. J Neurosurg Spine. 2009;11(2):119-29.

Chen H, Pan J, Nisar M, Zeng HB, Dai LF, Lou C, et al. The value of preoperative magnetic resonance imaging in predicting postoperative recovery in patients with cervical spondylosis myelopathy: a meta-analysis. Clinics (Sao Paulo, Brazil). 2016;71(3):179-84.

Downloads

Published

2020-09-23

Issue

Section

Original Research Articles