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doi: 10.1097/BRS.0000000000000436
Diagnostics

Do Quantitative Magnetic Resonance Imaging Parameters Correlate With the Clinical Presentation and Functional Outcomes After Surgery in Cervical Spondylotic Myelopathy? A Prospective Multicenter Study

Karpova, Alina MSc*; Arun, Ranganathan DM, FRCS (Tr&Orth), PGDip(Orth Engin), MRCS*; Kalsi-Ryan, Sukhvinder BScPT, PhD*; Massicotte, Eric M. MD, MSc*,†; Kopjar, Branko MD, PhD; Fehlings, Michael G. MD, PhD†,§

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Abstract

Study Design. A prospective multicenter cohort study.

Objective. To establish the relationship between preoperative quantitative magnetic resonance imaging (MRI) parameters and clinical presentation and postoperative outcomes in patients with cervical spondylotic myelopathy.

Summary of Background Data. Correlation of magnetic resonance imaging with clinical presentation and outcomes in cervical spondylotic myelopathy is poorly understood.

Methods. A total of 134 magnetic resonance imaging scans were reviewed from 12 sites across North America. The transverse area (TA) of the spinal cord at the site of maximal compression was computed, and spinal cord signal intensity (SI) changes on T1-/T2-weighted imaging (WI) were evaluated. Detailed clinical assessments—neurological signs, symptoms, Nurick grade, modified Japanese Orthopaedic Association, segmental-tract score, and long-tract score of modified Japanese Orthopaedic Association, 30-m walk test, Short-Form 36 questionnaire, and neck disability index were performed at admission, 6 months, and 12 months postoperatively.

Results. The total number of neurological signs in a patient correlated with TA (P = 0.01) and SI changes on T1-/T2WI (P = 0.05). Pre- and postoperative Nurick grade (P = 0.03, P = 0.02), modified Japanese Orthopaedic Association score (P = 0.005, P = 0.001), segmental-tract score (P = 0.05, P = 0.006), and long-tract score (P = 0.006, P = 0.002), 30-m walk test (P = 0.002, P = 0.01) correlated with TA. There was no significant difference in pre- and postoperative clinical scores in patients with/without SI changes. Patients with severe cord compression showed SI changes on T1-/T2WI more frequently (r =−0.27, r =−0.38). Pyramidal signs—plantar response, Hoffmann reflex and hyper-reflexia correlated with TA (P = 0.003, P = 0.0004, P = 0.024, respectively) and SI changes on T1/T2WI (P = 0.02).

Conclusion. TA closely mirrors the clinical presentation of cervical spondylotic myelopathy and may be used in predicting surgical outcomes. Pyramidal signs correlated with TA and/or SI changes on T1-/T2WI. The total number of neurological signs in a patient correlated with TA. There was no significant relationship between TA, age and duration of symptoms.

Level of Evidence: 3

© 2014 by Lippincott Williams & Wilkins

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