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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†,§

doi: 10.1097/BRS.0000000000000436

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

A prospective multicenter trial of patients with cervical spondylotic myelopathy (CSM) attempting clinicoradiological correlation was conducted. Signs and symptoms of CSM and postoperative outcomes were found to correlate with the magnetic resonance imaging parameters of cord compression.

*Krembil Neuroscience Centre, Toronto Western Hospital, Toronto, Ontario, Canada

Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada

School of Public Health, University of Washington, Seattle; and

§Department of Surgery, Neural Repair and Regeneration, Spinal Program, University Health Network, Toronto, Ontario, Canada.

Address correspondence and reprint requests to Michael G. Fehlings, MD, PhD, Department of Surgery, Neural Repair and Regeneration, The Toronto Western Hospital, University Health Network, Room 4W-449, 399 Bathurst St, Toronto, Ontario M5T 2S8, Canada; E-mail:

Acknowledgment date: July 10, 2012. First revision date: March 11, 2013. Second revision date: April 1, 2014. Third revision date: May 7, 2014. Acceptance date: May 9, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

AO Spine North America Inc., a 501(c) 3 nonprofit corporation, grant funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, grants, payment for lecture, travel/accommodations/meeting expenses.

© 2014 by Lippincott Williams & Wilkins