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Increased Flow Signal in Compressed Segments of the Spinal Cord in Patients With Cervical Spondylotic Myelopathy

Chang, Han Soo, MD; Nejo, Takahide, MD; Yoshida, Shinsuke, MD; Oya, Soichi, MD, PhD; Matsui, Toru, MD

doi: 10.1097/BRS.0000000000000607
Cervical Spine
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Study Design. Prospective controlled trial.

Objective. To describe a newly found increased flow signal in phase-contrast magnetic resonance imaging observed in compressed segments of the spinal cord in patients with cervical spondylotic myelopathy (CSM).

Summary of Background Data. Derangement of cerebrospinal fluid movement in the spine is a well-known cause of syringomyelia. However, its possible role in CSM has not been studied well, despite the fact that similar derangement takes place in CSM.

Methods. In a consecutive series of 57 patients with CSM, cardiac-gated phase-contrast magnetic resonance imaging was analyzed. The amplitude of the flow signal obtained in the compressed segment of the spinal cord was compared with that obtained in the lesion-free C2 segment. It was also compared with controls obtained from 10 healthy volunteers. We also studied whether the amplitude was correlated with the severity of cervical canal stenosis, neurological symptoms, indication of surgery, and the presence of intramedullary high-intensity signal on T2-weighted images. In 33 patients who underwent decompression surgical procedures, we compared the amplitude of the flow signal between the preoperative and the postoperative study.

Results. Increased flow signal on phase-contrast study was seen in compressed segments of the spinal cord in 36 (63%) patients. The mean amplitude of the signal in the compressed segment was 0.64 ± 0.06 cm/s, whereas that in the C2 segment was 0.27 ± 0.01 and that in the controls was 0.28 ± 0.01. The flow signal linearly increased as the severity of canal stenosis increased. It significantly correlated with the symptom of upper-extremity dysesthesia, and the indication of surgery in these patients. The mean amplitude of the signal tended to be higher in those with intramedullary high-intensity signal than in those without. After decompression surgery, the increased flow signal was markedly diminished, and returned to a level comparable with the controls.

Conclusion. Phase-contrast imaging demonstrated increased flow signal in compressed segments of the spinal cord in a majority of patients with CSM. This suggests a possible role played by derangement of cerebrospinal fluid movement in CSM. It also suggests potential usefulness of phase-contrast study in the management of patients with CSM.

Level of Evidence: 2

We observed increased flow signal from the compressed segments of the spinal cord in patients with cervical spondylotic myelopathy using cardiac-gated phase-contrast magnetic resonance imaging. It suggests that derangement of cerebrospinal fluid movement may play a role in the pathogenesis of cervical spondylotic myelopathy.

From the Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.

Address correspondence and reprint requests to Han Soo Chang, MD, Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Tsujimichi, Kamoda, Kawagoe, Saitama, Japan 350-8550; E-mail: chang-ind@umin.ac.jp

Acknowledgment date: April 16, 2014. Revision date: August 17, 2014. Acceptance date: September 2, 2014.

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

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins