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Postoperative Resolution of MR T2 Increased Signal Intensity in Cervical Spondylotic Myelopathy

The Impact of Signal Change Resolution on the Outcomes

Machino, Masaaki MD; Ando, Kei MD, PhD; Kobayashi, Kazuyoshi MD, PhD; Ota, Kyotaro MD; Morozumi, Masayoshi MD; Tanaka, Satoshi MD; Ito, Keigo MD, PhD; Kato, Fumihiko MD, PhD; Ishiguro, Naoki MD, PhD; Imagama, Shiro MD, PhD

doi: 10.1097/BRS.0000000000003128
CERVICAL SPINE
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Study Design. A prospective comparative imaging study.

Objective. This study investigated whether postoperative resolution of spinal cord increased signal intensity (ISI) reflected symptom improvement and surgical outcomes in cervical spondylotic myelopathy (CSM) patients.

Summary of Background Data. Although some CSM patients exhibit magnetic resonance imaging (MRI) ISI, its alteration and resolution have not been investigated. The association between postoperative ISI resolution and surgical outcomes in CSM patients remains controversial.

Methods. A total of 505 consecutive CSM patients (311 males; 194 females) aged a mean of 66.6 years (range, 41–91) were enrolled. All were treated with laminoplasty and underwent MRI scans preoperatively and after an average of 26.5 months postoperatively (range 12–66 months). ISI was classified pre- and postoperatively based on sagittal T2-weighted magnetic resonance images into Grade 0, none; Grade 1, light (obscure); and Grade 2, intense (bright). The patients’ pre- and postoperative neurological statuses were evaluated using the Japanese Orthopedic Association scoring system for cervical myelopathy [Japanese Orthopedic Association (JOA) score] and other quantifiable tests, including the 10-s grip and release (10-s G&R) test and 10-s step test.

Results. A total of 337 patients showed preoperative ISI. Among these, 42 (12.5%) showed postoperative ISI resolution, associated with better postoperative JOA score and recovery rate, 10-s G&R and 10-s step test scores than those who retained it. Patients with preoperative Grade 2 ISI had no postoperative ISI resolution. Patients with ISI improvement from Grade 1 to Grade 0 had better outcomes than those with ISI worsening from Grade 1 to Grade 2.

Conclusion. Postoperative ISI resolution in CSM patients reflects postoperative symptoms and surgical outcomes. Patients who exhibit ISI resolution have better clinical outcomes.

Level of Evidence: 3

A total of 337 cervical spondylotic myelopathy patients showed increased signal intensity on preoperative magnetic resonance imaging. Among these, 12.5% showed postoperative increased signal intensity resolution. Patients who exhibited increased signal intensity resolution showed better clinical outcomes than those who retained it did.

Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Nagoya, Japan.

Address correspondence and reprint requests to Shiro Imagama, MD, PhD, Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan; E-mail: imagama@med.nagoya-u.ac.jp

Received 22 February, 2019

Revised 30 April, 2019

Accepted 16 May, 2019

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.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.