Increased signal intensity on postoperative T2-weighted axial images in cervical spondylotic myelopathy: Patterns of changes and associated impact on outcomes |
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| Institution: | 1. Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea;2. Spine Center and Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea;1. The first department of radiology, Tianjin Hospital, China;2. Department of Orthopaedics and Traumatology, University of Hong Kong, Hong Kong;1. Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY, USA;2. Department of Orthopedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA;3. Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA;4. Department of Orthopedic Surgery, Brigham and Women’s Faulkner Hospital, Boston, MA, USA;1. Department of Neurosurgery, Laredo Regional Medical Center, Laredo, Texas, USA;2. Department of Neurosurgery, Liaquat National Hospital and Medical College, Karachi, Pakistan;1. Department of Neurosurgery, Yeungnam University Hospital, Daegu, Republic of Korea;2. Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea;3. Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea;4. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea;5. Department of Neurosurgery, Chungbuk National University, College of Medicine, Cheongju, Republic of Korea |
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| Abstract: | Although T2-weighted axial magnetic resonance imaging (MRI) has strength in demonstrating morphologic characteristics of the spinal cord in cervical spondylotic myelopathy (CSM), no study has investigated postoperative changes. We aimed to assess postoperative changes on T2-weighted axial MRI using the classification system based on axial imaging in cervical compressive myelopathy (Ax-CCM) and associated impact on outcome in CSM. In total, 250 patients with CSM who underwent decompressive surgery with preoperative and postoperative MRI were included. At first, we investigated the presence of increased signal intensity (SI) in cervical spinal cord on T2-weighted sagittal images. Next, the increased SI was assessed using Ax-CCM on T2weighted axial images. The classifications were type 0, no-signal abnormality; single-level type 1, diffuse; single-level type 2, fuzzy focal; single-level type 3, discrete focal; and two-level. The recovery rates (RRs) of modified Japanese Orthopaedic Association (mJOA) score were evaluated from 5 to 10 months postoperatively. Eighty-seven patients (34.8%) exhibited postoperative changes. Most of postoperative changes were in single-level type 1 and 2. Patterns of changes were resolution, reduced extent, or transition to discrete margin. The most common pattern was resolution in type 1 (23.9%) and transition to discrete margin in type 2 (46.5%). In each group, resolution showed the best RR, but insignificantly (p > 0.05). |
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| Keywords: | Cervical spondylotic myelopathy Magnetic resonance imaging T2-weighted axial image Surgical decompression Prognosis |
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