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Erschienen in: European Spine Journal 12/2015

01.12.2015 | Original Article

Predictors of surgical outcome in cervical spondylotic myelopathy: focusing on the quantitative signal intensity

verfasst von: Jing Tao Zhang, Fan Tao Meng, Shuai Wang, Lin Feng Wang, Yong Shen

Erschienen in: European Spine Journal | Ausgabe 12/2015

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Abstract

Purpose

The association between intramedullary increased signal intensity (ISI) on T2-weighted magnetic resonance imaging and surgical outcome in cervical spondylotic myelopathy (CSM) remains controversial. The purpose of this study is to assess the impact of quantitative signal change ratio (SCR) on the surgical outcome for CSM.

Methods

The prospective study included 108 consecutive patients who underwent surgical treatment for CSM. The Japanese Orthopaedic Association (JOA) score and recovery rate were used to evaluate clinical outcomes. JOA recovery rate less than 50 % was defined as a poor clinical result. The SCR was defined as the signal intensity at the level of ISI or severely compressed cord (in cases with no ISI) divided by the signal intensity at the C7–T1 disc level. Age, sex, body mass index, duration of symptoms, surgical technique, preoperative JOA score, levels of compression, preoperative SCR, preoperative C2–7 angle, preoperative C2–7 range of motion were assessed.

Results

Forty patients (37.0 %) had a recovery rate of less than 50 %. Multivariate logistic regression analysis revealed that a higher preoperative SCR and a longer duration of symptoms were significant risk factors for a poor clinical outcome. Receiver operating characteristic (ROC) curve analysis showed that the optimal preoperative SCR cutoff value as a predictor of poor clinical result was 1.46. The area under the ROC curve of preoperative SCR for predicting a poor surgical outcome was 0.844.

Conclusions

Preoperative SCR significantly reflected the surgical outcome in patients with CSM. Patients with SCR greater than or equal to 1.46 can experience poor recovery after surgery.
Literatur
1.
Zurück zum Zitat Clark CR (1988) Cervical spondylotic myelopathy: history and physical findings. Spine 13:847–849CrossRefPubMed Clark CR (1988) Cervical spondylotic myelopathy: history and physical findings. Spine 13:847–849CrossRefPubMed
2.
Zurück zum Zitat Clarke E, Robinson PK (1956) Cervical myelopathy: a complication of cervical spondylosis. Brain 79:483–510CrossRefPubMed Clarke E, Robinson PK (1956) Cervical myelopathy: a complication of cervical spondylosis. Brain 79:483–510CrossRefPubMed
3.
Zurück zum Zitat Mehalic TF, Pezzuti RT, Applebaum BI (1990) Magnetic resonance imaging and cervical spondylotic myelopathy. Neurosurgery 26:217–226CrossRefPubMed Mehalic TF, Pezzuti RT, Applebaum BI (1990) Magnetic resonance imaging and cervical spondylotic myelopathy. Neurosurgery 26:217–226CrossRefPubMed
4.
Zurück zum Zitat Okada Y, Ikata T, Yamada H et al (1993) Magnetic resonance imaging study on the results of surgery for cervical compression myelopathy. Spine 18:2024–2029CrossRefPubMed Okada Y, Ikata T, Yamada H et al (1993) Magnetic resonance imaging study on the results of surgery for cervical compression myelopathy. Spine 18:2024–2029CrossRefPubMed
5.
Zurück zum Zitat Matsuda Y, Miyazaki K, Tada K et al (1991) Increased MR signal intensity due to cervical myelopathy. Analysis of 29 surgical cases. J Neurosurg 74:887–892CrossRefPubMed Matsuda Y, Miyazaki K, Tada K et al (1991) Increased MR signal intensity due to cervical myelopathy. Analysis of 29 surgical cases. J Neurosurg 74:887–892CrossRefPubMed
6.
Zurück zum Zitat Suri A, Chabbra RP, Mehta VS et al (2003) Effect of intramedullary signal changes on the surgical outcome of patients with cervical spondylotic myelopathy. Spine J 3:33–45CrossRefPubMed Suri A, Chabbra RP, Mehta VS et al (2003) Effect of intramedullary signal changes on the surgical outcome of patients with cervical spondylotic myelopathy. Spine J 3:33–45CrossRefPubMed
7.
Zurück zum Zitat Takahashi M, Yamashita Y, Sakamoto Y et al (1989) Chronic cervical cord compression: clinical significance of increased signal intensity on MR images. Radiology 173:219–224CrossRefPubMed Takahashi M, Yamashita Y, Sakamoto Y et al (1989) Chronic cervical cord compression: clinical significance of increased signal intensity on MR images. Radiology 173:219–224CrossRefPubMed
8.
Zurück zum Zitat Morio Y, Teshima R, Nagashima H et al (2001) Correlation between operative outcomes of cervical compression myelopathy and mri of the spinal cord. Spine 26:1238–1245CrossRefPubMed Morio Y, Teshima R, Nagashima H et al (2001) Correlation between operative outcomes of cervical compression myelopathy and mri of the spinal cord. Spine 26:1238–1245CrossRefPubMed
9.
Zurück zum Zitat Yone K, Sakou T, Yanase M et al (1992) Preoperative and postoperative magnetic resonance image evaluations of the spinal cord in cervical myelopathy. Spine 17:S388–S392CrossRefPubMed Yone K, Sakou T, Yanase M et al (1992) Preoperative and postoperative magnetic resonance image evaluations of the spinal cord in cervical myelopathy. Spine 17:S388–S392CrossRefPubMed
10.
Zurück zum Zitat Wada E, Yonenobu K, Suzuki S et al (1999) Can intramedullary signal change on magnetic resonance imaging predict surgical outcome in cervical spondylotic myelopathy? Spine 24:455–461CrossRefPubMed Wada E, Yonenobu K, Suzuki S et al (1999) Can intramedullary signal change on magnetic resonance imaging predict surgical outcome in cervical spondylotic myelopathy? Spine 24:455–461CrossRefPubMed
11.
Zurück zum Zitat Alafifi T, Kern R, Fehlings M (2007) Clinical and MRI predictors of outcome after surgical intervention for cervical spondylotic myelopathy. J Neuroimaging 17:315–322CrossRefPubMed Alafifi T, Kern R, Fehlings M (2007) Clinical and MRI predictors of outcome after surgical intervention for cervical spondylotic myelopathy. J Neuroimaging 17:315–322CrossRefPubMed
12.
Zurück zum Zitat Mastronardi L, Elsawaf A, Roperto R et al (2007) Prognostic relevance of the postoperative evolution of intramedullary spinal cord changes in signal intensity on magnetic resonance imaging after anterior decompression for cervical spondylotic myelopathy. J Neurosurg Spine 7:615–622CrossRefPubMed Mastronardi L, Elsawaf A, Roperto R et al (2007) Prognostic relevance of the postoperative evolution of intramedullary spinal cord changes in signal intensity on magnetic resonance imaging after anterior decompression for cervical spondylotic myelopathy. J Neurosurg Spine 7:615–622CrossRefPubMed
13.
Zurück zum Zitat Zhang YZ, Shen Y, Wang LF et al (2010) Magnetic resonance T2 image signal intensity ratio and clinical manifestation predict prognosis after surgical intervention for cervical spondylotic myelopathy. Spine 35:E396–E399CrossRefPubMed Zhang YZ, Shen Y, Wang LF et al (2010) Magnetic resonance T2 image signal intensity ratio and clinical manifestation predict prognosis after surgical intervention for cervical spondylotic myelopathy. Spine 35:E396–E399CrossRefPubMed
14.
Zurück zum Zitat Wang LF, Zhang YZ, Shen Y et al (2010) Using the T2-weighted magnetic resonance imaging signal intensity ratio and clinical manifestations to assess the prognosis of patients with cervical ossification of the posterior longitudinal ligament. J Neurosurg Spine 13:319–323CrossRefPubMed Wang LF, Zhang YZ, Shen Y et al (2010) Using the T2-weighted magnetic resonance imaging signal intensity ratio and clinical manifestations to assess the prognosis of patients with cervical ossification of the posterior longitudinal ligament. J Neurosurg Spine 13:319–323CrossRefPubMed
15.
Zurück zum Zitat Hirabayashi K, Miyakawa J, Satomi K et al (1981) Operative results and postoperative progression of ossification among patients with ossification of posterior longitudinal ligament. Spine 6:354–364CrossRefPubMed Hirabayashi K, Miyakawa J, Satomi K et al (1981) Operative results and postoperative progression of ossification among patients with ossification of posterior longitudinal ligament. Spine 6:354–364CrossRefPubMed
16.
Zurück zum Zitat Furlan JC, Kalsi-Ryan S, Kailaya-Vasan A et al (2011) Functional and clinical outcomes following surgical treatment in patients with cervical spondylotic myelopathy: a prospective study of 81 cases. J Neurosurg Spine 14:348–355CrossRefPubMed Furlan JC, Kalsi-Ryan S, Kailaya-Vasan A et al (2011) Functional and clinical outcomes following surgical treatment in patients with cervical spondylotic myelopathy: a prospective study of 81 cases. J Neurosurg Spine 14:348–355CrossRefPubMed
17.
Zurück zum Zitat Cheung WY, Arvinte D, Wong YW et al (2008) Neurological recovery after surgical decompression in patients with cervical spondylotic myelopathy—a prospective study. Int Orthop 32:273–278PubMedCentralCrossRefPubMed Cheung WY, Arvinte D, Wong YW et al (2008) Neurological recovery after surgical decompression in patients with cervical spondylotic myelopathy—a prospective study. Int Orthop 32:273–278PubMedCentralCrossRefPubMed
18.
Zurück zum Zitat Tani T, Ushida T, Ishida K et al (2002) Relative safety of anterior microsurgical decompression versus laminoplasty for cervical myelopathy with a massive ossified posterior longitudinal ligament. Spine 27:2491–2498CrossRefPubMed Tani T, Ushida T, Ishida K et al (2002) Relative safety of anterior microsurgical decompression versus laminoplasty for cervical myelopathy with a massive ossified posterior longitudinal ligament. Spine 27:2491–2498CrossRefPubMed
19.
Zurück zum Zitat Uchida K, Nakajima H, Sato R et al (2005) Multivariate analysis of the neurological outcome of surgery for cervical compressive myelopathy. J Orthop Sci 10:564–573CrossRefPubMed Uchida K, Nakajima H, Sato R et al (2005) Multivariate analysis of the neurological outcome of surgery for cervical compressive myelopathy. J Orthop Sci 10:564–573CrossRefPubMed
20.
Zurück zum Zitat Fujiwara K, Yonenobu K, Ebara S et al (1989) The prognosis of surgery for cervical compression myelopathy. An analysis of the factors involved. J Bone Joint Surg Br 71:393–398PubMed Fujiwara K, Yonenobu K, Ebara S et al (1989) The prognosis of surgery for cervical compression myelopathy. An analysis of the factors involved. J Bone Joint Surg Br 71:393–398PubMed
21.
Zurück zum Zitat Koyanagi T, Hirabayashi K, Satomi K et al (1993) Predictability of operative results of cervical compression myelopathy based on preoperative computed tomographic myelography. Spine 18:1958–1963CrossRefPubMed Koyanagi T, Hirabayashi K, Satomi K et al (1993) Predictability of operative results of cervical compression myelopathy based on preoperative computed tomographic myelography. Spine 18:1958–1963CrossRefPubMed
22.
Zurück zum Zitat Singh A, Crockard HA, Platts A et al (2001) Clinical and radiological correlates of severity and surgery-related outcome in cervical spondylosis. J Neurosurg 94:189–198PubMed Singh A, Crockard HA, Platts A et al (2001) Clinical and radiological correlates of severity and surgery-related outcome in cervical spondylosis. J Neurosurg 94:189–198PubMed
23.
Zurück zum Zitat Matsuyama Y, Kawakami N, Mimatsu K (1995) Spinal cord expansion after decompression in cervical myelopathy. Investigation by computed tomography myelography and ultrasonography. Spine 20:1657–1663CrossRefPubMed Matsuyama Y, Kawakami N, Mimatsu K (1995) Spinal cord expansion after decompression in cervical myelopathy. Investigation by computed tomography myelography and ultrasonography. Spine 20:1657–1663CrossRefPubMed
24.
Zurück zum Zitat Takahashi M, Sakamoto Y, Miyawaki M et al (1987) Increased MR signal intensity secondary to chronic cervical cord compression. Neuroradiology 29:550–556CrossRefPubMed Takahashi M, Sakamoto Y, Miyawaki M et al (1987) Increased MR signal intensity secondary to chronic cervical cord compression. Neuroradiology 29:550–556CrossRefPubMed
25.
Zurück zum Zitat Al-Mefty O, Harkey LH, Middleton TH et al (1988) Myelopathic cervical spondylotic lesions demonstrated by magnetic resonance imaging. J Neurosurg 68:217–222CrossRefPubMed Al-Mefty O, Harkey LH, Middleton TH et al (1988) Myelopathic cervical spondylotic lesions demonstrated by magnetic resonance imaging. J Neurosurg 68:217–222CrossRefPubMed
26.
Zurück zum Zitat Yukawa Y, Kato F, Yoshihara H et al (2007) MR T2 image classification in cervical compression myelopathy: predictor of surgical outcomes. Spine 32:1675–1678CrossRefPubMed Yukawa Y, Kato F, Yoshihara H et al (2007) MR T2 image classification in cervical compression myelopathy: predictor of surgical outcomes. Spine 32:1675–1678CrossRefPubMed
27.
Zurück zum Zitat Chen CJ, Lyu RK, Lee ST et al (2001) Intramedullary high signal intensity on T2-weighted MR images in cervical spondylotic myelopathy: prediction of prognosis with type of intensity. Radiology 221:789–794CrossRefPubMed Chen CJ, Lyu RK, Lee ST et al (2001) Intramedullary high signal intensity on T2-weighted MR images in cervical spondylotic myelopathy: prediction of prognosis with type of intensity. Radiology 221:789–794CrossRefPubMed
28.
Zurück zum Zitat Okais N, Moussa R, Hage P (1997) Value of increased MRI signal intensity in cervical arthrosis in myelopathies. Neurochirurgie 43:285–290PubMed Okais N, Moussa R, Hage P (1997) Value of increased MRI signal intensity in cervical arthrosis in myelopathies. Neurochirurgie 43:285–290PubMed
Metadaten
Titel
Predictors of surgical outcome in cervical spondylotic myelopathy: focusing on the quantitative signal intensity
verfasst von
Jing Tao Zhang
Fan Tao Meng
Shuai Wang
Lin Feng Wang
Yong Shen
Publikationsdatum
01.12.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
European Spine Journal / Ausgabe 12/2015
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-015-4109-5

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