Clinical and MRI Predictors of Outcome After Surgical
Intervention for Cervical Spondylotic Myelopathy
T. Al***, MD, R. Kern, MD, MHSc, FRCP(C), M. Fehlings, MD, PhD, FRCS(C)
From the Stroke Department, University of Alberta Hospital, University of Alberta, Edmonton, Alberta, Canada (TA); Neurosurgery Department, Toronto Western Hospital (MF)
and Neurology Department, Mount Sinai Hospital (RK), University Health Network, University of Toronto, Toronto, Ontario (Canada).
Keywords: MRI A (N/N), MRI B (N/Hi),
MRI C (Lo/Hi)
Acceptance: Received December 14,
2006, and in revised form December 14,
2006. Accepted for publication December
18, 2006.
Correspondence: Address correspondence
to T. Al****** MD, Room 533
HMRC, Walter C. Mackenzie Health Sciences
Centre, University of Alberta, 8440
- 112 Street, Edmonton, AB T6G 2S2. Email:
**********@gmail.com.
J Neuroimaging 2007;17:1-9.
DOI 10.1111/j.1552-6569.2007.00119.x.
A B S T R A C T
BACKGROUND
Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction
in older individuals. Controversy remains in terms of the optimal timing and
indications for surgical intervention. In this context, it would be of benefit to define
clinical and magnetic resonance imaging (MRI) predictors of outcome after intervention
for CSM.
OBJECTIVE
We studied subjects with clinically documented cervical myelopathy to evaluate the relationship
among preoperative MRI signal change, clinical findings, and outcome after
surgical intervention.
METHODS
We performed a retrospective case study of 76 CSM patients who underwent cervical
decompressive surgery and who had pre- and postoperative MRI studies available for review.
Preoperative clinical findings and MRI abnormalities on T1- (T1WI) and T2-weighted
(T2WI) images were correlated with outcomes (Nurick scores; Odom’s criteria) following
surgical intervention. Postoperative MRIs were performed 2-4 months postsurgery
to assess for adequacy of decompression and resolution of preoperative signal changes.
The pattern of spinal cord signal intensity was classified as: Group A (MRI N/N), no
intramedullary signal intensity abnormality on T1WI or T2WI; Group B (MRI N/Hi), no
intramedullary signal intensity abnormality on T1WI and high intramedullary signal intensity
on T2WI; Group C (MRI Lo/Hi), low intensity intramedullary signal abnormality on
T1WI and high intensity intramedullary signal abnormality on T2WI. Statistical analyses
were performed using SAS (version 8.2).
RESULTS
We evaluated 76 patients (57% males, mean age 62 years, range 30-89) who experienced
preoperative symptoms for an average of 6.5 months (range 1 month to 9 years). Preoperative
MRI studies demonstrated the following: Group A (MRI N/N) = 45; Group B (MRI
N/Hi) = 23; and Group C (MRI Lo/Hi) = 8. The mean postoperative follow-up period was
2.5 years (range 2 months to 8.5 years). A positive Babinski sign and the presence of
intrinsic hand muscle atrophy showed the greatest association with abnormal preoperative
MRI signal change. High preoperative Nurick score, clonus, and leg spasticity were
associated with a less favorable postoperative outcome. In Group B (MRI N/Hi), 11/23
(52.17%) patients had recovery to MRI N/N (P < .0001) at their follow-up scan.
CONCLUSIONS
Patients with high intramedullary signal change on T2WI who do not have clonus or
spasticity may experience a good surgical outcome and may have reversal of the MRI
abnormality. A less favorable surgical outcome is predicted by the presence of low intramedullary
signal on T1WI, clonus, or spasticity. These data suggest that there may be
a window of opportunity to obtain optimal surgical outcomes in patients with CSM.
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a promssing criterias for early CSM prediction-study published-2007.
a prospective studies undrtaking now at several centers :Toronto neurosurgery, London Ontario & UK as these finding will open a new approach of CSM treatment.
American Society of Neuroimaging. .
Clinical and MRI predictors of outcome after surgical intervention for cervical spond
رد : Clinical and MRI predictors of outcome after surgical intervention for cervical 
مواقع النشر (المفضلة)