The value of preoperative magnetic resonance imaging in predicting postoperative recovery in patients with cervical spondylosis myelopathy: a meta-analysis

Abstract

This meta-analysis was designed to elucidate whether preoperative signal intensity changes could predict the surgical outcomes of patients with cervical spondylosis myelopathy on the basis of T1-weighted and T2-weighted magnetic resonance imaging images. We searched the Medline database and the Cochrane Central Register of Controlled Trials for this purpose and 10 studies meeting our inclusion criteria were identified. In total, 650 cervical spondylosis myelopathy patients with (+) or without (-) intramedullary signal changes on their T2-weighted images were examined. Weighted mean differences and 95% confidence intervals were used to summarize the data. Patients with focal and faint border changes in the intramedullary signal on T2 magnetic resonance imaging had similar Japanese Orthopaedic Association recovery ratios as those with no signal changes on the magnetic resonance imaging images of the spinal cord did. The surgical outcomes were poorer in the patients with both T2 intramedullary signal changes, especially when the signal changes were multisegmental and had a well-defined border and T1 intramedullary signal changes compared with those without intramedullary signal changes. Preoperative magnetic resonance imaging including T1 and T2 imaging can thus be used to predict postoperative recovery in cervical spondylosis myelopathy patients.

High cord signals on magnetic resonance and other factors predict poor outcomes of cervical spine surgery: A review

“…Here we reviewed multiple MR-based (MR: T1, T2, T1 enahnced studies) prognostic factors for CSM patients undergoing spinal surgery [Tables 1 – 3 ]. [ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 ] The best/better outcomes correlated with Grade 0/Grade 1 MR changes on preoperative/postoperative MR studies, or trends toward improvement where postoperative T2 HCS regressed. [ 5 8 9 ] Poorer/worse prognoses correlated with HCS seen on all preoperative/postoperative MR scans, their failure to regress, documentation of cord re-expansion at sites of prior HCS, and residual triangular cord configurations.…”

“…Outcomes were correlated with patients undergoing anteiror cervical diskectomy/fusion (ACDF), anterior corpectomy/fusion (ACF), laminectomy with/without posterior fusion (LAM), and laminoplasty (LOP) [Tables 1 – 3 ; Figures 1 – 6 ]. [ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 ] Several Types/Grades helped assess the severity/prognostic import of low cord signals (LCS) and high cord signals (HCS) on preoperative/postoperative MR studies; Type/Grade 0: no/absent low cord signal (LCS), Type/Grade 1: faint/fuzzy/mild/obscure LCS; Grade 2: middle/intense/sharp HCS; and Type/Grade 3: mixed/HCS. [ 1 5 8 14 ] Additionally, the location/extent of HCS on T2 sagittal MR studies also impacted outcome and were defined as: focal (single level), multifocal (with skip areas), and/or multisegmental (MS: >1 level; continuous).…”

“…In several studies, poorer prognoses correlated with preoperative HCS on MR (T1, T1-Gd-DTPA, and T2), preoperative and persistent postoperative triangular cord configuration (reflecting underlying cord atrophy), and cord re-expansion at the site of a prior HCS [Tables 1 and 2 ; Figures 1 and 2 ]. [ 1 2 3 4 6 11 13 14 ] When Matsuyama et al . (2004) evaluated 44 patients with CSM/OPLL undergoing LOP, the worst postoperative outcomes correlated with preoperative LCS on T1/HCS on T2 MR, postoperative MR-documented cord re-expansion, and triangular cord configuration (e.g.…”

“…(2016) evaluated 10 studies (Medline/Cochrane databases) involving 650 CSM surgical patients, better JOA outcomes correlated with Types/Grades 0–1 preoperative MR findings, while poorer outcomes were seen with postoperative HCS on T1/T2 studies (especially multisegmental). [ 2 ] For 112 patients with CSM undergoing 1 to 2 level ACDF, Kim et al . (2016) also correlated HCS on preoperative/persistent postoperative MR studies (T1, T1 Gd-DTPA, T2) with poorer outcomes.…”

Degenerative Cervical Myelopathy: Natural History, Clinical Presentation, Current Diagnosis and Treatment Review

“…Due to this fact, T2 sequences are affected earlier than T1 and T1 hypointense signals will always be accompanied by T2 hyperintense signals [82] . Therefore, T2 hyperintense signal is a marker of early myelopathy and the T1 hypointense signal is correlated to advanced spinal cord injury [83,84] . The hyperintense signs of the spinal cord were described as three types of Increased Signal Intensity (ISI) on T2-weighted MRI images: Type-1: none, Type-2: light and diffuse area, and Type-3: bright, strong hyperintense wellcircumscribed [85] .…”