Postoperative Magnetic Resonance Imaging Can Predict Neurological Recovery After Surgery for Cervical Spondylotic Myelopathy: A Prospective Study With Blinded Assessments

Arvin, B. Mak; Kalsi-Ryan, Sukhvinder; Karpova, Alina; Mercier, David; Furlan, Julio C.; Massicotte, Eric M.; Fehlings, Michael G.

doi:10.1227/neu.0b013e31821a418c

Cited by 46 publications

(49 citation statements)

References 20 publications

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“…Indeed in Seo et al series in 5 patients among 31 cases it increased in size and in 19 it remained the same [45]. The importance of this in relation to cervical spinal surgery is that every effort should be made to remove posterior osteophytes during anterior interbody fusion [11,45]. We agree with them and in all cases we had excised the posterior osteophytes to achieve good results.…”

Section: Fate Of the Posterior Osteophyte After Anterior Fusion Surgementioning

confidence: 58%

“…These were documented by following up of our patients for periods greater than 5 years along with post operative MRI scans. Lack of expansion of the spinal cord even after 6 months post surgery indicates poor prognosis [45]. Thus we opine it is probably due to inadequate decompression of the spinal cord which has occurred due to partial removal of the posterior osteophytes or non-removal of it.…”

Section: Fate Of the Posterior Osteophyte After Anterior Fusion Surgementioning

confidence: 78%

“…Stevens et al [11] and Seo et al [44] have shown that there was no evidence of remodeling or resorption of osteophytes and persistent posterior osteophytes continue to deform the spinal cord for up to 5 to 12 years after achieving good anterior interbody fusion following anterior cervical disc surgery ( Figure 9). Indeed in Seo et al series in 5 patients among 31 cases it increased in size and in 19 it remained the same [45]. The importance of this in relation to cervical spinal surgery is that every effort should be made to remove posterior osteophytes during anterior interbody fusion [11,45].…”

Section: Fate Of the Posterior Osteophyte After Anterior Fusion Surgementioning

confidence: 95%

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Posterior Osteophyte Evolution and its Impact in Cervical Spondylosis: A Literature Review

Lawrence¹

2013

J Spine

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Introduction: In cervical disc disease, the exact location of the posterior osteophyte with relationship to the bodies of the adjacent cervical vertebra at each disc space level, as observed during surgery under operating microscope and correlating it with the histopathological development of the posterior osteophyte has not been documented in literature. A detailed review of literature on the development of posterior osteophytes and its impact on cervical spinal cord is also being reviewed.

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Section: Fate Of the Posterior Osteophyte After Anterior Fusion Surgementioning

confidence: 58%

Section: Fate Of the Posterior Osteophyte After Anterior Fusion Surgementioning

confidence: 78%

Section: Fate Of the Posterior Osteophyte After Anterior Fusion Surgementioning

confidence: 95%

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Posterior Osteophyte Evolution and its Impact in Cervical Spondylosis: A Literature Review

Lawrence¹

2013

J Spine

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“…This disparity between clinical and radiological parameters may be related to factors independent of radiology, such as preoperative functional status, symptom duration, and concurrent lumbar spine or peripheral nerve disease as well as parameters that are difficult to quantify, such as patient motivation and expectation, glycemic control, and nicotine dependence. 2,8,12,23,36 The presence of a T1-weighted hypointensity is probably the single best predictor of outcome on preoperative imaging, 3,6,10,22,32,33 but these changes are relatively uncommon. The exact prognostic relevance of the quality of T2-weighted ISI changes in the absence of T1-weighted changes remains elusive.…”

Section: Prognostic Relevance Of T2-weighted Isimentioning

confidence: 99%

The evolution of T2-weighted intramedullary signal changes following ventral decompressive surgery for cervical spondylotic myelopathy

Sarkar¹,

Turel²,

Jacob

et al. 2014

SPI

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Object T2-weighted intramedullary increased signal intensity (ISI) on MRI in patients with cervical spondylotic myelopathy (CSM) appears to represent a wide spectrum of pathological changes that determine reversibility of cord damage. Although sharp T2-weighted ISI on preoperative imaging may correlate with poorer surgical outcomes, there are limited data on how these changes progress following surgery. In this study, the authors characterized pre-and postoperative ISI changes in patients undergoing surgery for CSM and studied their postoperative evolution in an attempt to quantify their clinical significance. Methods The preoperative and postoperative MR images obtained in 56 patients who underwent oblique cervical corpectomy for CSM were reviewed, and the ISI was classified into 4 subtypes based on margins and intensity: Type 0 (none), Type 1 (“fuzzy”), Type 2 (“sharp”), and Type 3 (“mixed”). The locations of the ISI were further classified as focal if they represented single discrete lesions, multifocal if there were multiple lesions with intervening normal cord, and multisegmental if the lesions were continuous over more than 1 segment. The maximum craniocaudal length of the ISI was measured on each midsagittal MR image. The Nurick grade and Japanese Orthopaedic Association (JOA) score were used to assess clinical status. The mean duration of follow-up was 28 months. Results T2-weighted ISI changes were noted preoperatively in 54 patients (96%). Most preoperative ISI changes were Type 1 (41%) or Type 3 (34%), with a significant trend toward Type 2 (71%) changes at follow-up. Multi-segmental and Type 3 lesions tended to regress significantly after surgery (p = 0.000), reducing to Type 2 changes at follow-up. Clinical outcomes did not correlate with ISI subtype; however, there was a statistically significant trend toward improvement in postoperative Nurick Grade in patients with a > 50% regression in ISI size. In addition, patients with more than 18 months of follow-up showed significant regression in ISI size compared with patients imaged earlier. On logistic regression analysis, preoperative Nurick grade and duration of follow-up were the only significant predictors of postoperative improvement in functional status (OR 4.136, p = 0.003, 95% CI 1.623–10.539 and OR 6.402, p = 0.033, 95% CI 1.165–35.176, respectively). Conclusions There is a distinct group of patients with multisegmental Type 3 intramedullary changes who show remarkable radiological regression after surgery but demonstrate a residual sharp focal ISI at follow-up. A regression of the ISI by > 50% predicts better functional outcomes. Patients with a good preoperative functional status remain the most likely to show improvement, and the improvement continues to occur even at remote follow-up. The clinical relevance of the quality of the T2-weighted ISI changes in patients with CSM remains uncertain; however, postoperative regression of the ISI change is possibly a more important correlate of patient outcome than the quality of the ISI change alone.

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“…MRI can show not only the etiology of myelopathy but also the intramedullary state of the spinal cord in detail, 6,7 thereby helping in both the diagnosis and prognosis of CSM. 8,9 To date, postoperative MRI has not yet been fully studied in relation to the correlation of morphology or signal change of cervical cord and longer-term prognosis in CSM patients. In our study, we have focused on quantitative analysis of signal intensity (SI) and transverse area (TA) of the spinal cord on T2-weighted MRI preoperatively and postoperatively.…”

Section: Introductionmentioning

confidence: 99%

Quantitative magnetic resonance imaging analysis correlates with surgical outcome of cervical spondylotic myelopathy

Wang

et al. 2014

Spinal Cord

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Study design: Prospective study. Objectives: To investigate whether preoperative and postoperative changes of signal intensity (SI) and transverse area (TA) of the spinal cord reflect the surgical outcome in patients with cervical spondylotic myelopathy (CSM). Setting: The Second Hospital of Tangshan, Tangshan, Hebei, China. Methods: In 45 consecutive prospective patients, magnetic resonance imaging (MRI) was performed preoperatively and 3 months postoperatively. The Japanese Orthopedic Association (JOA) scale was used to quantify the neurological status at admission and of at least 12-month follow-up. Preoperative and postoperative TA of the spinal cord at the site of maximal compression and grayscale of signal intensity (GSI) were measured using the image analysis software. Ratio of transverse area (RTA) and ratio of grayscale of signal intensity (RGSI) were used to assess the extent of spinal cord re-expansion and extent of SI regression. Preoperative status and postoperative recovery were assessed in relation to MRI parameters preoperatively and postoperatively using univariate and multivariate analysis. Results: Higher baseline JOA scores were associated with larger TA. Greater recovery rate was associated with larger preoperative and postoperative TA, along with greater RTA. Recovery rate negatively correlated with RGSI and age. Higher baseline JOA score was associated with greater recovery rate. RGSI negatively correlated with RTA. Multivariate stepwise regression analysis showed that the optimal combination of surgical outcome predictors included age, postoperative TA and RGSI. 1 The natural history of CSM is progressive neurological deterioration in the majority of patients. The surgical intervention have been advocated to alter the natural history and improve the prognosis of patients with CSM. How to predict neurological outcomes after surgery is of great importance for the management of CSM patients. Various factors that may influence the surgical outcome include the patient's age, duration of myelopathic symptoms, baseline neurological status, preoperative signal changes on magnetic resonance images and TA of the spinal cord. [2][3][4][5] There is no doubt that magnetic resonance imaging (MRI) is the best radiological modality for examination and evaluation of patients with CSM. MRI can show not only the etiology of myelopathy but also the intramedullary state of the spinal cord in detail, 6,7 thereby helping in both the diagnosis and prognosis of CSM. 8,9 To date, postoperative MRI has not yet been fully studied in relation to the correlation of morphology or signal change of cervical cord and longer-term prognosis in CSM patients. In our study, we have focused on quantitative analysis of signal intensity (SI) and transverse area (TA) of the spinal cord on T2-weighted MRI preoperatively and postoperatively. The purpose of the present study was to investigate

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Postoperative Magnetic Resonance Imaging Can Predict Neurological Recovery After Surgery for Cervical Spondylotic Myelopathy: A Prospective Study With Blinded Assessments

Abstract: Findings on postoperative MRI at 6 months is of predictive value in determining outcomes in CSM patients. The persistence and type of T2 signal change and lack of re-expansion of the cord correlate with poorer recovery and likely reflect irreversible structural changes in the spinal cord.

Cited by 46 publications

References 20 publications

Posterior Osteophyte Evolution and its Impact in Cervical Spondylosis: A Literature Review

Posterior Osteophyte Evolution and its Impact in Cervical Spondylosis: A Literature Review

The evolution of T2-weighted intramedullary signal changes following ventral decompressive surgery for cervical spondylotic myelopathy

Quantitative magnetic resonance imaging analysis correlates with surgical outcome of cervical spondylotic myelopathy

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