Prognosis in Spine Surgery

Gilbert, Jane; Wheeler, Greg R.; Spitalieri, John R.; Mick, Gregory E.

doi:10.3171/spi/2008/8/5/498

Cited by 6 publications

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“…MR imaging offers an exact morphologic visualization of the stenosis and the cord compression. However, there is no clear correlation between radiologic signs and clinical aspects of cervical myelopathy (3)(4)(5)(6). Patients with severe stenosis and hyperintense signal alterations on T2-weighted MR images can lack any symptoms, and the degree of spinal cord compression correlates neither with the neurologic deficits nor with the recovery after surgical decompression (3)(4)(5)(6).…”

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Hypermetabolism in ¹⁸F-FDG PET Predicts Favorable Outcome Following Decompressive Surgery in Patients with Degenerative Cervical Myelopathy

et al. 2013

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The aim of this study was to prospectively assess the regional changes of glucose metabolism of the cervical spinal cord in patients with degenerative cervical spine stenosis and symptomatic cervical myelopathy after decompressive surgery using 18 F-FDG PET. Methods: Twenty patients with symptomatic degenerative monosegmental cervical stenosis with neuroradiologic signs of spinal cord compression underwent decompressive surgery. The clinical course using a functional status score (Japanese Orthopedic Association [JOA] score), 18 F-FDG uptake, and MR imaging were assessed before and at follow-up 12 mo after surgery. Pre-and postoperative changes of 18 F-FDG PET were correlated to the patients' clinical outcome. Results: Ten patients demonstrated preoperatively a focally increased 18 F-FDG uptake at the level of the stenosis. At follow-up, the uptake declined significantly (P 5 0.008), and a significant improvement of JOA scores (P , 0.001) could be observed. The remaining 10 patients were characterized preoperatively by an inconspicuous glucose uptake at the level of cord compression in combination with a poststenotic decrease of 18 F-FDG uptake. At follow-up, both JOA scores and 18 F-FDG uptake changed insignificantly. Conclusion: Focal glucose hypermetabolism at the level of cervical spinal cord compression may predict an improved outcome after surgical decompression. Thus, this finding on 18 F-FDG PET suggests a functional damage in a reversible phase of cervical myelopathy. Compr ession of the cervical spinal cord due to degenerative cervical spine stenosis induces a progressive dysfunction of the myelon with subsequent neurologic deficits (i.e., cervical myelopathy) (1,2). MR imaging offers an exact morphologic visualization of the stenosis and the cord compression. However, there is no clear correlation between radiologic signs and clinical aspects of cervical myelopathy (3-6). Patients with severe stenosis and hyperintense signal alterations on T2-weighted MR images can lack any symptoms, and the degree of spinal cord compression correlates neither with the neurologic deficits nor with the recovery after surgical decompression (3-6). Therefore, mechanical compression of the cervical spinal cord alone seems not to be the essential factor for the development of myelopathy. Other factors such as a compression-induced neuroinflammation have been recently discussed (7-9).Given the limitations of conventional MR imaging in prediction of clinical outcome in patients with cervical myelopathy, 18 F-FDG PET has been used for metabolic assessment of the healthy, noncompressed cervical spinal cord (10-14) as well of the affected spinal cord (13). In a previous publication (15), we reported preliminary results of this prospective study on 18 F-FDG uptake in 20 patients with compression of the cervical spinal cord due to degenerative cervical spine stenosis and cervical myelopathy. In the present work, we report the final results including pre-and postoperative data of MR imaging and 18 F-FDG PET as well as the clinical...

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Hypermetabolism in ¹⁸F-FDG PET Predicts Favorable Outcome Following Decompressive Surgery in Patients with Degenerative Cervical Myelopathy

et al. 2013

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“…Neither clinical symptoms nor postsurgical outcome correlates with the morphological aspects of CSM as assessed by structural MRI. 13,18,25,35 To date, our knowledge of what brings about recovery, even without decompressive surgery to resolve the cause of compression, is limited. Recently, there has been Clinically there were no symptoms of myelopathy (JOA score of 17).…”

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confidence: 99%

“…The MR images (C 1 , D 1 , and E 1 ) show, morphologically, the typical degenerative stenosis with cord compression and intramedullary hyperintensity (arrow). The corresponding 18 F-FDG PET scans (C 2 , D 2 , and E 2 ) reveal an increased "peak" uptake of glucose (local hypermetabolism) at the individual level of stenosis. F and G: Two patients with clinically chronic myelopathy and stable symptoms (JOA score < 12) for at least 12 months.…”

Section: ©Aans 2013mentioning

confidence: 99%

“…Metabolic evaluation of spinal cord pathologies using 18 F-FDG PET has been performed for more than 25 years, especially in cases of neoplastic diseases 8,16,24,26,27,29,32,40 but also in a variety of cases involving benign inflammatory intraspinal lesions such as infections, 17 tophaceous gout, 33 and neurosarcoidosis. 10,31 In all of these space-occupying and compressive lesions, 18 F-FDG PET has been used to differentiate between benign and malignant pathologies or to monitor biological activity.…”

Section: F-fdg Pet Imaging In Patients With Csmmentioning

confidence: 99%

“…10,31 In all of these space-occupying and compressive lesions, 18 F-FDG PET has been used to differentiate between benign and malignant pathologies or to monitor biological activity. For the most part, all malignant entities like spinal metastasis and inflammatory diseases like neurosarcoidosis are characterized by an increased glucose uptake.…”

Section: F-fdg Pet Imaging In Patients With Csmmentioning

confidence: 99%

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Clinical value of 2-deoxy-[18F]fluoro-d-glucose positron emission tomography in patients with cervical spondylotic myelopathy

Eicker¹,

Langen²,

Galldiks

et al. 2013

FOC

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Cervical spondylotic myelopathy (CSM) is one of the most common spinal cord disorders in the elderly. It is usually diagnosed by MRI, but in a significant number of patients the clinical course of CSM does not correlate with the extent of the spinal cord compression. Recent studies have suggested that a distinct metabolic pattern of the cervical cord, as assessed by PET with 2-deoxy-[18F]fluoro-d-glucose (18F-FDG) may predict a patient's clinical outcome after decompressive surgery for cervical spine stenosis. The authors provide an overview of the recent literature regarding the value of PET with 18F-FDG of the cervical cord in patients with CSM, paying attention to prognostic aspects and the potential role of inflammatory processes in the acute phase of the disease.

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Regional impairment of 18F-FDG uptake in the cervical spinal cord in patients with monosegmental chronic cervical myelopathy

et al. 2010

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Prognosis in Spine Surgery

Cited by 6 publications

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Hypermetabolism in ¹⁸F-FDG PET Predicts Favorable Outcome Following Decompressive Surgery in Patients with Degenerative Cervical Myelopathy

Hypermetabolism in ¹⁸F-FDG PET Predicts Favorable Outcome Following Decompressive Surgery in Patients with Degenerative Cervical Myelopathy

Clinical value of 2-deoxy-[18F]fluoro-d-glucose positron emission tomography in patients with cervical spondylotic myelopathy

Regional impairment of 18F-FDG uptake in the cervical spinal cord in patients with monosegmental chronic cervical myelopathy

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Prognosis in Spine Surgery

Cited by 6 publications

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Hypermetabolism in 18F-FDG PET Predicts Favorable Outcome Following Decompressive Surgery in Patients with Degenerative Cervical Myelopathy

Hypermetabolism in 18F-FDG PET Predicts Favorable Outcome Following Decompressive Surgery in Patients with Degenerative Cervical Myelopathy

Clinical value of 2-deoxy-[18F]fluoro-d-glucose positron emission tomography in patients with cervical spondylotic myelopathy

Regional impairment of 18F-FDG uptake in the cervical spinal cord in patients with monosegmental chronic cervical myelopathy

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Hypermetabolism in ¹⁸F-FDG PET Predicts Favorable Outcome Following Decompressive Surgery in Patients with Degenerative Cervical Myelopathy

Hypermetabolism in ¹⁸F-FDG PET Predicts Favorable Outcome Following Decompressive Surgery in Patients with Degenerative Cervical Myelopathy