The Relationship Between MRI Signal Intensity Changes, Clinical Presentation and Surgical Outcome in Degenerative Cervical Myelopathy: Analysis of a Global Cohort

Nouri, Aria; Martín, Allan; Kato, So; Kermani, Hamed Reihani; Riehm, Lauren; Fehlings, Michael G.

doi:10.1016/j.spinee.2017.07.208

Cited by 18 publications

(30 citation statements)

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“… 2 The likelihood of myelopathy being present on clinical examination significantly increases with the presence of T2WI cord signal hyperintensity, and there appears to be a stepwise increase in neurological impairment as well as an increased prevalence of signs when comparing patients with no signal change, T2 hyperintensity, and both T2 hyperintensity and T1 hypointensity. 24 , 25 In addition, the number of signs and symptoms and impairment are more prevalent in patients with a greater number of T2 hyperintensity levels. 24 , 25 Similarly, a significant association between a T2WI hyperintensity at the level of maximal spinal cord compression and a lower mJOA has been found.…”

Section: Cervical Spinal Cord Compression With Minimal Symptoms Of Mymentioning

confidence: 99%

“… 24 , 25 In addition, the number of signs and symptoms and impairment are more prevalent in patients with a greater number of T2 hyperintensity levels. 24 , 25 Similarly, a significant association between a T2WI hyperintensity at the level of maximal spinal cord compression and a lower mJOA has been found. 26 However, similar hyperintensity may also be an incidental finding.…”

Section: Cervical Spinal Cord Compression With Minimal Symptoms Of Mymentioning

confidence: 99%

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Clinico-Radiographic Discordance: An Evidence-Based Commentary on the Management of Degenerative Cervical Spinal Cord Compression in the Absence of Symptoms or With Only Mild Symptoms of Myelopathy

Witiw

Mathieu

Nouri

et al. 2017

Global Spine Journal

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Study Design:Narrative review with commentary.Objectives:The growing use of magnetic resonance imaging (MRI) often leaves clinicians faced with scenarios where imaging findings are inconsistent with the clinical picture. This is particularly relevant for degenerative cervical spinal cord compression (CSCC). In this article, we provide a focused narrative literature review to address whether (1) surgery should be offered to asymptomatic patients with CSCC and (2) should MRI spinal cord signal changes influence clinical decisions for a patient with mild myelopathy from CSCC?Methods:Illustrative cases are presented with expert commentary which is supplemented by a focused literature review.Results:The literature suggests that CSCC from degenerative pathology is a common incidental radiographic finding. For those without symptoms of myelopathy, the short-term risk of progression is low. There is a lack of evidence to support surgery for asymptomatic individuals with CSCC who have no risk factors for progression. For these patients, the authors suggest non-operative management that includes education on the symptoms of myelopathy, clinical follow-up within 6 to 12 months, and avoidance of high-risk activities. Conversely, symptomatic patients have a notable risk of progression. Surgical intervention improves neurological function and quality of life regardless of severity. The authors support surgery as an option for all patients with mild myelopathy who are appropriate operative candidates. Intramedullary signal change on MRI has not been shown to reliably predict progression.Conclusions:While MRI technologies are under evolution, we advise that surgical decisions for patients with CSCC should rely on clinical assessment and not imaging findings.

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Section: Cervical Spinal Cord Compression With Minimal Symptoms Of Mymentioning

confidence: 99%

Section: Cervical Spinal Cord Compression With Minimal Symptoms Of Mymentioning

confidence: 99%

Clinico-Radiographic Discordance: An Evidence-Based Commentary on the Management of Degenerative Cervical Spinal Cord Compression in the Absence of Symptoms or With Only Mild Symptoms of Myelopathy

Witiw

Mathieu

Nouri

et al. 2017

Global Spine Journal

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“…MRIs were assessed for the presence and absence of specific pathologies (e.g., isolated disc pathology, spondylolisthesis), for the presence of T2 signal hyperintensity, and T1 signal hypointensity changes. Signal intensity changes on T2 and T1 were reviewed by 3 raters, and the relationship between these changes and clinical presentation, as well as surgical outcome, were previously reported [2]. Therein, inter-rater reliability for signal changes was reported as being in substantial agreement for T2 hyperintensity (Fleiss Kappa: 0.60), and in fair agreement for T1 hypointensity (Fleiss Kappa: 0.31).…”

Section: Mri Datamentioning

confidence: 99%

“…The underlying pathology is heterogeneous and can include intervertebral disc disease, arthritic changes, hypertrophy and/or ossification of the spinal canal ligaments, and spondylolisthesis, ultimately leading to spinal cord injury through static and dynamic injury mechanisms [1]. Depending on the number of cervical levels involved, the degree of cord compression, and the natural history, patients present with a wide-ranging spectrum of clinical manifestations [2,3]. Symptoms include hyperreflexia, weakness, numbness, and loss of proprioception/balance, and clinical signs, such as Hoffmann's sign, Babinski reflex, Lhermitte's phenomenon, ankle clonus, inverted brachioradialis reflex, and Romberg's sign, which may be elicited on clinical examination [2,4,5].…”

Section: Introductionmentioning

confidence: 99%

“…Depending on the number of cervical levels involved, the degree of cord compression, and the natural history, patients present with a wide-ranging spectrum of clinical manifestations [2,3]. Symptoms include hyperreflexia, weakness, numbness, and loss of proprioception/balance, and clinical signs, such as Hoffmann's sign, Babinski reflex, Lhermitte's phenomenon, ankle clonus, inverted brachioradialis reflex, and Romberg's sign, which may be elicited on clinical examination [2,4,5]. Neurophysiological examination may indicate changes in motor and sensory evoked potentials; MRI signal intensity changes on T2 and T1 may highlight injury to the spinal cord.…”

Section: Introductionmentioning

confidence: 99%

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The Relationship Between Gastrointestinal Comorbidities, Clinical Presentation and Surgical Outcome in Patients with DCM: Analysis of a Global Cohort

Nouri

Badhiwala

Kato

et al. 2020

JCM

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Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord impairment in adults, presenting most frequently in patients 50 years or older. Gastrointestinal comorbidities (GICs) commonly occur in this group; however, their relationship with DCM has not been thoroughly investigated. It is the objective of the present study to investigate the difference between patients with or without GICs who are surgically treated for DCM. A cohort of 757 patients with clinical data and 458 with magnetic resonance imaging (MRI) data from the AOSpine North America and AOSpine International studies on DCM was evaluated. GICs were obtained at presentation and included gastric, intestinal, hepatic, and pancreatic conditions. Patients were dichotomized into 2 groups: those with GICs and those without GICs. Both clinical and MRI presentation, as well as baseline neurological and functional status, were compared. Neurological and functional outcomes at 2-year follow-up were also compared. GICs were present in 121 patients (16%). These patients were less commonly male (48.76% vs. 65.4%, p = 0.001) and were slightly less neurologically impaired based on the Nurick grade (3.05 ± 1.10 vs. 3.28 ± 1.16, p = 0.044) but not based on mJOA (12.74 ± 2.62 vs. 12.48 ± 2.76, p = 0.33). They also had a worse physical health score (32.80 ± 8.79 vs. 34.65 ± 9.38 p = 0.049), worse neck disability (46.31 ± 20.04 vs. 38.23 ± 20.44, p < 0.001), a lower prevalence of upper motor neuron signs (hyperreflexia, 70.2% vs. 78.9%, p = 0.037; Babinski’s sign 24.8% vs. 37.3%, p = 0.008), and a higher rate of psychiatric comorbidities (31.4% vs. 10.4%, p < 0.0001). On MRI, GIC patients less commonly exhibited signal intensity changes (T2 hyperintensity, 49.2% vs. 75.6%, p < 0.001; T1 hypointensity, 9.7% vs. 21.1%, p = 0.036), and had a lower number of T2 hyperintensity levels (0.82 ± 0.98 vs. 1.3 ± 1.11, p = 0.001). There was no difference in surgical outcome between the groups. DCM patients with GICs are more likely to be female and have significantly more general health impairment and neck disability. However, these patients have less clinical and MRI features typical of more severe neurological impairment. This constellation of symptoms is considerably different than those typically observed in DCM, and it is therefore plausible that nutritional factors may contribute to this unique observation.

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Apparent diffusion coefficient as an indicator of spinal cord compression due to anterior atlanto-axial subluxation in rheumatoid arthritis patients

et al. 2019

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The aim of this retrospective study was to evaluate the apparent diffusion coefficient (ADC) as a potential parameter of spinal cord damage in cervical spine instability at the atlanto-axial level in rheumatoid arthritis (RA) patients. Methods One hundred and six RA patients were included in the study. MRI examinations were performed with 1.5T scanner. The ADC was measured at six locations in the cervical spinal cord at the height of the first six cervical vertebrae (from C-1 to C-6). The ADC values were assessed in 2 groups: with and without anterior atlanto-axial subluxation (AAS) diagnosed on plain radiographs. Correlations between ADC values and radiographic measurements and RA activity indicators were evaluated. ResultsThe ADC values at C1 level (ADC 1 ) was higher in the group with anterior AAS than in the group without AAS (p < 0.001). Statistically significant moderate positive correlation between ADC 1 and anterior atlanto-axial diameter interval AADI (rho = 0.58; p < 0.008) was found as well as statistically significant weak negative correlation between ADC 1 and posterior atlanto-axial diameter interval PADI (rho = − 0.34; p < 0.008). Conclusions The conducted study demonstrates the applicability of the ADC maps in the identification of spinal cord compression due to anterior AAS in RA patients. The results encourage the practical use of the ADC as an additional parameter in the qualification for surgical treatment.

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The Relationship Between MRI Signal Intensity Changes, Clinical Presentation and Surgical Outcome in Degenerative Cervical Myelopathy: Analysis of a Global Cohort

Cited by 18 publications

References 0 publications

Clinico-Radiographic Discordance: An Evidence-Based Commentary on the Management of Degenerative Cervical Spinal Cord Compression in the Absence of Symptoms or With Only Mild Symptoms of Myelopathy

Clinico-Radiographic Discordance: An Evidence-Based Commentary on the Management of Degenerative Cervical Spinal Cord Compression in the Absence of Symptoms or With Only Mild Symptoms of Myelopathy

The Relationship Between Gastrointestinal Comorbidities, Clinical Presentation and Surgical Outcome in Patients with DCM: Analysis of a Global Cohort

Apparent diffusion coefficient as an indicator of spinal cord compression due to anterior atlanto-axial subluxation in rheumatoid arthritis patients

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