Cervical spondylotic myelopathy due to chronic compression: the role of signal intensity changes in magnetic resonance images.
OBJECTIVE
Although there is agreement that low-intensity signal changes on T1-weighted magnetic resonance (MR) images are a prognostic factor for poor outcome after surgical treatment of cervical myelopathy due to chronic cord compression, the role of high-intensity signal changes on T2-weighted images is still controversial. The aim of the present study was to determine whether T2-weighted MR imaging can help assess the prognosis of the disease.


METHODS
A prospective case series study was conducted. The population comprised 67 patients who underwent surgery between 1994 and 2004 to treat myelopathy caused by chronic cervical cord compression. The mean follow-up period was 39 months. Preoperative and postoperative functional status was evaluated using a modified Japanese Orthopaedic Association scale, and the recovery rate was calculated using the Hirabayashi method. Magnetic resonance images were acquired 3 months or less before surgery. High-intensity signal changes were evaluated according to the extent of these changes on T2-weighted sequences; low-intensity T1-weighted signal changes were also evaluated. In patients with low-intensity changes on T1-weighted images and in those with high-intensity changes spanning multiple levels on T2-weighted images, the authors documented a poor functional recovery.


CONCLUSIONS
Multisegmental high-intensity change on T2-weighted MR imaging is a more sensitive indicator of outcomes than T1-weighted signal changes because of its higher frequency in patients with advanced myelopathy.
Fernández de Rota
Juan Jose
JJ
Department of Spinal Surgery, University Hospital Virgen de la Victoria, Málaga, Spain.
Meschian
Stephan
S
Fernández de Rota
Antonio
A
Urbano
Victor
V
Baron
Manuel
M
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009187:Myelitis / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D019637:Orthopedic Procedures / Q000379:methods*; D011182:Postoperative Care; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D012720:Severity of Illness Index; D013117:Spinal Cord Compression / Q000150:complications* / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D013166:Spondylitis / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D017211:Treatment Failure