title: Postoperative magnetic resonance imaging can predict neurological recovery after surgery for cervical spondylotic myelopathy: a prospective study with blinded assessments.
abstract: BACKGROUND
  Factors that can predict the recovery of cervical spondylotic myelopathy (CSM) patients postoperatively are of significant interest to physicians and patients and their families. Magnetic resonance imaging (MRI) scans are a common method of examination after surgery, and thus of interest as a predictor of outcome.
  
  
  OBJECTIVE
  To investigate whether findings on MRI at 6 months postoperatively could predict recovery at 1 year in CSM patients.
  
  
  METHODS
  In 52 consecutive prospective patients, MRI was performed preoperatively and 6 months postoperatively. T1 and T2 signal change (area, height, and segmentation) and spinal cord re-expansion were measured. Outcome measures evaluated at 1 year postoperatively were compared with preoperative values. Univariate and stepwise multiple regressions were undertaken.
  
  
  RESULTS
  Using univariate analysis, patients whose cord failed to re-expand had poorer outcome according to the modified Japanese Orthopedic Association score and Nurick score (P = .014) and grip test (P = .006) postoperatively. Stepwise multivariate regression showed lack of cord re-expansion to be predictive of prognosis postoperatively in the modified Japanese Orthopedic Association score (P = .013) and Berg Balance Scale (P = .014), and walking test (P = .011). Postoperative hyperintense T2 signal change was predictive of worse outcome on the Berg Balance Scale (P = .014) and walking test (P = .020), Nurick score (P = .001), and Short Form-36 scores (P = .020). In cases in which the T2 signal intensified, there was a poorer outcome on Nurick scores (P = .013), grip test (P = .017), and Short Form-36 scores (P = .030).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosurgery, Queens Hospital, Romford Essex, United Kingdom.
authors.forename: Babak
authors.initials: B
authors.lastname: Arvin
authors.forename: Sukhvinder
authors.initials: S
authors.lastname: Kalsi-Ryan
authors.forename: Alina
authors.initials: A
authors.lastname: Karpova
authors.forename: David
authors.initials: D
authors.lastname: Mercier
authors.forename: Julio C
authors.initials: JC
authors.lastname: Furlan
authors.forename: Eric M
authors.initials: EM
authors.lastname: Massicotte
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011237:Predictive Value of Tests; D020127:Recovery of Function / Q000502:physiology*; D016037:Single-Blind Method; D013118:Spinal Cord Diseases / Q000473:pathology*; D055009:Spondylosis / Q000473:pathology*