title: Cervical spondylotic myelopathy: the prediction of outcome following surgical intervention in 93 patients using T1- and T2-weighted MRI scans.
abstract: BACKGROUND
  Cervical spondylotic myelopathy (CSM) can lead to significant disability through a spectrum of clinical manifestations ranging from dexterity loss to more profound weakness, incontinence and paralysis.
  
  
  OBJECTIVE
  To determine the outcome of surgical decompression for CSM and investigate pre-operative predictors of outcome.
  
  
  METHODS
  Prospectively collected data on all patients who underwent decompressive surgery for CSM and completed 12-month follow-up were reviewed. Data on age, MRI T1 and T2 signal changes pre-operatively, surgical approach and the Nurick's Myelopathy Grade (NMG) was analysed pre-operatively and 1 year post-surgery.
  
  
  RESULTS
  Data on 93 consecutive patients who underwent surgery for CSM were reviewed. Median age was 62 (23-94) years and 59% were male. The median follow-up was 37 (17-88) months. The approach was anterior in 38 (42%) patients, posterior in 55 (58%); improvement was not significantly different when the two groups were compared. The number of levels decompressed increased with age (p value <0.0001). The group with a pre-operatively high signal on T1-weighted MRI images [n = 28 (30%)] was associated with less neurological recovery post-operatively compared to the patients with a normal T1 cord signal. None of the patients deteriorated neurologically post-operatively, while 66% improved by at least one NMG.
  
  
  CONCLUSIONS
  Surgical decompressions for CSM stop the progress of symptoms at 12 months post-surgery and may result in a significant improvement of NMG in two-thirds of the patients. Changes in the T1-weighted MRI images predict worse outcomes following surgery.
authors.affiliation: Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK.
authors.forename: Hatem M I
authors.initials: HM
authors.lastname: Salem
authors.affiliation: Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK.
authors.forename: Khalid M I
authors.initials: KM
authors.lastname: Salem
authors.affiliation: Department of Abdominal, Thoracic Surgery and Traumatology, 1st Medical School, Charles University, Prague, Czech Republic.
authors.forename: Filip
authors.initials: F
authors.lastname: Burget
authors.affiliation: Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK.
authors.forename: Raj
authors.initials: R
authors.lastname: Bommireddy
authors.affiliation: Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK. klezl.zdenek.sen@seznam.cz.|Department of Orthopaedics and Traumatology, 3rd Medical School, Charles University, Prague, Czech Republic. klezl.zdenek.sen@seznam.cz.
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Klezl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013118:Spinal Cord Diseases / Q000175:diagnosis / Q000601:surgery*; D055009:Spondylosis / Q000601:surgery*; D055815:Young Adult
keywords: Cervical spondylotic myelopathy; Decompression; MRI; Outcome