title: Diffusion Tensor Imaging Correlates with Short-Term Myelopathy Outcome in Patients with Cervical Spondylotic Myelopathy.
abstract: OBJECTIVE
  To determine if spinal cord diffusion tensor imaging indexes correlate with short-term clinical outcome in patients undergoing elective cervical spine surgery for cervical spondylotic myelopathy (CSM).
  
  
  METHODS
  A prospective consecutive cohort study was performed in patients undergoing elective cervical spine surgery for CSM. After obtaining informed consent, patients with CSM underwent preoperative T2-weighted magnetic resonance imaging and diffusion tensor imaging of the cervical spine. Fractional anisotropy (FA) values at the level of maximum cord compression and at the noncompressed C1-2 level were calculated on axial images. We recorded the modified Japanese Orthopaedic Association (mJOA) scale, Neck Disability Index, and Short Form-36 physical functioning subscale scores for all patients preoperatively and 3 months postoperatively. Statistical analysis was performed to identify correlations between FA and clinical outcome scores.
  
  
  RESULTS
  The study included 27 patients (mean age 54.5 years ± 1.9, 12 men). The mean postoperative changes in mJOA scale, Neck Disability Index, and Short Form-36 physical functioning subscale scores were 0.9 ± 0.3, -6.0 ± 1.9, and 3.4 ± 1.9. The mean FA at the level of maximum compression was significantly lower than the mean FA at the C1-2 level (0.5 vs. 0.55, P = 0.01). FA was significantly correlated with change in mJOA scale score (Pearson r = -0.42, P = 0.02). FA was significantly correlated with the preoperative mJOA scale score (Pearson r = 0.65, P < 0.001).
  
  
  CONCLUSIONS
  Preoperative FA at the level of maximum cord compression significantly correlates with the 3-month change in mJOA scale score among patients with CSM. FA was also significantly associated with preoperative mJOA scale score and is a potential biomarker for spinal cord dysfunction in CSM.
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Aditya
authors.initials: A
authors.lastname: Vedantam
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: Avinash
authors.initials: A
authors.lastname: Rao
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. Electronic address: skurpad@mcw.edu.
authors.forename: Shekar N
authors.initials: SN
authors.lastname: Kurpad
authors.affiliation: Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Jirjis
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Gerald
authors.initials: G
authors.lastname: Eckardt
authors.affiliation: Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin, USA.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Schmit
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: Marjorie C
authors.initials: MC
authors.lastname: Wang
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery*; D015331:Cohort Studies; D056324:Diffusion Tensor Imaging / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055009:Spondylosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D016896:Treatment Outcome
keywords: Cervical spine; Diffusion tensor; Diffusion tensor imaging; Fractional anisotropy; Magnetic resonance imaging; Myelopathy; Spondylosis