The Relationship Between Preoperative Clinical Presentation and Quantitative Magnetic Resonance Imaging Features in Patients With Degenerative Cervical Myelopathy.
Degenerative cervical myelopathy encompasses a group of conditions resulting in progressive spinal cord injury through static and dynamic compression. Although a constellation of changes can present on magnetic resonance imaging (MRI), the clinical significance of these findings remains a subject of controversy and discussion.



To investigate the relationship between clinical presentation and quantitative MRI features in patients with degenerative cervical myelopathy.



A secondary analysis of MRI and clinical data from 114 patients enrolled in a prospective, multicenter study was conducted. MRIs were assessed for maximum spinal cord compression (MSCC), maximum canal compromise (MCC), signal changes, and a signal change ratio (SCR). MRI features were compared between patients with and those without myelopathy symptoms with the use of t tests. Correlations between MRI features and duration of symptoms were assessed with the Spearman ρ.



Numb hands and Hoffmann sign were associated with greater MSCC ( P < .05); broad-based, unstable gait, impairment of gait, and Hoffmann sign were associated with greater MCC ( P < .05); and numb hands, Hoffmann sign, Babinski sign, lower limb spasticity, hyperreflexia, and T1 hypointensity were associated with greater SCR ( P < .05). Patients with a T2 signal hyperintensity had greater MSCC and MCC ( P < .001).



MSCC was associated with upper limb manifestations, and SCR was associated with upper limb, lower limb, and general neurological deficits. Hoffmann sign occurred more commonly in patients with a greater MSCC, MCC and SCR. The Lhermitte phenomenon presented more commonly in patients with a lower SCR and may be an early indicator of mild spinal cord involvement. Research to validate these findings is required.
Division of Neurosurgery and Spine Program, Toronto Western Hospital, Toronto, Ontario, Canada.
Aria
A
Nouri
Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada.
Lindsay
L
Tetreault
Christchurch Public Hospital & Burwood Spinal Unit, Christchurch, New Zealand.
Kristian
K
Dalzell
Department of Orthopedics, Hospital del Trabajador de Santiago, Santiago, Chile.
Juan J
JJ
Zamorano
Division of Neurosurgery and Spine Program, Toronto Western Hospital, Toronto, Ontario, Canada.
Michael G
MG
Fehlings
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013118:Spinal Cord Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D013130:Spinal Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery
Cervical spondylotic myelopathy; Clinical presentation; Diagnosis; Imaging; Spinal cord compression