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CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(01): 106-110
DOI: 10.4103/ajns.AJNS_262_17
Original Article

The relation between cord signal and clinical outcome after anterior cervical discectomy in patients with degenerative cervical disc herniation

Ali Hamdan
Department of Neurosurgery, Faculty of Medicine, South Valley University, Qena
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Introduction: Cervical spondylotic myelopathy is a cervical cord compressive lesion that occurs as a result of the normal degenerative process which may cause magnetic resonance imaging (MRI) cord intensity changes that may worsen the clinical outcome even after successful anterior cervical decompression. Objective: To assess the relation between MRI T2 Weighted images (T2 WI) hyperintense cord signal and clinical outcome after anterior cervical discectomy in patients with degenerative cervical disc herniation. Materials and Methods: This is a retrospective observational study that was conducted on twenty-five patients with degenerative cervical disc prolapse associated with MRI T2WI hyperintense cord signal, at the Department of Neurosurgery, Qena University Hospital, South Valley University from August 2014 to December 2016. A complete clinical and radiological evaluation of the patients was done. Anterior cervical discectomy and fusion was done for all patients. Patients were clinically assessed preoperatively and postoperatively at 3, 6, and 12 months using Modified Japanese Orthopedic Association (MJOA) score. Radiographic assessment was done by preoperative and postoperative T2WI MRI. The statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software (version 22.0). Results: There were 25 patients included in the study; 16 (64%) females and 9 (36%) males. The mean age was 46.89 ± 7.52 standard deviation (SD) years with range from 26 to 64 years, 3 (12%) patients had worsened in the form of postoperative motor power deterioration, and 14 (56%) patients has no improvement and remain as preoperative condition. The remaining 8 (32%) patients had a reported postoperative improvement of symptoms and signs according to MJOA score. The mean follow-up period (in months) was 11 ± 2.34 (SD). Conclusion: The presence of T2W hyperintense signal on preoperative MRI predicts a poor surgical outcome in patients with cervical disc prolapse. The regression of T2W ISI postoperatively correlates with better functional outcomes.

Key-words:

Anterior cervical discectomy - cervical spondylotic myelopathy - compressive myelopathy - T2 hyperintense signal - clinical outcome

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Publication History

Article published online:
09 September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Nouri A, Tetreault L, Singh A, Karadimas SK, Fehlings MG. Degenerative cervical myelopathy: Epidemiology, genetics, and pathogenesis. Spine (Phila Pa 1976) 2015;40:E675-93.
  • 2 Ames CP, Blondel B, Scheer JK, Schwab FJ, Le Huec JC, Massicotte EM, et al. Cervical radiographical alignment: Comprehensive assessment techniques and potential importance in cervical myelopathy. Spine (Phila Pa 1976) 2013;38:S149-60.
  • 3 Cook C, Brown C, Isaacs R, Roman M, Davis S, Richardson W, et al. Clustered clinical findings for diagnosis of cervical spine myelopathy. J Man Manip Ther 2010;18:175-80.
  • 4 Karadimas SK, Gatzounis G, Fehlings MG. Pathobiology of cervical spondylotic myelopathy. Eur Spine J 2015;24 Suppl 2:132-8.
  • 5 Kim TH, Ha Y, Shin JJ, Cho YE, Lee JH, Cho WH, et al. Signal intensity ratio on magnetic resonance imaging as a prognostic factor in patients with cervical compressive myelopathy. Medicine (Baltimore) 2016;95:e4649.
  • 6 Kadanka Z, Kerkovsky M, Bednarik J, Jarkovsky J. Cross-sectional transverse area and hyperintensities on magnetic resonance imaging in relation to the clinical picture in cervical spondylotic myelopathy. Spine (Phila Pa 1976) 2007;32:2573-7.
  • 7 Tetreault LA, Dettori JR, Wilson JR, Singh A, Nouri A, Fehlings MG, et al. Systematic review of magnetic resonance imaging characteristics that affect treatment decision making and predict clinical outcome in patients with cervical spondylotic myelopathy. Spine (Phila Pa 1976) 2013;38:S89-110.
  • 8 Harrop JS, Naroji S, Maltenfort M, Anderson DG, Albert T, Ratliff JK, et al. Cervical myelopathy: A clinical and radiographic evaluation and correlation to cervical spondylotic myelopathy. Spine (Phila Pa 1976) 2010;35:620-4.
  • 9 Vedantam A, Rajshekhar V. Does the type of T2-weighted hyperintensity influence surgical outcome in patients with cervical spondylotic myelopathy? A review. Eur Spine J 2013;22:96-106.
  • 10 Chen CJ, Lyu RK, Lee ST, Wong YC, Wang LJ. Intramedullary high signal intensity on T2-weighted MR images in cervical spondylotic myelopathy: Prediction of prognosis with type of intensity. Radiology 2001;221:789-94.
  • 11 Wang LF, Zhang YZ, Shen Y, Su YL, Xu JX, Ding WY, et al. Using the T2-weighted magnetic resonance imaging signal intensity ratio and clinical manifestations to assess the prognosis of patients with cervical ossification of the posterior longitudinal ligament. J Neurosurg Spine 2010;13:319-23.
  • 12 Salem HM, Salem KM, Burget F, Bommireddy R, Klezl Z. Cervical spondylotic myelopathy: The prediction of outcome following surgical intervention in 93 patients using T1- and T2-weighted MRI scans. Eur Spine J 2015;24:2930-5.
  • 13 Arvin B, Kalsi-Ryan S, Mercier D, Furlan JC, Massicotte EM, Fehlings MG, et al. Preoperative magnetic resonance imaging is associated with baseline neurological status and can predict postoperative recovery in patients with cervical spondylotic myelopathy. Spine (Phila Pa 1976) 2013;38:1170-6.
  • 14 Nouri A, Tetreault L, Zamorano JJ, Dalzell K, Davis AM, Mikulis D, et al. Role of magnetic resonance imaging in predicting surgical outcome in patients with cervical spondylotic myelopathy. Spine (Phila Pa 1976) 2015;40:171-8.
  • 15 Nouri A, Tetreault L, Dalzell K, Zamorano JJ, Fehlings MG. The relationship between preoperative clinical presentation and quantitative magnetic resonance imaging features in patients with degenerative cervical myelopathy. Neurosurgery 2017;80:121-8.
  • 16 Ahn JS, Lee JK, Kim BK. Prognostic factors that affect the surgical outcome of the laminoplasty in cervical spondylotic myelopathy. Clin Orthop Surg 2010;2:98-104.
  • 17 Arvin B, Kalsi-Ryan S, Karpova A, Mercier D, Furlan JC, Massicotte EM, et al. Post-operative magnetic resonance imaging can predict neurological recovery following surgery for cervical spondylotic myelopathy: A prospective study with blinded assessments. Neurosurgery 2011;69:362-8.
  • 18 Kohno K, Kumon Y, Oka Y, Matsui S, Ohue S, Sakaki S, et al. Evaluation of prognostic factors following expansive laminoplasty for cervical spinal stenotic myelopathy. Surg Neurol 1997;48:237-45.
  • 19 Mehalic TF, Pezzuti RT, Applebaum BI. Magnetic resonance imaging and cervical spondylotic myelopathy. Neurosurgery 1990;26:217-26.
  • 20 Yukawa Y, Kato F, Yoshihara H, Yanase M, Ito K. MR T2 image classification in cervical compression myelopathy: Predictor of surgical outcomes. Spine (Phila Pa 1976) 2007;32:1675-8.
  • 21 Singh A, Crockard HA, Platts A, Stevens J. Clinical and radiological correlates of severity and surgery-related outcome in cervical spondylosis. J Neurosurg 2001;94:189-98.
  • 22 Mastronardi L, Elsawaf A, Roperto R, Bozzao A, Caroli M, Ferrante M, et al. Prognostic relevance of the postoperative evolution of intramedullary spinal cord changes in signal intensity on magnetic resonance imaging after anterior decompression for cervical spondylotic myelopathy. J Neurosurg Spine 2007;7:615-22.
  • 23 Benzel EC, Lancon J, Kesterson L, Hadden T. Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy. J Spinal Disord 1991;4:286-95.
  • 24 Vedantam A, Jonathan A, Rajshekhar V. Association of magnetic resonance imaging signal changes and outcome prediction after surgery for cervical spondylotic myelopathy. J Neurosurg Spine 2011;15:660-6.
  • 25 Papadopoulos CA, Katonis P, Papagelopoulos PJ, Karampekios S, Hadjipavlou AG. Surgical decompression for cervical spondylotic myelopathy: Correlation between operative outcomes and MRI of the spinal cord. Orthopedics 2004;27:1087-91.
  • 26 Chatley A, Kumar R, Jain VK, Behari S, Sahu RN. Effect of spinal cord signal intensity changes on clinical outcome after surgery for cervical spondylotic myelopathy. J Neurosurg Spine 2009;11:562-7.
  • 27 Mizuno J, Nakagawa H, Inoue T, Hashizume Y. Clinicopathological study of “snake-eye appearance” in compressive myelopathy of the cervical spinal cord. J Neurosurg 2003;99:162-8.
  • 28 Shen HX, Li L, Yang ZG, Hou TS. Position of increased signal intensity in the spinal cord on MR images: Does it predict the outcome of cervical spondylotic myelopathy? Chin Med J (Engl) 2009;122:1418-22.
  • 29 Zhang YZ, Shen Y, Wang LF, Ding WY, Xu JX, He J, et al. Magnetic resonance T2 image signal intensity ratio and clinical manifestation predict prognosis after surgical intervention for cervical spondylotic myelopathy. Spine (Phila Pa 1976) 2010;35:E396-9.
  • 30 Suri A, Chabbra RP, Mehta VS, Gaikwad S, Pandey RM. Effect of intramedullary signal changes on the surgical outcome of patients with cervical spondylotic myelopathy. Spine J 2003;3:33-45.
  • 31 Avadhani A, Rajasekaran S, Shetty AP. Comparison of prognostic value of different MRI classifications of signal intensity change in cervical spondylotic myelopathy. Spine J 2010;10:475-85.
  • 32 Wada E, Yonenobu K, Suzuki S, Kanazawa A, Ochi T. Can intramedullary signal change on magnetic resonance imaging predict surgical outcome in cervical spondylotic myelopathy? Spine (Phila Pa 1976) 1999;24:455-61.
  • 33 Park YS, Nakase H, Kawaguchi S, Sakaki T, Nikaido Y, Morimoto T, et al. Predictors of outcome of surgery for cervical compressive myelopathy: Retrospective analysis and prospective study. Neurol Med Chir (Tokyo) 2006;46:231-8.