Spinal Cord Signal Intensity Predicts Functional Outcomes in the Operative Management of Degenerative Cervical Myelopathy

Clin Spine Surg, 2023 · DOI: 10.1097/BSD.0000000000001479 · Published: December 1, 2023

Surgery Medical Imaging Spinal Disorders

Simple Explanation

This study investigates the link between spinal cord signal changes seen on MRI and how well patients recover after surgery for Degenerative Cervical Myelopathy (DCM). Researchers looked at whether the intensity of these signals before and after surgery could predict functional outcomes, measured by mJOA scores. The study found that while the presence of signal change before surgery didn't directly predict overall improvement, improvement in signal grade after surgery was linked to better neurological recovery.

Study Duration

2009 to 2022

Participants

104 DCM patients

Evidence Level

Prospective single institutional cohort study

Key Findings

1
The presence of preoperative T2 weighted signal change was associated with lower preoperative mJOA scores.
2
Improvement in T2 weighted spinal cord signal grade on postoperative MRI was significantly associated with degree of neurological improvement following surgery.
3
Patients with preoperative spinal cord signal change had significantly lower mJOA scores than those that did not.

Research Summary

This prospective study on 104 DCM patients, showed significant neurological improvement was found following surgery. The presence of preoperative T2 weighted signal change was associated with lower preoperative mJOA scores, but not change in mJOA following surgery or postoperative neurological recovery rate. Improvement in T2 weighted spinal cord signal grade on postoperative MRI was significantly associated with degree of neurological improvement following surgery.

Practical Implications

Prognostic Indicator

Spinal cord signal intensity and presence noted on T2-weighted MR imaging can be utilized similarly in clinical practice.

Surgical Planning

Improvements in spinal cord signal postoperatively are clinically important as the majority of subjects with DCM have graded signal intensity and could benefit from intervention.

Recovery Expectations

Complete resolution of signal change and improvement of signal change were both associated with better neurological recovery following surgery than patients that did not have any improvement in spinal cord signal change.

Study Limitations

1
The single-center prospective cross-sectional observational nature of this study is a limitation itself, not only limiting sample size/demographics, but also power analysis.
2
No standardized quantitative methodology exists to grade signal change intensity. The Applebaum classification was utilized in this study
3
The Applebaum classification system is subject to observer bias.

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