Signal Change In Cervical Spondylotic Myelopathy As A Marker Of Neurological Prognosis

Introduction: Cervical spondylotic myelopathy can lead to severe functional consequences for patients. Predicting the final clinical condition following surgical intervention and understanding the factors that influence recovery or permanent neurological deficits are crucial for counseling patients and their families. We aim to identify preoperative radiographic and prognostic factors that can predict the final neurological outcome in patients with cervical spondylotic myelopathy.

Methods: A retrospective analysis was conducted on consecutive patients with cervical spondylotic myelopathy who underwent cervical spine surgery for decompression and stabilization. The inclusion criteria comprised adult patients over 18 years old with preoperative cervical MRI and a postoperative follow-up of at least 12 months. All radiographic parameters were evaluated on the preoperative MRI, including the T1 and T2 signal intensity within the myelopathy area of the spinal cord, the anteroposterior and transverse diameter of the spinal canal, and the signal intensity of the cerebrospinal fluid (CSF). Preoperative and postoperative clinical outcomes were assessed using the Nurick scale and modified Japanese Orthopaedic Association (mJOA) score.

Results: The study included 43 patients. When patients were categorized based on their final mJOA score, with a score equal to or higher than 16 versus a score lower than 16, significant differences were observed between the groups in terms of the intensity of signal change on the spinal cord T2 sequences relative to the intensity of the CSF in the same T2 sequence preoperatively (p=0.008) and AP spinal canal diameter (p=0.028). No other differences were found between the groups in the univariate analysis.

Conclusion : The index, which calculates the intensity change of the spinal cord in T2 cervical spine MRI relative to the intensity of the CSF in the same sequence, along with the preoperative diameter of the spinal canal, may help identify patients who will achieve a more favorable neurological outcome. Further research is needed.