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Postoperative Resolution of MR T2 Increased Signal Intensity in Cervical Spondylotic Myelopathy: The Impact of Signal Change Resolution on the Outcomes.

STUDY DESIGN
Prospective comparative imaging study.


OBJECTIVE
This study investigated whether postoperative resolution of spinal cord increased signal intensity (ISI) reflected symptom improvement and surgical outcomes in cervical spondylotic myelopathy (CSM) patients.


SUMMARY OF BACKGROUND DATA
Although some CSM patients exhibit magnetic resonance imaging (MRI) ISI, its alteration and resolution have not been investigated. The association between postoperative ISI resolution and surgical outcomes in CSM patients remains controversial.


METHODS
A total of 505 consecutive CSM patients (311 males; 194 females) aged a mean of 66.6 years (range, 41-91) were enrolled. All were treated with laminoplasty and underwent MRI scans preoperatively and after an average of 26.5 months postoperatively (range 12-66 months). ISI was classified pre- and postoperatively based on sagittal T2-weighted magnetic resonance images into: Grade 0, none; Grade 1, light (obscure); and Grade 2, intense (bright). The patients' pre- and postoperative neurological statuses were evaluated using the Japanese Orthopedic Association scoring system for cervical myelopathy (JOA score) and other quantifiable tests, including the 10-s grip and release (10-s G&R) test and 10-s step test.


RESULTS
A total of 337 patients showed preoperative ISI. Among these, 42 (12.5%) showed postoperative ISI resolution, associated with better postoperative JOA score and recovery rate, 10-s G&R and 10-s step test scores than those who retained it. Patients with preoperative Grade 2 ISI had no postoperative ISI resolution. Patients with ISI improvement from Grade 1 to Grade 0 had better outcomes than those with ISI worsening from Grade 1 to Grade 2.


CONCLUSIONS
Postoperative ISI resolution in CSM patients reflects postoperative symptoms and surgical outcomes. Patients who exhibit ISI resolution have better clinical outcomes.


LEVEL OF EVIDENCE
3.