MR T2 image classification in cervical compression myelopathy: predictor of surgical outcomes

Prospective imaging study of patients undergoing surgery for cervical compressive myelopathy. OBJECTIVES.: To investigate whether the classification of increased signal intensity (ISI) on magnetic resonance imaging (MRI) in patients with cervical compressive myelopathy reflects the severity of symptoms and surgical outcome.

The association between ISI and surgical outcome in cervical myelopathy remains controversial. The degree of ISI has not been well discussed.

A total of 104 patients with cervical compressive myelopathy were prospectively enrolled. All were treated with cervical expansive laminoplasty. MRI was performed in all patients before surgery. ISI of spinal cord was classified into three groups based on sagittal T2-weighted images as follows: Grade 0, none; Grade 1, light (obscure); and Grade 2, intense (bright). The severity of myelopathy was evaluated according to the Japanese Orthopedic Association (JOA) score for cervical myelopathy.

Eighty-six patients (83%) showed ISI before surgery. Patients with ISI were significantly older, and had a longer duration of disease, a lower postoperative JOA score, and a worse postoperative recovery rate of JOA score than those without ISI. Preoperative MRI showed 18 patients in Grade 0, 49 patients in Grade 1, and 37 in Grade 2. Duration of disease was the shortest in Grade 0 and longest in Grade 2. Although there was no significant difference in preoperative JOA scores among the three groups, Grade 0 patients had a higher postoperative JOA score and the best postoperative recovery, and Grade 2 had a lower postoperative JOA score and the worst postoperative recovery.

Preoperative ISI on T2-weighted sagittal MRI was correlated with patient age, duration of disease, postoperative JOA score, and postoperative recovery rate. Patients with the greatest ISI had the worst postop erative recovery. Classification of ISI can be a predictor of surgical outcome.