[Value of neuroradiologic procedures in preoperative assessment of cervical myelopathy]

The diagnostic value of computed tomography (CT), myelography, myelo-CT and magnetic resonance imaging (MRI) was retrospectively investigated in 94 patients in whom Cloward's operation had been performed due to symptoms of cervical myelopathy (CM). In 55 patients with "classical" cervical spondylotic myelopathy all investigated diagnostic procedures demonstrated a comparably high degree of sensitivity and specificity, thus proving comparable for diagnosing pathological alterations of the cervical spine. In 39 patients with CM as a consequence of an acute cervical disk prolapse, however, MRI was superior and offered the highest diagnostic accuracy. The following general diagnostic strategy in patients with CM can be suggested: Conventional plain film radiography of the cervical spine, axial CT of the involved segments and MRI of the cervical spine in sagittal and transversal orientation, using T1 and T2 weighted pulse sequences. The combined use of these techniques allows the exact evaluation of any relevant structure alterations of the cervical spine that determine differential therapeutic approaches.