Introduction: Clinical significance of changes on magnetic resonance imaging (MRI) in cervical spondylotic myelopathy (CSM) such as high signal intensity and degree of spinal cord compression remains controversial. The correlations between MRI changes and clinical findings before and after decompressive surgery were investigated.

Methods: A total of 93 patients with cervical spondylotic myelopathy were underwent different types of the anterior decompressive surgery between 1999 and 2012. The mean age was 49,09 ± 1,03 years (range 24-75). There were 69 males and 24 females. MRI features of spinal cord compression and T2 intraparenchymal cord high signal intensity (HSI) were recorded. Degree of spinal cord compression on the T2-weighted sagittal images was classified according to Takahashi et al (1989). HSI were classified according to Chen et all (2001). HSI were also evaluated according to the extent of these changes on T2-weighted sequences (de Rota et al, 2007). Patient outcomes were assessed by European Myelopathy Score (EMS) with recovery ratio.

Results: Minimal follow-up period was 12 months. 28 patients (30.1 %) showed HSI before surgery and 24 (25.8 %) after surgery. CSM severity conform to increase of the degree of spinal cord compression as tendency (0,05=P<0,09 on a complex of the used nonparametric criteria). Increased signal intensity on T2-weighted MRI was not related to the severity of myelopathy regardless of its type (p >> 0,05). Multisegmental HSI on T2-weighted MRI was a statistically significant association (?<0,05) with myelopathy severity than focal (R=+0,42) (Odds Ratio = 2,4).

Conclusions: The correct preoperative planning in patients with CSM is based on comparison of MRI changes of the cervical spine and clinical findings. Spinal cord HSI does not correlate with myelopathic syndrome severity. Multisegmental HSI is a more sensitive indicator of poor outcome in patients with CSM. There was no significant correlation between HSI detection and degree of spinal cord compression.

Patient Care: European Myelopathy Score recovery ratio

Learning Objectives: The aim of this study to compare clinical findings and neuroimaging data in patients with CSM before and after decompressive surgery.

References: 1. Takahashi M, Yamashita Y, Sakamoto Y, Kojima R. Chronic cervical cord compression: clinical significance of increased signal intensity on MR images. Radiology 1989; 173:219–224. 2. Chen CJ, Lyu RK, Lee ST, Wong YC, Wang LJ. Intramedullary high signal intensity on T2-weighted MR images in cervical spondylotic myelopathy: prediction of prognosis with type of intensity. Radiology 2001; 221:789–794. 3. Fernandez de Rota JJ, Meschian , Fernandez de Rota A, Urbano V, Baron M. Cervical spondylotic myelopathy due to chronic compression: the role of signal intensity changes in magnetic resonance images. J Neurosurg Spine 6:17–22, 2007.