Introduction: Degenerative Cervical Myelopathy (DCM) encompasses a group of degenerative conditions of the cervical spine, including cervical spondylotic myelopathy (CSM), that result in spinal cord pathology through static and dynamic injury mechanisms. While there are a constellation of degenerative findings that can present in patients with DCM on MRI, the association between these findings and specific clinical symptoms has not been thoroughly investigated.

Methods: One hundred and fourteen patients enrolled in the prospective and multicenter AOSpine CSM North American study with complete MRI and clinical data were evaluated. Patients were enrolled if they had =1 clinical signs of myelopathy. Mid-sagittal MRIs were assessed for maximum spinal cord compression (MSCC) and maximum cord compromise (MCC). Additionally, the presence of T1 and T2 signal changes as well as the degree of T2 signal hyperintensity deviation was evaluated. MRI features were then statistically related with the presence of upper and lower limb neurological symptoms as well as generalized neurological dysfunction.

Results: Numb hands (p=0.01) and Hoffmann’s sign (p=0.003) were associated with greater MSCC; broad-based, unstable gait (p=0.042), impairment of gait (p=0.008) and Hoffmann’s sign (p=0.013) were associated with greater MCC; Numb hands (p=0.037), Hoffmann’s sign (p=0.017), Babinski sign (p=0.002), lower limb spasticity (p=0.011), hyperreflexia (p=0.004), and presence of T1 hypointensity were associated with a greater deviation of signal intensity on T2 MRI. Patients with the presence of T2 signal hyperintensity also had greater MSCC (p<0.001) and MCC (p<0.001).

Conclusions: A positive Hoffmann’s sign was more commonly present in patients with greater MSCC, MCC and T2 signal hyperintensity deviation. Greater MSCC was predominately associated with upper limb manifestations and MCC with lower limb manifestations. Greater deviation of signal intensity on T2 was associated with the presence of upper limb, lower limb and general neurological deficits.

Patient Care: This research will impact patient care by improving how neurosurgeons understand the relationship between clinical and MRI features. Also, this research demonstrated that certain clinical signs relate much more strongly than others to MRI features of myelopathy, potentially indicating a greater sensitivity for diagnosis.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Understand the potential association between the clinical manifestation of DCM patients and MRI findings. 2) Discuss how MRI findings can help diagnose DCM patients 3) Discuss the various MRI methods that can be used in the diagnostic process.

References: (1) Nouri A, Tetreault L, Zamorano JJ, Dalzell K, Davis AM, Mikulis D, Yee A, Fehlings MG. Role of magnetic resonance imaging in predicting surgical outcome in patients with cervical spondylotic myelopathy. Spine (Phila Pa 1976). 2015 Feb 1;40(3):171-8. (2) Fehlings MG, Wilson JR, Kopjar B, Yoon ST, Arnold PM, Massicotte EM, Vaccaro AR, Brodke DS, Shaffrey CI, Smith JS, Woodard EJ, Banco RJ, Chapman JR, Janssen ME, Bono CM, Sasso RC, Dekutoski MB, Gokaslan ZL. Efficacy and safety of surgical decompression in patients with cervical spondylotic myelopathy: results of the AOSpine North America prospective multi-center study. J Bone Joint Surg Am. 2013 Sep 18;95(18):1651-8.