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  • Role of MRI Features as a Prognostic Index in Cervical Spondilogenetic Myelopathy

    Final Number:

    Savino Iodice; Nicola Zelletta MD; Giulio Cecchini MD; Roberto Gaudio M.D.; Pasquale Cascardi MD; Antonio De Tommasi MD, PhD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: The importance of a correct pre-operative radiological diagnosis in patients with cervical myelopathy has been widely demonstrated. Indeed, few studies still exist about the correlation between post-operative radiographic and clinical modifications.

    Methods: The authors present a prospective study of 54 patients with cervical spondilogenetic myelopathy, which underwent surgery for corpectomy and anterior fusion with mesh in a period between January 2005 and August 2013. Images of cervical RMN were studied pre-and post-operatively and attention has been focused on alterations of intramedullary signal on T1 and T2-weighted sequences. Pre-and post-operative changes were correlated with clinical data (obtained by means of a Nurick scales and Joa classification -modified by Benzel-). In relation to cervical rm-based studies patients were divided into 3 groups: A - no intramedullary signal alteration; B -alterations in T2weighted sequences; C -alterations of the signal in both T1 and T2-weighted sequences

    Results: In all patients, decompression of the cervical spinal cord has been demonstrated by extension of the antero-posterior diameter of the spinal canal and by increase in the thickness of the subarachnoid space. In group A patients no intramedullary signal changes were highlighted post-operatively. Patients in group B showed improvement on the base of hyperintensity disappearance on T2-weighted MRI, correlating with an improvement in the clinical quadro. Patients of group C have not been showing changes in the intramedullary MRI signal despite spinal cord decompression.

    Conclusions: Signal alterations in T1 are an unfavorable prognostic index and proved to be irreversible. They correlate with a lack of clinical improvement of the patient. Patients in group B are those with the greatest clinical benefit after surgery and in whom clinical improvement correlates clearly with the radiological outcome.

    Patient Care: Describe the importance of the correlation between post-operative radiographic and clinical modifications.

    Learning Objectives: Describe the importance of the correlation between post-operative radiographic and clinical modifications.


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