177 The Relationship Between MRI Signal Intensity Changes, Clinical Presentation, and Surgical Outcome in Degenerative Cervical Myelopathy: Analysis of a Global Cohort

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 246-246
Author(s):  
Aria Nouri ◽  
Allan R Martin ◽  
So Kato ◽  
Hamed Reihani-Kermani ◽  
Lauren Riehm ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Surgical Outcome ◽  
Neurological Recovery ◽  
Recovery Ratio ◽  
Baseline Severity ◽  
Signal Change ◽  
Signal Changes ◽  
T2 Hyperintensity ◽  
Degenerative Cervical Myelopathy ◽  
The Relationship

Abstract INTRODUCTION Several reports have investigated the relationship between MRI signal changes and the extent of spinal cord dysfunction and potential for postoperative neurological recovery in patients with Degenerative Cervical Myelopathy (DCM). However, there remains ambiguity if these signal changes relate with baseline severity, and predict neurological recovery after surgical treatment. The present study aims to address this knowledge gap by investigating a large global cohort of DCM patients. METHODS 419 MRIs from two prospective multicenter studies were examined. Images were assessed for the presence, levels, and location of cord signal changes and compared with clinical data (signs/symptoms, mJOA, Nurick). Inter-rater reliability for signal changes was calculated. Signal changes were also evaluated for prediction of 2-year post-operative outcome using 2 approaches: (1) Hirabayashi recovery ratio, (2) a dichotomized mJOA score of <16 and = 16 at 2-years representing a suboptimal and optimal neurological outcome, respectively. RESULTS >MRIs were categorized by signal change: no signal change (28.9%), T2 hyperintensity-only (T2-only, 51.8%), and T2-hyperintensity and T1-hypointensity (T1+T2, 19.3%). T2-hyperintensity was present at multiple levels in 27% of patients overall. There was moderate/substantial agreement (Kappa: 0.60) for T2-hyperintensity, and fair agreement for T1-hypointensity (Kappa: 0.31) identification among 3 raters. Baseline severity increased from no signal change to T2-only to T2+T1 (P < 0.0001), and there was an incremental increase in the frequency of signs/symptoms. The presence of T1-hypointensity correlated with reduced recovery ratio (P = 0.03) and likelihood of an optimal surgical outcome (P = 0.005). Greater number of T2-hyperintensity levels was also associated with worse baseline severity (P < 0.0001) and recovery ratio (P = 0.001). CONCLUSION This is the largest study of DCM patients to show an increasing stepwise impairment from no signal change to T2-hypertensity to T1-hypointensity. While T2-hyperintensity alone does not predict outcomes, T1-hypointensity indicates more permanent injury, portending decreased functional recovery. Multilevel T2-hyperintensity suggests additional tissue injury, correlating with worse impairment and recovery potential.

The Relationship Between MRI Signal Intensity Changes, Clinical Presentation, and Surgical Outcome in Degenerative Cervical Myelopathy

Spine ◽  
2017 ◽  
Vol 42 (24) ◽  
pp. 1851-1858 ◽  
Author(s):  
Aria Nouri ◽  
Allan R. Martin ◽  
So Kato ◽  
Hamed Reihani-Kermani ◽  
Lauren E. Riehm ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Surgical Outcome ◽  
Signal Intensity ◽  
Clinical Presentation ◽  
Intensity Changes ◽  
Degenerative Cervical Myelopathy ◽  
The Relationship

Congenital Cervical Spine Stenosis in a Multicenter Global Cohort of Patients With Degenerative Cervical Myelopathy: An Ambispective Report Based on a Magnetic Resonance Imaging Diagnostic Criterion

Neurosurgery ◽  
2018 ◽  
Vol 83 (3) ◽  
pp. 521-528 ◽  
Author(s):  
Aria Nouri ◽  
Lindsay Tetreault ◽  
Satoshi Nori ◽  
Allan R Martin ◽  
Anick Nater ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Cervical Spine ◽  
Magnetic Resonance ◽  
Surgical Outcomes ◽  
Cervical Myelopathy ◽  
Spinal Canal ◽  
Resonance Imaging ◽  
Baseline Severity ◽  
Degenerative Cervical Myelopathy

Abstract BACKGROUND Congenital spinal stenosis (CSS) of the cervical spine is a risk factor for acute spinal cord injury and development of degenerative cervical myelopathy (DCM). OBJECTIVE To develop magnetic resonance imaging (MRI)-based criteria to diagnose preexisting CSS and evaluate differences between patients with and without CSS. METHODS A secondary analysis of international prospectively collected data between 2005 and 2011 was conducted. We examined the data of 349 surgical DCM patients and 27 controls. Spinal canal and cord anteroposterior diameters were measured at noncompressed sites to calculate spinal cord occupation ratio (SCOR). Torg–Pavlov ratios and spinal canal diameters from radiographs were correlated with SCOR. Clinical and MRI factors were compared between patients with and without CSS. Surgical outcomes were also assessed. RESULTS Calculation of SCOR was feasible in 311/349 patients. Twenty-six patients with CSS were identified (8.4%). Patients with CSS were younger than patients without CSS (P = .03) and had worse baseline severity as measured by the modified Japanese Orthopedic Association score (P = .04), Nurick scale (P = .05), and Neck Disability Index (P &lt; .01). CSS patients more commonly had T2 cord hyperintensity changes (P = .09, ns) and worse SF-36 Physical Component scores (P = .06, ns). SCOR correlated better with Torg–Pavlov ratio and spinal canal diameter at C3 than C5. Patients with SCOR ≥ 65% were also younger but did not differ in baseline severity. CONCLUSION SCOR ≥ 70% is an effective criterion to diagnose CSS. CSS patients develop myelopathy at a younger age and have greater impairment and disability than other patients with DCM. Despite this, CSS patients have comparable duration of symptoms, MRI presentations, and surgical outcomes to DCM patients without CSS.

scholarly journals The Relationship Between Gastrointestinal Comorbidities, Clinical Presentation and Surgical Outcome in Patients with DCM: Analysis of a Global Cohort

2020 ◽  
Vol 9 (3) ◽  
pp. 624 ◽  
Author(s):  
Aria Nouri ◽  
Jetan H. Badhiwala ◽  
So Kato ◽  
Hamed Reihani-Kermani ◽  
Kishan Patel ◽  
...  
Keyword(s):  
Surgical Outcome ◽  
Neurological Impairment ◽  
International Studies ◽  
Mri Features ◽  
Intensity Changes ◽  
The Difference ◽  
Magnetic Resonance Imaging Mri ◽  
T2 Hyperintensity ◽  
Neck Disability ◽  
Degenerative Cervical Myelopathy

Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord impairment in adults, presenting most frequently in patients 50 years or older. Gastrointestinal comorbidities (GICs) commonly occur in this group; however, their relationship with DCM has not been thoroughly investigated. It is the objective of the present study to investigate the difference between patients with or without GICs who are surgically treated for DCM. A cohort of 757 patients with clinical data and 458 with magnetic resonance imaging (MRI) data from the AOSpine North America and AOSpine International studies on DCM was evaluated. GICs were obtained at presentation and included gastric, intestinal, hepatic, and pancreatic conditions. Patients were dichotomized into 2 groups: those with GICs and those without GICs. Both clinical and MRI presentation, as well as baseline neurological and functional status, were compared. Neurological and functional outcomes at 2-year follow-up were also compared. GICs were present in 121 patients (16%). These patients were less commonly male (48.76% vs. 65.4%, p = 0.001) and were slightly less neurologically impaired based on the Nurick grade (3.05 ± 1.10 vs. 3.28 ± 1.16, p = 0.044) but not based on mJOA (12.74 ± 2.62 vs. 12.48 ± 2.76, p = 0.33). They also had a worse physical health score (32.80 ± 8.79 vs. 34.65 ± 9.38 p = 0.049), worse neck disability (46.31 ± 20.04 vs. 38.23 ± 20.44, p < 0.001), a lower prevalence of upper motor neuron signs (hyperreflexia, 70.2% vs. 78.9%, p = 0.037; Babinski’s sign 24.8% vs. 37.3%, p = 0.008), and a higher rate of psychiatric comorbidities (31.4% vs. 10.4%, p < 0.0001). On MRI, GIC patients less commonly exhibited signal intensity changes (T2 hyperintensity, 49.2% vs. 75.6%, p < 0.001; T1 hypointensity, 9.7% vs. 21.1%, p = 0.036), and had a lower number of T2 hyperintensity levels (0.82 ± 0.98 vs. 1.3 ± 1.11, p = 0.001). There was no difference in surgical outcome between the groups. DCM patients with GICs are more likely to be female and have significantly more general health impairment and neck disability. However, these patients have less clinical and MRI features typical of more severe neurological impairment. This constellation of symptoms is considerably different than those typically observed in DCM, and it is therefore plausible that nutritional factors may contribute to this unique observation.

scholarly journals The Role of Nutrition in Degenerative Cervical Myelopathy: A Systematic Review

2021 ◽  
Vol 14 ◽  
pp. 117863882110546
Author(s):  
Celine I Partha Sarathi ◽  
Oliver D Mowforth ◽  
Amil Sinha ◽  
Faheem Bhatti ◽  
Aniqah Bhatti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Cervical Myelopathy ◽  
Surgical Outcome ◽  
Assessment Tool ◽  
Hospital Readmissions ◽  
Functional Improvement ◽  
Current Evidence ◽  
Degenerative Cervical Myelopathy

Introduction: Degenerative cervical myelopathy (DCM) is the commonest cause of adult spinal cord impairment worldwide, encompassing chronic compression of the spinal cord, neurological disability and diminished quality of life. Evidence on the contribution of environmental factors is sparse; in particular, the role of nutrition in DCM is unknown. The objective of this review was to assess the effect of nutrition on DCM susceptibility, severity and surgical outcome. Methods: A systematic review in MEDLINE and Embase was conducted following PRISMA guidelines. Full-text papers in English papers, focussing on cervical myelopathy and nutrition, published before January 2020 were considered eligible. Quality assessments were performed using the GRADE assessment tool. Patient demographics, nutritional factor and DCM outcomes measures were recorded. Relationships between nutritional factors, interventions and disease prognosis were assessed. Results: In total, 5835 papers were identified of which 44 were included in the final analysis. DCM patients with pathological weight pre-operatively were more likely to see poorer improvements post-surgically. These patients experienced poorer physical and mental health improvements from surgery compared to normal weight patients and were more likely to suffer from post-operative complications such as infection, DVT, PE and hospital readmissions. Two trials reporting benefits of nutritional supplements were identified, with 1 suggesting Cerebrolysin to be significant in functional improvement. An unbalanced diet, history of alcohol abuse and malnourishment were associated with poorer post-operative outcome. Conclusion: Although the overall strength of recommendation is low, current evidence suggests nutrition may have a significant role in optimising surgical outcome in DCM patients. Although it may have a role in onset and severity of DCM, this is a preliminary suggestion. Further work needs to be done on how nutrition is defined and measured, however, the beneficial results from studies with nutritional interventions suggest nutrition could be a treatment target in DCM.

The Relationship of Minor Trauma with the Surgical Outcome in Patients with Cervical Myelopathy

2015 ◽  
Vol 22 (4) ◽  
pp. 133
Author(s):  
Min-Woo Kim ◽  
Kyu Yeol Lee ◽  
Dong Ryul Kim ◽  
Young Hoon Jung ◽  
Chul Soon Im
Keyword(s):  
Cervical Myelopathy ◽  
Surgical Outcome ◽  
Minor Trauma ◽  
Relationship Of ◽  
The Relationship

scholarly journals Degenerative Cervical Myelopathy: How to Identify the Best Responders to Surgery?

2020 ◽  
Vol 9 (3) ◽  
pp. 759 ◽  
Author(s):  
Rocco Severino ◽  
Aria Nouri ◽  
Enrico Tessitore
Keyword(s):  
Cervical Myelopathy ◽  
Diffusion Tensor ◽  
Inverse Correlation ◽  
Postoperative Outcome ◽  
Definitive Treatment ◽  
Conduction Time ◽  
Japanese Orthopedic Association ◽  
Conventional Mri ◽  
T2 Hyperintensity ◽  
Degenerative Cervical Myelopathy

Surgery is the only definitive treatment for degenerative cervical myelopathy (DCM), however, the degree of neurological recovery is often unpredictable. Here, we assess the utility of a multidimensional diagnostic approach, consisting of clinical, neurophysiological, and radiological parameters, to identify patients likely to benefit most from surgery. Thirty-six consecutive patients were prospectively analyzed using the modified Japanese Orthopedic Association (mJOA) score, MEPs/SSEPs and advance and conventional MRI parameters, at baseline, and 3- and 12-month postoperatively. Patients were subdivided into “normal” and “best” responders (<50%, ≥50% improvement in mJOA), and correlation between Diffusion Tensor Imaging (DTI) parameters, mJOA, and MEP/SSEP latencies were examined. Twenty patients were “best” responders and 16 were “normal responders”, but there were no statistical differences in age, T2 hyperintensity, and midsagittal diameter between them. There was a significant inverse correlation between the MEPs central conduction time and mJOA in the preoperative period (p = 0.0004), and a positive correlation between fractional anisotropy (FA) and mJOA during all the phases of the study, and statistically significant at 1-year (r = 0.66, p = 0.0005). FA was significantly higher amongst “best responders” compared to “normal responders” preoperatively and at 1-year (p = 0.02 and p = 0.009). A preoperative FA > 0.55 was predictor of a better postoperative outcome. Overall, these results support the concept of a multidisciplinary approach in the assessment and management of DCM.

scholarly journals Predictors associated with neurological recovery after anterior decompression with fusion for degenerative cervical myelopathy

2020 ◽  
Author(s):  
Hiroyuki Inose ◽  
Takashi Hirai ◽  
Toshitaka Yoshii ◽  
Atsushi Kimura ◽  
Katsushi Takeshita ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Recovery Rate ◽  
Neck Disability Index ◽  
Multiple Linear Regression Model ◽  
Vertical Axis ◽  
Neurological Recovery ◽  
Anterior Decompression ◽  
Sagittal Vertical Axis ◽  
Japanese Orthopedic Association ◽  
Degenerative Cervical Myelopathy

Abstract Background Anterior decompression with fusion (ADF) has often been performed for degenerative cervical myelopathy (DCM) in patients with poor cervical spine alignment and/or anterior cord compression. However, it is difficult to preoperatively predict the extent to which patients will experience postoperative neurological improvement. We aimed to identify predictors associated with neurological recovery after ADF in a retrospective study of prospectively collected data. Methods We prospectively enrolled patients who were scheduled for ADF for DCM. The associations of baseline variables with recovery rate were investigated using a multiple linear regression model. Results In total, 36 patients completed the 1-year follow-up. Regarding clinical outcomes, the Japanese Orthopedic Association score for the assessment of cervical myelopathy, European Quality of Life Five Dimensions Scale, Neck Disability Index, and Physical Component Summary of the SF-36 (PCS) scores improved postoperatively. The recovery rate was significantly correlated with the sagittal vertical axis (SVA) and T1 pelvic angle. Univariate regression analyses showed that the SVA and PCS score were significantly associated with recovery rate. Lastly, multiple regression analysis identified the independent predictors of recovery rate after ADF as thoracic kyphosis (TK), PCS, and SVA. According to this prediction model, the following equation was obtained: recovery rate = − 8.26 + 1.17 × (TK) – 0.45 × (SVA) + 0.85 × (PCS). Conclusion Patients with lower TK, lower PCS score, and higher SVA were more likely to have poor neurological recovery after ADF. Therefore, DCM patients with these predictors who undergo ADF might be cautioned about poor recovery and be required to provide adequate informed consent.

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