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The relevance of intramedullary high signal intensity and gadolinium (Gd-DTPA) enhancement to the clinical outcome in cervical compressive myelopathy

 Yong Eun Cho  ;  Jun Jae Shin  ;  Keun Su Kim  ;  Dong Kyu Chin  ;  Sung Uk Kuh  ;  Ji Hae Lee  ;  Woo Ho Cho 
 EUROPEAN SPINE JOURNAL, Vol.20(12) : 2267-2274, 2011 
Journal Title
Issue Date
Adult ; Aged ; Cervical Vertebrae/pathology ; Cervical Vertebrae/surgery* ; Decompression, Surgical/methods ; Diskectomy/methods* ; Follow-Up Studies ; Gadolinium DTPA* ; Humans ; Magnetic Resonance Imaging/methods* ; Male ; Middle Aged ; Postoperative Period ; Prognosis ; Prospective Studies ; Spinal Cord Compression/pathology ; Spinal Cord Compression/surgery* ; Spinal Fusion/methods* ; Treatment Outcome
Cervical compressive myelopathy ; Magnetic resonance imaging (MRI) ; Increased signal intensity ; Intramedullary Gd-DTPA enhancement
PURPOSE: We prospectively investigated whether high intramedullary SI and contrast [gadolinium-diethylene-triamine-pentaacetic acid (Gd-DTPA)] enhancement in magnetic resonance imaging (MRI) are associated with postoperative prognosis in cervical compressive myelopathy (CCM) patients.

METHODS: Seventy-four patients with ventral cord compression at one or two levels underwent anterior cervical discectomy and fusion (ACDF) for CCM between March 2006 and June 2009. The mean follow-up period was 39.7 months (range, 12.7-55.7 months). The cervical cord compression ratio and clinical outcomes were measured using Japanese Orthopedic Association (JOA) scores for cervical myelopathy. Patients were classified into three groups based on the SI change in T2WI, T1-weighted images (T1WI), and contrast (Gd-DTPA) enhancement.

RESULTS: The mean preoperative and postoperative JOA scores were 10.5 ± 2.9 and 15.0 ± 2.1 (P < 0.05), respectively. The mean recovery ratio of the JOA score was 70.9 ± 20.2%. There were statistically significant differences in postoperative JOA and recovery ratio among three groups. However, post-surgical neurological outcomes were not associated with age, symptom duration, preoperative JOA, and cord compression.

CONCLUSIONS: We found that intramedullary SI change is a poor prognostic factor and the intramedullary contrast (Gd-DTPA) enhancement on preoperative MRI should be viewed as the worst predictor of surgical outcomes in cervical myelopathy. Contrast (Gd-DTPA) enhancement and postoperative MRI are useful for identifying the prognosis of patients with poor neurological recovery.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kuh, Sung Uk(구성욱) ORCID logo https://orcid.org/0000-0003-2566-3209
Kim, Keun Su(김근수) ORCID logo https://orcid.org/0000-0002-3384-5638
Cho, Yong Eun(조용은) ORCID logo https://orcid.org/0000-0001-9815-2720
Chin, Dong Kyu(진동규) ORCID logo https://orcid.org/0000-0002-9835-9294
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