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

STUDY DESIGN.Retrospective analysis of prospective data OBJECTIVE.To assess the relationship between MRI signal intensity changes, clinical presentation, and surgical outcome in degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA.Several studies have sought to assess the extent of spinal cord dysfunction and the potential for postoperative neurological recovery through the evaluation of spinal cord signal change on T2-weighted (T2WI) and T1-weighted images (T1WI). There remains ambiguity if T2WI and T1WI signal changes (1) relate to baseline severity, and (2) predict neurological recovery after surgical treatment. METHODS.419 MRIs from two prospective multicenter studies were examined. Images were assessed for the presence, levels, and location of spinal cord signal intensity changes and compared with clinical data. Signal changes were also evaluated for prediction of 2-year post-operative outcome using mJOA parameters. RESULTS.MRIs were categorized by T1WI and T2WI signal changeno signal change (28.9%), T2WI hyperintensity-only (T2WI-only, 51.8%), and T2WI-hyperintensity and T1WI-hypointensity (T1WI+T2WI, 19.3%). T2WI-hyperintensity was present at multiple levels in 27% of patients overall. Baseline severity increased from no signal change to T2WI-only to T2WI+T1WI (p