Cervical spondylotic myelopathy: Association of MRI changes and outcome predictors after surgical intervention

Abstract

Introduction: Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in older individuals. Controversy remains in terms of the optimal timing and indications for surgical intervention. In this context, it would be of benefit to define clinical and magnetic resonance imaging (MRI) predictors of outcome after intervention for CSM. Material and Methods: This was a prospective and observational study conducted in the Department of Radio diagnosis, Subbaiah Institute of Medical Sciences, Shimoga. All patients with functional disability secondary to cervical degenerative myelopathy and radiculopathy underwent surgery for decompression of the spinal cord with or without spinal stabilization from January 2020 to September 2020 were studied. A diagnosis of CSM required radiological confirmation (MRI) and at least one or more “upper motor neuron” findings (spasticity, hyper-reflexia, clonus and positive Babinski sign). Result: Among group A patients, 7 patients (77.7%) have improved postoperatively when compared according to Nurick grading. 9 patients (60%) have improved postoperatively. Among group C patients, only 2 patient (33.3%) have improved and majority (66.6%) remained in same grade as per Nurick grading. Conclusions: MR techniques play an indispensable role in the management of CSM patients and have evolved primarily from a diagnostic modality to a method that can potentially predict patient outcome following surgical intervention. Functional MRI can help to assess the neurological functional recovery after decompression surgery for CSM