Intramedullary Signal Intensity Research Articles

Torticollis and right arm weakness due to atraumatic spinal epidural hematoma in a 5-year-old girl child

Spontaneous spinal epidural hematoma (SEH) is a rare presentation as cause of neurological weakness in children and is neurological emergency. The most commonly affected site in children is cardiothoracic region. Early management is associated with better functional outcomes. We report a 5-year-old girl who presented with long standing neck pain now presenting to emergency with torticollis and right arm weakness around shoulder joint. Magnetic resonance imaging of C-spine revealed posterior epidural hematoma that extend from C3/C4 level down to C6/C7 level, it is causing moderate spinal canal stenosis and mass-effect on the spinal cord, with mild intramedullary abnormal T2 signal intensity indicating myelomalacia. There were no predisposing factors in our patient. Epidural hematoma was drained surgically and post-surgery patient started showing neurological recovery on follow. Cases of spontaneous SEH have been reported in infants as well and the clinical features in children are often nonspecific leading to a delay in diagnosis. This case report aims to raise awareness about this neurological emergency, in which early intervention is crucial.

Characteristics of Hirayama Disease in Young South Korean Soldiers.

The purpose of this study was to describe the clinical presentation and features in electrodiagnostic and imaging investigations of young South Korean males diagnosed with Hirayama disease (HD). We reviewed the electronic medical records of South Korean enlisted soldiers who were diagnosed with HD and discharged from military service during 2011-2021. We investigated the clinical characteristics and results of electrodiagnostic and magnetic resonance imaging (MRI) investigations. We analyzed laterality and identified the involved muscles using needle electromyography (EMG). Loss of lordosis, localized cervical cord atrophy, loss of attachment between the posterior dura and subjacent lamina, asymmetric flattening of the cord, crescent-shaped mass in the posterior epidural space, and noncompressive intramedullary T2-weighted high signal intensity were investigated using neutral- or flexion-position MRI. Forty-two male patients aged 20.2±0.8 years (mean±standard deviation) were identified. All patients complained of hand weakness, and 10 complained of hand tremor (23.8%). Four patients (9.5%) had symptoms in both upper limbs, and five (11.9%) had sensory disturbances. Needle EMG revealed that muscles in the C7-T1 myotome were commonly involved, and C5-C6 involvement of the deltoid (10.5%) and biceps brachii (12.5%) was also observed. In cervical MRI, localized cord atrophy (90.0%) was the most characteristic finding, and cord atrophy was most severe at the C5-C6 level (58.3%). This is the first description of a large number of patients with HD in South Korea. The clinical presentation and features found in electrodiagnostic and imaging investigations will improve the understanding of HD in the young South Korean male population.

Cervical disc arthroplasty for magnetic resonance-evident cervical spondylotic myelopathy: comparison with anterior cervical discectomy and fusion.

Anterior cervical discectomy and fusion (ACDF) is a standard surgical approach for cervical spondylotic myelopathy (CSM) caused by disc herniations. Although cervical disc arthroplasty (CDA) has become, in the past decade, a viable alternative to ACDF in selected patients, the differences among patients with CSM treated with CDA and ACDF remain elusive. The effectiveness of motion preservation devices in CSM is also unclear. Adult patients who underwent 1- or 2-level CDA or ACDF between 2007 and 2021 were retrospectively reviewed. Patients whose preoperative T2-weighted MRI demonstrated increased intramedullary signal intensity (IISI) were included and analyzed for the following: comparison of the length of IISI on pre- and postoperative MR images as well as range of motion (ROM) at the indexed levels between the CDA and ACDF groups. Measurement for clinical outcomes included the visual analog scale (VAS) of the arm and neck, the Neck Disability Index, and modified Japanese Orthopaedic Association scores. Perioperative clinical data were also compared between the two groups. A total of 122 patients were allocated to the CDA group and 108 to the ACDF group, with mean follow-ups of 46.6 and 39.0 months, respectively. Patients in the CDA group were younger than those in the ACDF group (47.64 ± 12.40 vs 61.73 ± 12.25 years, p < 0.001) (mean ± SD). The ACDF group had more 2-level surgery compared to the CDA group (p = 0.002). Both groups had significant regression of IISI on postoperative MRI compared to that of preoperative imaging (CDA: 1.23 ± 0.84 to 0.28 ± 0.39 cm; ACDF: 1.07 ± 0.60 to 0.37 ± 0.42 cm; both p < 0.001). The decrease in the length of IISI was similar between the two groups (p = 0.058). The postoperative ROM was well preserved in the CDA group (superior to ACDF, which yielded minimal ROM postoperatively). Both the CDA and ACDF groups demonstrated improvement in Neck Disability Index and modified Japanese Orthopaedic Association scores at 24 months postoperatively. The CDA group had significant improvements on VAS scores, whereas the improvement did not reach significance for the ACDF group at 24 months postoperatively. Significant shortening of IISI on T2-weighted MRI was demonstrated after both CDA and ACDF. At 24 months postoperatively, all clinical outcomes demonstrated improvement after both strategies, except that the VAS score was not significantly improved for ACDF. Therefore, CDA is a safe and effective option for patients with MR-evident CSM.

Spinal Cord Ischemia Secondary to Atrial Fibrillation: A Case Report

Spinal cord ischemia is exceptionally uncommon, accounting for 0.3–1% of all strokes. Here, we reported the case of a 64-year-old patient with spinal cord ischemia secondary to atrial fibrillation. Spinal magnetic resonance imaging showed increased intramedullary signal intensity at the T9 level in T2-weighted. An electrocardiogram showed atrial fibrillation. The patient was given corticosteroids and antiplatelet agent therapy. After 8 weeks of rehabilitation, the patient was able to walk with the support of a medical walker.

Serum C-reactive protein is an early, simple and inexpensive prognostic marker for the progression of intramedullary lesion on magnetic resonance imaging from acute to subacute stage in patients with spinal cord injury.

Retrospective chart audit. This study aimed to identify conventional routine blood testing biomarkers associated with the progression of intramedullary injured area in patients with spinal cord injury (SCI). A spinal cord injury center in Hokkaido, Japan. We retrospectively reviewed 71 consecutive adults with acute SCI who were admitted within 24 h after injury and diagnosed as American Spinal Injury Association Impairment Scale Grade A or B at admission. Participants were divided into the progression (P group) and no progression group (NP group) based on the change of the hyperintense signal abnormality in the spinal cord on magnetic resonance imaging from the time of admission to 4 weeks after injury. Individual characteristics and blood testing data obtained in the first 4 weeks after injury were compared between groups. The P and NP groups were comprised of 16 and 55 participants, respectively. In univariate analyses, white blood cell (WBC) count on day 3 was significantly higher in group P than group NP (P = 0.021), as was serum C-reactive protein (CRP) level on day 3 (P = 0.015) and day 7 (P = 0.047). Multivariable analysis identified serum CRP level on day 3 as a significant independent prognostic factor for the progression of secondary SCI (OR, 1.138; 95% confidence interval, 1.01-1.28; P = 0.034). Serum CRP level on day 3 after injury was a good predictor for the progression of intramedullary signal intensity change on MRI from acute to subacute stage in patients with SCI.

Magnetic resonance imaging predictors of outcome after surgical intervention for cervical spondylotic myelopathy

Background: Cervical spondylotic myelopathy (CSM) is a commonly seen spinal cord disease. There are no well-defined indications and optimal timing for surgical intervention. Therefore, defining predictors for outcome after surgical intervention will have great advantage in taking decisions for interventions.Methods: A consecutive series of all patients having signs and symptoms of cervical spondylotic myelopathy admitted to Department of Neurosurgery, Medical College, Thiruvananthapuram who underwent decompressive surgery with or without stabilization in one year were studied. Pre-operative magnetic resonance imaging (MRI) findings were correlated with post-operative surgical outcomes (Nurick grade) after 3 months of follow up. The pattern of spinal cord signal intensity was classified as: group A (MRI N/N) - no SI T1WI or T2WI, group B (MRI N/Hi) - no SI T1WI and high SI on T2WI and, group C (MRI Lo/Hi) - low SI T1WI and high SI on T2WI. CSM clinical outcomes were evaluated using Nurick grading system, which was used pre- and post-operatively (pre op and post op).Results: Post operatively improvement was seen in 75% of group A and 61.35 % of group B patients, but among group C only 25% patient improved according to Nurick grading pre op and post op.Conclusions: Patients with high intramedullary signal intensity on T2WI may experience a good surgical outcome. A less favorable surgical outcome is predicted by the presence of low intramedullary signal on T1WI.

Anti-myelin oligodendrocyte glycoprotein antibodies in an Egyptian boy with recurrent paraplegia

Abstract We report a case of NMOSD anti-MOG demyelinating disorder in a 5-year-old male. Case presentation A previously healthy 5-year-old male presented due to secondary inability to walk and incontinence. Initial neuroimaging identified demyelinating lesions of both corona radiata and centrum semiovale with intramedullary abnormal signal intensity opposite C5 and a long segment at upper dorsal spinal cord extending from D2 to D4. The patient received oral steroid with complete resolution of his symptoms. 2 years later, the patient presented with quadriparesis and incontinence. MRI brain and cervical spine revealed multiple cerebral demyelinating lesions and intramedullary high signal intensity opposite most of cervical spinal cord. After a course of oral steroid, the patient showed complete resolution of his symptoms except for mild right-hand weakness. CBC, ESR, ANA were normal. Aquaporin- 4 was negative. VEP showed mild bilateral optic nerve affection. CSF revealed no cells with no abnormal oligoclonal bands, but high IgG index was detected. As a result, IV methyl-prednisolone was initiated. Four months later, the patient presented with sudden diminution of vision. MRI brain showed bilateral symmetrical occipital T2 hyperintense signal. Anti-MOG antibody evaluation was positive. The patient received IV methyl-prednisolone and was commenced on mycophenolate mofetil. He showed complete clinical remission with no relapses. Conclusions This case outlines the management of anti-MOG demyelinating disorder. Understanding the presentation of this clinical entity may allow for earlier intervention and diagnosis with concomitant reduction of morbidity.

Spinal cord swelling in patients with cervical compression myelopathy

BackgroundIntramedullary hyperintense lesions associated with spinal cord edema on T2-weighted MR images (T2WI) are rare findings in patients with cervical spondylosis and are poorly characterized. We investigated the clinical characteristics of spinal cord edema due to cervical spondylosis (SCECS).MethodsIn total, 214 patients with cervical spondylotic myelopathy who underwent surgery between April 2007 and March 2017 were divided into SCECS and non-SCECS groups with SCECS defined as follows: (1) intramedullary signal intensity (ISI) of the cervical spinal cord in sagittal T2WI extending to more than one vertebral body height; (2) “fuzzy” ISI, recognized as a faint intramedullary change with a largely indistinct and hazy border; and (3) a larger sagittal diameter of the spinal cord segment with ISI just above or below the cord compression area compared with areas of the cervical spine without ISI. Radiographic parameters, demographic characteristics, and the Japanese Orthopedic Association (JOA) surgical outcomes score were compared between the groups.ResultsSeventeen patients (7.9%) were diagnosed with SCECS. These patients were younger than those in the non-SCECS group [median (interquartile range), 64 (20) vs. 69 (15) years, respectively, p = 0.016], and the disease duration from onset to surgery was significantly shorter in the SCECS group than in the non-SCECS group [6 (7) vs. 20 (48) months, respectively]. No significant difference was observed between groups with respect to sex, radiologic findings, or surgical outcomes.ConclusionThe disease showed an earlier onset and more rapid progression in the patients with SCECS than in those without SCECS.

Relationship of preoperative intramedullary MRI signal intensity and dynamic factors with surgical outcomes of laminoplasty for cervical ossification of the posterior longitudinal ligament

ObjectiveWe aimed to analyze the relationship of preoperative signal intensity on magnetic resonance imaging (MRI) and dynamic factor with surgical outcomes of laminoplasty for cervical ossification of the posterior longitudinal ligament (OPLL). Patients and methodsWe retrospectively reviewed the records of 29 patients (20 males and 9 females) who underwent double-door laminoplasty for cervical OPLL. T2-weighted MRI was performed preoperatively. To assess the high-signal changes of the spinal cord, signal intensity was classified as grade 0 (low signal, no changes), grade 1 (medium signal, mild changes), and grade 2 (bright signal, pronounced changes). The following factors were analyzed for their relationship with surgical outcome, expressed as the Japanese Orthopedic Association (JOA) score recovery rate: pre- and postoperative C2-C7 range of motion (ROM), segmental ROM, C2-C7 lordotic angle, and spinal cord occupying ratio, as well as disease duration. ResultsDisease duration was significantly longer in patients with pronounced high-signal changes on preoperative MRI (P < 0.05 for grade 2 vs. grade 1 or 0). The mean preoperative JOA score and JOA score recovery rate were significantly lower in patients with pronounced high-signal changes on preoperative MRI (P < 0.05 for grade 2 vs. grade 1 or 0). Preoperatively, segmental ROM was significantly smaller in patients with no MRI signal intensity changes (P < 0.05 for grade 0 vs. grade 1 or 2). Additionally, preoperative segmental ROM was negatively correlated with JOA score recovery rate (R=-0.470, P = 0.01) and positively correlated with high-signal changes on preoperative MRI (R = 0.460, P = 0.012). On multivariate analysis, preoperative segmental ROM was negatively associated with JOA score recovery rate (odds ratio, - 0.407; P = 0.046). ConclusionGiven its negative correlation with JOA score recovery rate and positive correlation with high-signal changes on preoperative MRI, higher preoperative segmental ROM may be associated with spinal cord damage due to repeated minor trauma, predicting poor surgical outcome of laminoplasty in cervical OPLL.

Failure to generate baseline muscle motor evoked potentials during spine surgery: Risk factors and association with the postoperative outcomes

ObjectiveTo identify factors associated with the failure to generate baseline muscle motor evoked potentials (mMEPs) during spinal surgery, and to determine the association between baseline mMEP generation and postoperative outcomes. MethodsA total of 345 patients who underwent spine surgery with intraoperative mMEP monitoring were included, and we retrospectively reviewed their demographic/clinical parameters, and mMEP recording results according to lesion locations. ResultsMultivariable logistic regression analysis revealed that preoperative Medical Research Council grade of the weakest muscle <3 was significantly associated with failure of baseline mMEP generation in both cervical and thoracic lesions. In addition, high intramedullary T2 signal intensity on spine MRI for cervical lesions and male sex for thoracic lesions were also significantly associated with baseline mMEP generation failure. Moreover, the failure of baseline mMEP generation was a significantly associated factor for poor functional outcome in patients with thoracic lesions. ConclusionSex, radiological abnormality, and preoperative functional status were associated with baseline mMEP generation failure during spine surgery with different patterns according to lesion location. Moreover, baseline mMEP generation failure in thoracic lesion could be associated with risk of postoperative deficits. SignificanceThe risk of baseline mMEP recording failure could be evaluated based on preoperative clinical parameters.

Surgical outcomes of laminoplasty for cervical spondylotic myelopathy in very elderly patients (older than 80 years): Time from symptom onset to surgery and changes in spinal cord signal intensity on MRI

ObjectiveWe aimed to assess the surgical outcomes of laminoplasty for cervical spondylotic myelopathy (CSM) in very elderly patients (older than 80 years), focusing specifically on the time from symptom onset to surgery and on the loss in spinal cord signal intensity on magnetic resonance imaging (MRI). Patients and methodsWe retrospectively reviewed 100 consecutive patients (61 males and 39 females) with CSM who underwent laminoplasty between 2006 and 2014. The patients were stratified based on the age at the time of surgery, with Group A consisting of 26 patients aged 80 years or older and Group B consisting of 74 patients younger than 80 years. The severity of myelopathy was assessed in terms of the Japanese Orthopaedic Association (JOA) score. Signal intensity loss on MRI was graded from I to III based on the size of the area with intensity changes (Grade I, one disk; Grade II, larger than one disk) and presence of intramedullary hypointensity on T1-weighted sagittal scans (Grade III). Surgical outcome, morbidities, and changes in spinal cord signal intensity on MRI were analyzed. ResultsThe time from symptom onset to surgery was 6.2±5.2 and 16.5±18.8months in Groups A and B, respectively, with significantly shorter duration of symptoms in Group A (p<0.001). Compared to Group B, Group A had lower mean JOA score preoperatively (8.8±1.9 vs. 10.1±1.7) and postoperatively (12.1±1.7 vs. 13.5±1.6), as well as lower mean JOA score recovery rate (40.7±12.5% vs. 51.0±15.4%) (p<0.05 for all). However, there was no difference between the groups regarding achieved JOA score (Group A, 3.3±1.0; Group B, 3.4±1.0). Preoperatively, intramedullary signal intensity change was observed in 84.6% of patients in Group A (22/26; 3, 13, and 6 patients with Grade I, II, and III, respectively), and in (82.4%) of patients in Group B (61/74; 18, 38, and 5 patients with Grade I, II, and , respectively), with significantly higher incidence of Grade III pattern in Group A than in Group B. ConclusionCompared to younger patients, very elderly patients had a shorter time from symptom onset to surgery but lower preoperative JOA score, indicating that the condition of very elderly patients is likely to deteriorate and become severe rapidly after the onset of myelopathy. However, it is very important to know these pathologies and optimize the timing of surgery, as laminoplasty for CSM can be beneficial even in very elderly patients.

Heroin-induced acute myelopathy with extreme high levels of CSF glial fibrillar acidic protein indicating a toxic effect on astrocytes

A man aged 33 years with previous heroin substance abuse was found unconscious lying in a bush. The patient had been without heroin for some time but had just started...

Signal intensity ratio on magnetic resonance imaging as a prognostic factor in patients with cervical compressive myelopathy.

Patients with intramedullary signal intensity (SI) changes have a poor prognosis after surgical decompression in cervical compressive myelopathy (CCM); however, some patients show no clear relationship between the SI and postsurgical prognosis. This discrepancy may be because no comprehensive and proper quantitative evaluation exists to assess SI on magnetic resonance imaging (MRI). The purpose of this study was prospectively to evaluate the correlation between the clinical features, neurological outcome of patients with CCM, and the quantitative assessment of SI changes preoperatively and postoperatively, and the correlation with SI severity.A total of 112 patients with CCM at 1 or 2 levels underwent anterior cervical discectomy and fusion. We quantitatively analyzed MR signal changes on T1-weighted MR images (T1WI), gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA) contrast-enhanced T1WI, and T2-weighted MR images (T2WI) using the signal intensity ratio (SIR). We evaluated the correlations between various variables and neurological outcome using the Japanese Orthopedic Association (JOA) scale, and the severity of SI change by grade (i.e., grade 0 ["none"], grade 1 ["light"], and grade 2 ["bright on T2WI"]).Significant differences between the 3 grades existed in symptom duration, preoperative JOA score, SIR on T2WI, and JOA recovery ratio. The JOA recovery ratio was negatively correlated with symptom duration and the SIR on T2WI, and positively correlated with the preoperative JOA score and cord compression ratio, but not with the SIR on T1WI and contrast-enhanced T1WI. On the postoperative 12-month follow-up MRI, the JOA recovery ratio and SIR on T2WI of the SI reversal patients were better than those of the nonreversal patients. On multiple regression analysis, the SIR on T2WI was the main significant prognostic factor of surgical outcome.The grading system on T2WI provided reliable predictive information for neurological outcome. Quantitative alterations in the SI on preoperative and postoperative T2WI, but not T1WI or contrast-enhanced T1WI, reflected the clinical features, surgical outcomes, and the correlation with SI severity. The patients with a longer duration of symptoms, lower cord compression ratio, severe myelopathy, intense signal change (i.e., grade 2) on the spinal cord, and an SIR greater than 1.55 had a poor recovery after a surgical operation.

Should Cervical Disc Arthroplasty Be Done on Patients with Increased Intramedullary Signal Intensity on Magnetic Resonance Imaging?

Several trials from the U.S. Food and Drug Administration have demonstrated the success of cervical disc arthroplasty (CDA) in patients with degenerative disc disease causing radiculopathy, myelopathy, or both. For patients who had increased intramedullary signal intensity (IISI) on magnetic resonance image (MRI), however, the effectiveness and safety of CDA was unclear. This study aimed to evaluate the outcomes of CDA for patients with IISI on preoperative MRI. Consecutive patients who received 1-level CDA for symptomatic degenerative disc disease were reviewed retrospectively. Patients with IISI on preoperative T2-weighted MRI were compared to those without IISI (non-IISI). Clinical outcome parameters including visual analog scale, Neck Disability Index, Japanese Orthopedic Association (JOA), and Nurick scores were analyzed. Radiographic studies included dynamic lateral radiography and MRI. A total of 91 patients were analyzed (22 in the IISI group and 69 in the non-IISI group). The mean follow-up was 30.0 months. The demographic data were mostly similar between the 2 groups. All clinical outcomes, including visual analog scale, Neck Disability Index, JOA, and Nurick scores in the IISI group demonstrated significant improvement after operation. The IISI group had similar clinical outcomes to the non-IISI group, except that the JOA scores were generally worse. Follow-up MRI demonstrated significant regression of the length of IISI (P= 0.009). Both groups had preserved motion after CDA. Both clinical and radiological outcomes improved (the average length of IISI in the cervical spinal cord became shorter) after CDA. Therefore, CDA is a safe and effective option for patients even when there is IISI on the preoperative T2-weighted MRI.

Clinical significance of high intramedullary signal on T2-weighted cervical flexion–extension magnetic resonance imaging in cervical myelopathy

BackgroundIn cervical myelopathy, significant findings are seen in flexion–extension MRI due to the increased likelihood of cord compression during neck extension. In addition, a high intramedullary signal on T2-weighted MR images has been reported to be a prognostic factor in this condition. However, the relationship between Japanese Orthopaedic Association (JOA) scores and the signal intensity in preoperative cervical flexion–extension T2-weighted images has not been evaluated. The purpose of this study was to evaluate whether preoperative flexion–extension MRI may be used to predict surgical outcomes in patients with cervical myelopathy. MethodsA total of 121 patients who underwent surgery for cervical myelopathy were included. All patients underwent preoperative cervical flexion–extension MRI followed by cervical decompression surgery, with or without spinal fusion, and postoperative follow-up for at least 2years. Pre- and postoperative (2years after surgery) JOA scores were recorded, and the degree of postoperative improvement was calculated. The relationship between intramedullary signal intensity on preoperative cervical dynamic MRI findings and degree of clinical recovery was examined. ResultsPatients with a high intramedullary signal on the extension MRI had significantly better neurological recovery than those with a high signal on the flexion MRI (p<0.000005). There was no significant difference in neurological recovery between patients with and without a high intramedullary signal on extension MRI. ConclusionsA preoperative high intramedullary signal on flexion MRI was associated with a poor surgical outcome, while no such association was seen with extension MRI.

Prognostic factors for surgical outcome in spinal cord injury associated with ossification of the posterior longitudinal ligament (OPLL).

BackgroundOssification of the posterior longitudinal ligament (OPLL) may increase the risk of spinal cord injury (SCI) with various neurological deficits after minor trauma. However, few studies have investigated the influence of OPLL on neurological outcome after acute cord injury. We examined whether severe spinal canal stenosis caused by OPLL affects neurological outcome after SCI based on intramedullary signal intensity (SI) changes on magnetic resonance imaging (MRI).MethodsFrom June 2006 to July 2013, we treated 246 patients with cervical cord injury. Fifty-one (20.7 %) patients had ventral cord compression due to OPLL without any bony fractures. Among them, 38 patients (34 men, mean age 62.7 years) underwent cervical laminoplasty (8) and cervical decompression and fixation (30). The neurologic assessments were performed in patients who had 1-year follow-up, and the mean follow-up period was 42.2 months. OPLL type, cause of injury, cervical sagittal angle, cervical spine stenosis, cord compression ratio (space available for the spinal cord (SAC)), and grade of intramedullary SI (grade 0, none; grade 1, light; grade 2, intense T2WI) were assessed.ResultsMean American Spinal Injury Association (ASIA) motor score at admission was 38.4 ± 21.9 (range, 2–70) and improved to 67.7 ± 19.1 (range, 8–94) at last follow-up (p < 0.05). Mean recovery rate of the motor score was 55.8 ± 19.9 %. Five patients had SI grade 0, 20 patients had SI grade 1, and 13 patients had SI grade 2. Among the variables tested, age, initial ASIA motor grade, intramedullary SI grade, and SAC were significantly related to neurological outcome. However, initial cervical alignment, canal diameter, length of SI, time interval between injury and operation, and OPLL type had no significant effect on neurological outcome.ConclusionsPreoperative neurological status, cord compression ratio, and SI grade are related to neurological outcome in patients with SCI associated with OPLL. The better the preoperative neurological status, the more favorable the neurological outcome after surgery. A higher SI grade on preoperative T2WI was negatively related to neurological outcome. Therefore, the severity of SI change, cord compression ratio, and preoperative neurological status can be regarded as significant prognostic factors in patients with SCI associated with OPLL.

Factors Associated With Intramedullary MRI Abnormalities in Patients With Ossification of the Posterior Longitudinal Ligament

A retrospective clinical study of 113 patients with ossification of the posterior longitudinal ligament (OPLL), who underwent either anterior or posterior surgery between 2006 and 2009. To evaluate the risk factors affecting the intramedullary spinal cord changes in signal intensity on magnetic resonance imaging (MRI) for the patients with OPLL. The relationship between the intramedullary spinal cord changes in signal intensity on MRI and neurological deficits, as well as the surgical outcomes, has been described. To obtain better prognosis, early surgery should be conducted in patients with OPLL who have potential abilities to develop intramedullary spinal cord changes in signal intensity on MRI. Various factors may be affecting the development of intramedullary spinal cord changes in signal intensity on MRI. The clinical and radiographic data of 113 patients with OPLL who underwent either anterior or posterior surgery between 2006 and 2009 were reviewed. Age, sex, complication, mean occupying ratio of OPLL (the greatest thickness of OPLL divided by the anteroposterior diameter of the bony spinal canal), duration of symptoms, type of OPLL, preoperative Japanese Orthopedic Association (JOA) score, and range of motion of the cervical spine were collected. Logistic regression analysis was used. Changes in the intramedullary signal intensity on MRI were observed in 33 of the 113 patients. Statistical results show that duration of symptoms, occupying ratio of OPLL, preoperative JOA score, kyphosis, and instability of the cervical spine are the relevant risk factors for intramedullary spinal cord changes in signal intensity on MRI, with regression coefficients of 2.437, 0.953, -1.952, 2.093, and 1.516, respectively. For patients with OPLL, the longer the duration of the symptoms, or the higher occupying ratio of OPLL, or the lower preoperative JOA score, the greater the likelihood of intramedullary spinal cord changes in signal intensity on MRI. As intramedullary spinal cord changes in signal intensity on MRI indicated severe damage to spinal cord and poor prognosis as we described before, early surgery is suggested for patients with OPLL who manifest one of the following factors: prolonged symptoms, high occupying ratio, low preoperative JOA score, kyphosis, or instability of the cervical spine. These factors are closely related to the intramedullary spinal cord changes in signal intensity on MRI.

Intramedullary Signal Intensity and Other Prognostic Factors for Surgical Outcome in Spinal Cord Injury Associated With Ossification of the Posterior Longitudinal Ligament (OPLL)

Ossification of the posterior longitudinal ligament (OPLL) might cause stenotic changes in the spinal canal and lead to cervical myelopathy. Also, it may increase the risk of spinal cord injury (SCI) with various neurological deficits after minor trauma. However, there are only a few reports that discuss the influence of OPLL on the neurological outcome after acute cord injury. We have tried to find out whether severe spinal canal stenosis caused by OPLL affects neurological outcome after SCI without any bony fractures or intramedullary signal intensity (SI) changes on MRI to evaluate critical prognostic factors for SCI associated with OPLL.

Does intramedullary signal intensity on MRI affect the surgical outcomes of patients with ossification of posterior longitudinal ligament?

ObjectivesPatients with cervical ossification of posterior longitudinal ligament (OPLL) are susceptible to cord injury, which often develops into myelopathic symptoms. However, little is known regarding the prognostic factors that are involved in minor trauma. We evaluated the relationship between minor trauma and neurological outcome of OPLL and investigated the prognostic factors with a focus on compressive factors and intramedullary signal intensity (SI).MethodsA total of 74 patients with cervical myelopathy caused by OPLL at more than three-levels were treated with posterior decompression surgeries. We surveyed the space available for spinal cord (SAC), the severity of SI change on T2-weighted image, and diabetes mellitus (DM). The neurological outcome using Japanese Orthopedic Association (JOA) scale was assessed at admission and at 12-month follow-up.ResultsAmong the variables tested, preoperative JOA score, severity of intramedullary SI, SAC, and DM were significantly related to neurological outcome. The mean preoperative JOA were 11.3±1.9 for the 41 patients who did not have histories of trauma and 8.0±3.1 for the 33 patients who had suffered minor traumas (p<0.05). However, there were no significant differences in the recovery ratios between those two groups.ConclusionsInitial neurological status and high intramedullary SI in the preoperative phase were related to poorer postoperative outcomes. Moreover, the patients with no histories of DM and larger SACs exhibited better improvement than did the patients with DM and smaller SACs. Although the initial JOA scores were worse for the minor trauma patients than did those who had no trauma prior to surgery, minor trauma exerted no direct effects on the surgical outcomes.

Compressive myelopathy: magnetic resonance imaging findings simulating idiopathic acute transverse myelopathy

To provide magnetic resonance imaging (MRI) findings of compressive myelopathy simulating idiopathic acute transverse myelopathy (ATM). From 19,416 patients who had spinal MRI from 1 September 2004 to 10 July 2011, the patients who met inclusion criteria were enrolled as follows: (1) definable cord compression, (2) long-segmental intramedullary T2-high signal intensity (HSI) extending more than 2 vertebral segments, and (3) no history of trauma, malignancy, or demyelinating disease. The characteristics of T2-HSI and contrast enhancement pattern were analyzed. The patients' clinical information was collected in the process. Thirteen patients (10 men, 3 women; mean age, 52.8 years; age range, 43-77 years) were included in this study. Twelve patients had cervical cord compression and one had thoracic compression. Common findings of T2-HSI included fusiform shape (100 %) with cord swelling (92.3 %), cord compression in midline location (76.9 %), diffuse distribution occupying more than two-thirds of the cross-sectional dimension of the cord in axial image (84.6 %), and focal and peripheral enhancement (63.6 %). Intravenous corticosteroid was administered to four patients, including two patients following decompressive surgery, and interval decrease in T2-HSI was seen in three patients, but with residual lesions at cord compression level. Spinal cord compression can induce long-segmental cord signal change, such as idiopathic ATM.