Aria Nouri1, Lindsay Tetreault2, Kristian Dalzell3, Juan J Zamorano4, Michael G Fehlings1. 1. Division of Neurosurgery and Spine Program, Toronto Western Hospital, Toronto, Ontario, Canada. 2. Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada. 3. Christchurch Public Hospital & Burwood Spinal Unit, Christchurch, New Zealand. 4. Department of Orthopedics, Hospital del Trabajador de Santiago, Santiago, Chile.
Abstract
BACKGROUND: Degenerative cervical myelopathy encompasses a group of conditions resulting in progressive spinal cord injury through static and dynamic compression. Although a constellation of changes can present on magnetic resonance imaging (MRI), the clinical significance of these findings remains a subject of controversy and discussion. OBJECTIVE: To investigate the relationship between clinical presentation and quantitative MRI features in patients with degenerative cervical myelopathy. METHODS: A secondary analysis of MRI and clinical data from 114 patients enrolled in a prospective, multicenter study was conducted. MRIs were assessed for maximum spinal cord compression (MSCC), maximum canal compromise (MCC), signal changes, and a signal change ratio (SCR). MRI features were compared between patients with and those without myelopathy symptoms with the use of t tests. Correlations between MRI features and duration of symptoms were assessed with the Spearman ρ. RESULTS: Numb hands and Hoffmann sign were associated with greater MSCC ( P < .05); broad-based, unstable gait, impairment of gait, and Hoffmann sign were associated with greater MCC ( P < .05); and numb hands, Hoffmann sign, Babinski sign, lower limb spasticity, hyperreflexia, and T1 hypointensity were associated with greater SCR ( P < .05). Patients with a T2 signal hyperintensity had greater MSCC and MCC ( P < .001). CONCLUSION: MSCC was associated with upper limb manifestations, and SCR was associated with upper limb, lower limb, and general neurological deficits. Hoffmann sign occurred more commonly in patients with a greater MSCC, MCC and SCR. The Lhermitte phenomenon presented more commonly in patients with a lower SCR and may be an early indicator of mild spinal cord involvement. Research to validate these findings is required.
BACKGROUND:Degenerative cervical myelopathy encompasses a group of conditions resulting in progressive spinal cord injury through static and dynamic compression. Although a constellation of changes can present on magnetic resonance imaging (MRI), the clinical significance of these findings remains a subject of controversy and discussion. OBJECTIVE: To investigate the relationship between clinical presentation and quantitative MRI features in patients with degenerative cervical myelopathy. METHODS: A secondary analysis of MRI and clinical data from 114 patients enrolled in a prospective, multicenter study was conducted. MRIs were assessed for maximum spinal cord compression (MSCC), maximum canal compromise (MCC), signal changes, and a signal change ratio (SCR). MRI features were compared between patients with and those without myelopathy symptoms with the use of t tests. Correlations between MRI features and duration of symptoms were assessed with the Spearman ρ. RESULTS:Numb hands and Hoffmann sign were associated with greater MSCC ( P < .05); broad-based, unstable gait, impairment of gait, and Hoffmann sign were associated with greater MCC ( P < .05); and numb hands, Hoffmann sign, Babinski sign, lower limb spasticity, hyperreflexia, and T1 hypointensity were associated with greater SCR ( P < .05). Patients with a T2 signal hyperintensity had greater MSCC and MCC ( P < .001). CONCLUSION: MSCC was associated with upper limb manifestations, and SCR was associated with upper limb, lower limb, and general neurological deficits. Hoffmann sign occurred more commonly in patients with a greater MSCC, MCC and SCR. The Lhermitte phenomenon presented more commonly in patients with a lower SCR and may be an early indicator of mild spinal cord involvement. Research to validate these findings is required.
Authors: Benjamin Davies; Oliver Mowforth; Iwan Sadler; Bizhan Aarabi; Brian Kwon; Shekar Kurpad; James S Harrop; Jefferson R Wilson; Robert Grossman; Michael G Fehlings; Mark Kotter Journal: BMJ Open Date: 2019-10-10 Impact factor: 2.692
Authors: Jamie R F Wilson; Jetan H Badhiwala; Fan Jiang; Jefferson R Wilson; Branko Kopjar; Alexander R Vaccaro; Michael G Fehlings Journal: J Clin Med Date: 2019-10-17 Impact factor: 4.241