The treatment of mild cervical spondylotic myelopathy with increased signal intensity on T2-weighted magnetic resonance imaging

Abstract

Study design:A retrospective comparative study.Objectives:To compare clinical outcomes of surgery or non-operated treatment for mild cervical spondylotic myelopathy (CSM) patients with intramedullary increased signal intensity (ISI) on T2-weighted imaging (T2WI) of magnetic resonance imaging (MRI), related factors that may affect prognosis were explored.Methods:Data from 91 patients treated from July 2008 to June 2011 were retrospectively analyzed. The Japanese Orthopedic Association (JOA) recovery ratio was used to compare outcomes of surgery and non-operated treatment. Correlation and multiple linear regression analyses were performed between JOA recovery ratio and age, disease course, segmental lordosis, total range of motion (ROM), segmental ROM, local slip, extent of spinal cord compression or ISI type.Results:Patients were divided into two groups by therapy methods: Group A (n=53, 33 males, age 36-68 years) underwent anterior cervical decompression and fusion surgery, average follow-up 30.68±8.19 months; Group B (n=38, 14 males, age 28-76 years) received non-operated treatment, average follow-up 34.08±9.05 months. There were no significant differences in clinical outcomes between the two groups. There were significant correlations between JOA recovery ratio and clinical course (P<0.01) or segmental lordosis (P<0.01). Patients with shorter disease course and larger segmental lordosis have better clinical outcomes as shown by multiple linear regression analysis.Conclusion:For mild CSM patients with ISI on T2WI-MRI, there are no significant differences in clinical outcome between surgery and non-operated treatment during the short-term follow-up. Patients with shorter disease course and larger segmental lordosis have better clinical outcomes than those with longer course and segmental kyphosis. © 2014 International Spinal Cord Society. All rights reserved.