The Severity of Myelopathy as a Diagnostic and Prognostic Indicator in the Treatment of Patients with Cervical Spinal Stenosis

Cervical spinal stenosis is accompanied by dysfunction of the spinal cord, leading to numerous complications and disability of patients. These issues are well known to radiologists, vertebrologists, and neurosurgeons, however, not all of multiple diagnostic problems and issues of surgical treatment can be considered resolved.

Purpose of the study. Justification of the possibilities and necessity of qualitative and quantitative MRI study of the severity of myelopathy in cervical spinal stenosis.

Materials and methods. The results of an MRI examination of 82 patients with cervical spinal stenosis due to degenerative processes were carried out with the use of osteoplastic bilateral laminoplasty technique with simultaneous foraminotomy under neurophysiological control. The examination was conducted before and after the treatment. The study was carried out using standard programs, such as T2 haste localizer, t2_tse_cor_p2, t2_tse_sag_p2, t1_tse_sag_p2.

Results. The focus of myelopathy was detected by MRI in 74.4 % of cases, which confirmed the severity of the pathology. 28 out of 60 patients with myelopathy displayed a clearly defined «snakeeyes» sign, also knows as «owl-eyes» or «fried-eggs» appearance. In some patients, one zone was identified in the form of a rounded focus of increased signal intensity on the axial section.

The average value of the signal intensity coefficient in patients before treatment was 1.89 ± 0.31, after treatment — 1.63 ± 0.21. Significant differences in MRI before and after treatment occurred in 45 % of patients.

Conclusion. The results of the work showed that quantitative assessment of the signal intensity from the spinal cord in stenosis can be used to assess the severity of myelopathy and compare data before and after treatment. In order to identify the source of the most intense signal more accurately and increase the overall measurement accuracy, it is advisable to carry out color mapping of images.

1. Gushcha A. O., Dreval’ M. D., Yusupova A. R., Arestov S. O., Petrosyan D. V. Cervical spondylogenic myelopathy: 10-year treatment experience. Annals of Clinical and Experimental Neurology. 2021; Russ.). https://doi.org/10.18019/1028-4427-2024-30-3-353-361. EDN: ETBFJW

2. Sufianov A. A., Nabiev D. N., Burtsev A. V., Sufianov R. A., Karsanova M. T., Piterov V. V. MSCT-semiotics of vertebrae in patients with cervical spine stenosis. Ge nij Ortopedii. 2024;30(3):353-361. (In Russ.). https://doi.org/10.18019/10284427-2024-30-3-353-361. EDN: ETBFJW

3. Badhiwala J. H., Wilson J. R. The Natural history of degenerative cervical myelopathy. Neurosurg. Clin. of N. Am. 2018;29(1):21-32. https://doi.org/10.1016/j.nec.2017.09.002

4. Bhosale S., Ingale P., Srivastava S., Marathe N., Bhide P. Diffusion tensor imaging as an additional postoperative prognostic predictor factor in cervical myelopathy patients: An observational study. J. Craniovertebr Junction Spine. 2019;10(1):10-13. https://doi.org/10.4103/jcvjs.JCVJS_77_18

5. Chen X., Shan T., Li Y. Prognostic effect of increased postoperative MRI T2WI high signal intensity in degenerative cervical myelopathy. Spine J. 2022;22(12):1964-1973. https://doi.org/10.1016/j.spinee.2022.07.097

6. Dave B. R., Krishnan A., Rai R. R., Degulmadi D., Mayi S., Patidar V. Does MR Signal Intensity Change have Prognostic Value in Multilevel Cervical Myelopathy? A Single-Center, Prospective Study. Neurol. India. 2023; 71(2):285-290. https://doi.org/10.4103/0028-3886.375382

7. Dohle E., Beardall S., Chang A., Mena K. P. C., Jovanović L., Nath U., Lee K. S., Smith A. H., Thirunavukarasu A. J., Touzet A. Y., Norton E. J., Mowforth O D., Kotter M. R. N., Davies B. M. Human spinal cord tissue is an underutilised resource in degenerative cervical myelopathy: findings from a systematic review of human autopsies. Acta Neurochi. 2023;165(5):1121-1131. https://doi.org/10.1007/s00701-023-05526-5

8. Firempong G. K., Sheppard W. L., Gelfand Y., Ellingson B. M., Holly L. T. Spinal Cord Signal Intensity Predicts Functional Outcomes in the Operative Management of Degenerative Cervical Myelopathy. Clin. Spine. Surg. 2023;36(10):438-443. https://doi.org/10.1097/BSD.0000000000001479

9. Fontanella M. M., Zanin L., Bergomi R., Fazio M., Zattra C. M., Agosti E., Saraceno G., Schembari S., De Maria L., Quartini L., Leggio U., Filosto M., Gasparotti R., Locatelli D. Snake-Eye Myelopathy and Surgical Prognosis: Case Series and Systematic Literature Review. J. Clin. Med. 2020;9(7):2197. https://doi.org/10.3390/jcm9072197

10. Fotakopoulos G., Georgakopoulou V. E., Lempesis I. G., Papalexis P., Sklapani P., Trakas N., Spandidos D. A., Faropoulos K. Pathophysiology of cervical myelopathy (Review). Biomed Rep. 2023;19(5):84. https://doi.org/10.3892/br.2023.1666

11. Funaba M., Imajo Y., Suzuki H., Nishida N., Nagao Y., Sakamoto T., Fujimoto K., Sakai T. Impact of various MRI signal intensity changes on radiological parameters, the neurological status, and surgical outcomes in degenerative cervical myelopathy. Clin. Neurol. Neurosurg. 2021;207:106802.https://doi.org/10.1016/j.clineuro.2021.106802

12. Grassner L., Wutte C., Zimmermann G., Grillhösl A., Schmid K.., Weiβ T., Maier W., Hauck S., Hollerith T., Vogel M., Bierschneider M., Vastmans J., Thomé C., Gonschorek O., Strowitzki M. Influence of Preoperative Magnetic Resonance Imaging on Surgical Decision Making for Patients with Acute Traumatic Cervical Spinal Cord Injury: A Survey Among Experienced Spine Surgeons. World Neurosurg. 2019;131:e586-e592. https://doi.org/10.1016/j.wneu.2019.08.009

13. He B., Sheldrick K., Das A., Diwan A. Clinical and Research MRI Techniques for Assessing Spinal Cord Integrity in Degenerative Cervical Myelopathy-A Scoping Review. Biomedicines. 2022;10(10): 2621. https://doi.org/10.3390/biomedicines10102621

14. Hesni S., Baxter D., Saifuddin A. The imaging of cervical spondylotic myeloradiculopathy. Skeletal Radiol. 2023; 52(1):2341-2365. https://doi.org/10.1007/s00256-023-04329-0

15. Martin A. R., Tadokoro N., Tetreault L., Arocho-Quinones E. V., Budde M. D., Kurpad S. N., Fehlings M. G. Imaging evaluation of degenerative cervical myelopathy. Neurosurg. Clin. of N. Am. 2018; 29(1):33-45. https://doi.org/10.1016/j.nec.2017.09.003

16. Nam T. H., Lee J. W., Yeom J. S., Lee E., Kang Y., Ahn J. M., Kang H. S. Increased signal intensity on postoperative T2-weighted axial images in cervical spondylotic myelopathy: Patterns of changes and associated impact on outcomes. J. Clin. Neurosci. 2021;90:244-250. https://doi.org/10.1016/j.jocn.2021.06.007

17. Nouri A., Martin A. R., Nater A. The influence of MRI features on surgicaldecision making in degenerative cervical myelopathy: results from a global survey of AO Spine international members. World Neurosurg. 2017;105:864-874. https://doi.org/10.1016/j.wneu.2017.06.025

18. Ren H., Feng T., Wang L., Liu J., Zhang P., Yao G., Shen Y. Using a Combined Classification of Increased Signal Intensity on Magnetic Resonance Imaging (MRI) to Predict Surgical Outcome in Cervical Spondylotic Myelopathy. Med. Sci. Monit. 2021;27:e929417. https://doi.org/10.12659/MSM.929417

19. Sangondimath G., Mallepally A. R., Marathe N., Mak K. C., Salimath S. Degenerative cervical myelopathy: Recent updates and future directions. J. Clin. Orthop Trauma. 2020;11(5):822-829. https://doi.org/10.1016/j.jcot.2020.07.012

20. Scalia G., Costanzo R., Brunasso L., Garufi G., Bonosi L., Ricciardo G., Graziano F., Nicoletti G. F., Cardali S. M., Iacopino D. G., Maugeri R., Umana G. E. Correlation between "Snake-Eyes" Sign and Role of Surgery with a Focus on Postoperative Outcome: A Systematic Review. Brain Sci. 2023;10;13(2):301. https://doi.org/10.3390/brainsci13020301

21. You J. Y., Lee J. W., Lee E., Lee G. Y., Yeom J. S., Kang H. S. MR Classification System Based on Axial Images for Cervical Compressive Myelopathy. Radiology. 2015;276(2):553-61 https://doi.org/10.1148/radiol.2015142384

22. Zhang J., Wang L., Wang S., Li J., Shen Y. Risk factors for poor outcome of surgery for cervical spondylotic myelopathy. Spinal Cord. 2016;54(12):1127-1131. https://doi.org/10.1038/sc.2016.64