Preoperative patient selection with magnetic resonance imaging, computed tomography, and electroencephalography: does the test predict outcome after cervical surgery?

Restricted access

Object

The objective of this systematic review was to use evidence-based medicine to assess whether preoperative imaging or electromyography (EMG) predicts surgical outcomes in patients undergoing cervical surgery.

Methods

The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to the preoperative imaging and EMG. Abstracts were reviewed after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons.

Results

Preoperative MR imaging and CT myelography are successful in confirming clinical radiculopathy (Class II). Multilevel T2 hyperintensity, T1 focal hypointensity combined with T2 focal hyperintensity, and spinal cord atrophy each convey a poor prognosis (Class III). There is conflicting data concerning whether focal T2 hyperintensity or cervical stenosis are associated with a worse outcome. Electromyography has mixed utility in predicting outcome (Class III).

Conclusions

Magnetic resonance imaging or CT myelography are important for preoperative assessment. Magnetic resonance imaging may be helpful in assessing prognosis, whereas EMG has mixed utility in assessing outcome.

Abbreviations used in this paper: ACCF = anterior cervical corpectomy with fusion; ACD = anterior cervical discectomy; ACDF = ACD with fusion; CDH = cervical disc herniation; CSM = cervical spondylotic myelopathy; EMG = electromyography; JOA = Japanese Orthopaedic Association; mJOA = modified JOA; OPLL = ossification of the posterior longitudinal ligament.

Article Information

Address correspondence to: Paul G. Matz, M.D., Neurosurgery and Neurology, LLC, 232 South Woods Mill Road, Chesterfield, Missouri 63017. email: matzpg@yahoo.com.

© AANS, except where prohibited by US copyright law.

Headings

References

  • 1

    Alrawi MFKhalil NMMitchell PHughes SP: The value of neurophysiological and imaging studies in predicting outcome in the surgical treatment of cervical radiculopathy. Eur Spine J 16:4955002007

    • Search Google Scholar
    • Export Citation
  • 2

    Ashkan KJohnston PMoore AJ: A comparison of magnetic resonance imaging and neurophysiological studies in the assessment of cervical radiculopathy. Br J Neurosurg 16:1461482002

    • Search Google Scholar
    • Export Citation
  • 3

    Bucciero AVizioli LTedeschi G: Cord diameters and their significance in prognostication and decisions about management of cervical spondylotic myelopathy. J Neurosurg Sci 37:2232281993

    • Search Google Scholar
    • Export Citation
  • 4

    Chen CJLyu RKLee STWong YCWang LJ: Intramedullary high signal intensity on T2-weighted MR images in cervical spondylotic myelopathy: prediction of prognosis with type of intensity. Radiology 221:7897942001

    • Search Google Scholar
    • Export Citation
  • 5

    Chibbaro SBenvenuti LCarnesecchi SMarsella MPulera FSerino D: Anterior cervical corpectomy for cervical spondylotic myelopathy: experience and surgical results in a series of 70 consecutive patients. J Clin Neurosci 13:2332382006

    • Search Google Scholar
    • Export Citation
  • 6

    Chiles BW IIILeonard MAChoudhri HFCooper PR: Cervical spondylotic myelopathy: patterns of neurological deficit and recovery after anterior cervical decompression. Neurosurgery 44:7627701999

    • Search Google Scholar
    • Export Citation
  • 7

    Choi SLee SHLee JYChoi WGChoi WCChoi G: Factors affecting prognosis of patients who underwent corpectomy and fusion for treatment of cervical ossification of the posterior longitudinal ligament: analysis of 47 patients. J Spinal Disord Tech 18:3093142005

    • Search Google Scholar
    • Export Citation
  • 8

    Fernandez de Rota JJMeschian SFernandez de Rota AUrbano VBaron M: Cervical spondylotic myelopathy due to chronic compression: the role of signal intensity changes in magnetic resonance images. J Neurosurg Spine 6:17222007

    • Search Google Scholar
    • Export Citation
  • 9

    Fujiwara KYonenobu KEbara SYamashita KOno K: The prognosis of surgery for cervical compression myelopathy. An analysis of the factors involved. J Bone Joint Surg Br 71:3933981989

    • Search Google Scholar
    • Export Citation
  • 10

    Fukushima TIkata TTaoka YTakata S: Magnetic resonance imaging study on spinal cord plasticity in patients with cervical compression myelopathy. Spine 16:10 SupplS534S5381991

    • Search Google Scholar
    • Export Citation
  • 11

    Houten JKCooper PR: Laminectomy and posterior cervical plating for multilevel cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament: effects on cervical alignment, spinal cord compression, and neurological outcome. Neurosurgery 52:108110882003

    • Search Google Scholar
    • Export Citation
  • 12

    Huang RCGirardi FPPoynton ARCammisa FP Jr: Treatment of multilevel cervical spondylotic myeloradiculopathy with posterior decompression and fusion with lateral mass plate fixation and local bone graft. J Spinal Disord Tech 16:1231292003

    • Search Google Scholar
    • Export Citation
  • 13

    Kasai YUchida A: New evaluation method using preoperative magnetic resonance imaging for cervical spondylotic myelopathy. Arch Orthop Trauma Surg 121:5085102001

    • Search Google Scholar
    • Export Citation
  • 14

    Koyanagi IIwasaki YHida KImamura HAbe H: Magnetic resonance imaging findings in ossification of the posterior longitudinal ligament of the cervical spine. J Neurosurg 88:2472541998

    • Search Google Scholar
    • Export Citation
  • 15

    Koyanagi THirabayashi KSatomi KToyama YFujimura Y: Predictability of operative results of cervical compression myelopathy based on preoperative computed tomographic myelography. Spine 18:195819631993

    • Search Google Scholar
    • Export Citation
  • 16

    Matsuda YMiyazaki KTada KYasuda ANakayama TMurakami H: Increased MR signal intensity due to cervical myelopathy. Analysis of 29 surgical cases. J Neurosurg 74:8878921991

    • Search Google Scholar
    • Export Citation
  • 17

    Matsuyama YKawakami NMimatsu K: Spinal cord expansion after decompression in cervical myelopathy. Investigation by computed tomography myelography and ultrasonography. Spine 20:165716631995

    • Search Google Scholar
    • Export Citation
  • 18

    Matsuyama YKawakami NYanase MYoshihara HIshiguro NKameyama T: Cervical myelopathy due to OPLL: clinical evaluation by MRI and intraoperative spinal sonography. J Spinal Disord Tech 17:4014042004

    • Search Google Scholar
    • Export Citation
  • 19

    Mehalic TFPezzuti RTApplebaum BI: Magnetic resonance imaging and cervical spondylotic myelopathy. Neurosurgery 26:2172271990

  • 20

    Mizuno JNakagawa HInoue THashizume Y: Clinicopathological study of “snake-eye appearance” in compressive myelopathy of the cervical spinal cord. J Neurosurg 99:1621682003

    • Search Google Scholar
    • Export Citation
  • 21

    Morio YTeshima RNagashima HNawata KYamasaki DNanjo Y: Correlation between operative outcomes of cervical compression myelopathy and MRI of the spinal cord. Spine 26:123812452001

    • Search Google Scholar
    • Export Citation
  • 22

    Morio YYamamoto KKuranobu KMurata MTuda K: Does increased signal intensity of the spinal cord on MR images due to cervical myelopathy predict prognosis?. Arch Orthop Trauma Surg 113:2542591994

    • Search Google Scholar
    • Export Citation
  • 23

    Naderi SOzgen SPamir MNOzek MMErzen C: Cervical spondylotic myelopathy: surgical results and factors affecting prognosis. Neurosurgery 43:43501998

    • Search Google Scholar
    • Export Citation
  • 24

    Nagata KOhashi TAbe JMorita MInoue A: Cervical myelopathy in elderly patients: clinical results and MRI findings before and after decompression surgery. Spinal Cord 34:2202261996

    • Search Google Scholar
    • Export Citation
  • 25

    Negrin PLelli SFardin P: Contribution of electromyography to the diagnosis, treatment and prognosis of cervical disc disease: a study of 114 patients. Electromyogr Clin Neurophysiol 31:1731791991

    • Search Google Scholar
    • Export Citation
  • 26

    Okada YIkata TYamada HSakamoto RKatoh S: Magnetic resonance imaging study on the results of surgery for cervical compression myelopathy. Spine 18:202420291993

    • Search Google Scholar
    • Export Citation
  • 27

    Papadopoulos CAKatonis PPapagelopoulos PJKarampekios SHadjipavlou AG: Surgical decompression for cervical spondylotic myelopathy: correlation between operative outcomes and MRI of the spinal cord. Orthopedics 27:108710912004

    • Search Google Scholar
    • Export Citation
  • 28

    Park YSNakase HKawaguchi SSakaki TNikaido YMorimoto T: Predictors of outcome of surgery for cervical compressive myelopathy: retrospective analysis and prospective study. Neurol Med Chir (Tokyo) 46:2312392006

    • Search Google Scholar
    • Export Citation
  • 29

    Satomi KOgawa JIshii YHirabayashi K: Short-term complications and long-term results of expansive open-door laminoplasty for cervical stenotic myelopathy. Spine J 1:26302001

    • Search Google Scholar
    • Export Citation
  • 30

    Singh ACrockard HAPlatts AStevens J: Clinical and radiological correlates of severity and surgery-related outcome in cervical spondylosis. J Neurosurg 94:1891982001

    • Search Google Scholar
    • Export Citation
  • 31

    Suri AChabbra RPMehta VSGaikwad SPandey RM: Effect of intramedullary signal changes on the surgical outcome of patients with cervical spondylotic myelopathy. Spine J 3:33452003

    • Search Google Scholar
    • Export Citation
  • 32

    Takahashi MYamashita YSakamoto YKojima R: Chronic cervical cord compression: clinical significance of increased signal intensity on MR images. Radiology 173:2192241989

    • Search Google Scholar
    • Export Citation
  • 33

    Wada EOhmura MYonenobu K: Intramedullary changes of the spinal cord in cervical spondylotic myelopathy. Spine 20:222622321995

  • 34

    Wada EYonenobu KSuzuki SKanazawa AOchi T: Can intramedullary signal change on magnetic resonance imaging predict surgical outcome in cervical spondylotic myelopathy?. Spine 24:4554621999

    • Search Google Scholar
    • Export Citation
  • 35

    Yamazaki TYanaka KSato HUemura KTsukada ANose T: Cervical spondylotic myelopathy: surgical results and factors affecting outcome with special reference to age differences. Neurosurgery 52:1221262003

    • Search Google Scholar
    • Export Citation
  • 36

    Yone KSakou TYanase MIjiri K: Preoperative and postoperative magnetic resonance image evaluations of the spinal cord in cervical myelopathy. Spine 17:10 SupplS388S3921992

    • Search Google Scholar
    • Export Citation

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 309 309 11
Full Text Views 76 76 0
PDF Downloads 60 60 0
EPUB Downloads 0 0 0

PubMed

Google Scholar