Using the T2-weighted magnetic resonance imaging signal intensity ratio and clinical manifestations to assess the prognosis of patients with cervical ossification of the posterior longitudinal ligament

Clinical article

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The aim of this study was to investigate the clinical significance of both the signal intensity ratio obtained from MR imaging and clinical manifestations on the prognosis of patients with cervical ossification of the posterior longitudinal ligament.


The authors retrospectively reviewed the records of 58 patients with cervical ossification of the posterior longitudinal ligament who underwent cervical laminoplasty from February 1999 to July 2007. Magnetic resonance imaging (1.5-T) was performed in all patients before surgery. Sagittal T2-weighted images of the cervical spinal cord compressed by the ossified posterior longitudinal ligament showed increased intramedullary signal intensity, whereas the sagittal images obtained at the C7–T1 disc levels were of normal intensity. The signal intensity ratio between regions of intramedullary increased signal intensity and the normal C7–T1 disc level was calculated based on the signal intensity values generated from the MR imaging workstation. Patients were divided into 3 groups according to their signal intensity ratio (high, intermediate, and low signal intensity groups).


There were significant differences between the 3 groups regarding recovery rate (p < 0.001), age (p = 0.022), duration of disease (p = 0.001), Babinski sign (p < 0.001), ankle clonus (p < 0.001), and both pre- and postoperative Japanese Orthopaedic Association score (p < 0.001). There was no significant difference in sex among the 3 groups (p = 0.391).


Patients with low signal intensity ratios that changed on T2-weighted imaging experienced a good surgical outcome. Low increased signal intensity might reflect mild neuropathological alteration in the spinal cord and greater recuperative potential. An increased signal intensity ratio with positive pyramidal signs indicates less recuperative potential of the spinal cord and a poor surgical outcome.

Abbreviations used in this paper:IQR = interquartile range; JOA = Japanese Orthopaedic Association; OPLL = ossification of the posterior longitudinal ligament; ROI = region of interest.

Article Information

Address correspondence to: Yong Shen, M.D., Department of Spinal Surgery, Third Hospital of HeBei Medical University, 139 Ziqiang Road, Shijiazhuang, China 050051. email:

© AANS, except where prohibited by US copyright law.



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    Sagittal MR images (A–C) and corresponding CT scans (a–c) of representative patients from each group. A: The signal intensity ratio of this patient at the C4–5 disc level is 1.09 (Group 1). B: The signal intensity ratio of this patient at C-5 is 1.68 (Group 2). C: The signal intensity ratio of this patient at C-4 is 1.92 (Group 3). a–c: Corresponding CT scans show severe canal narrowing resulting from OPLL.



Alafifi TKern RFehlings M: Clinical and MRI predictors of outcome after surgical intervention for cervical spondylotic myelopathy. J Neuroimaging 17:3153222007


Al-Mefty OHarkey LHMiddleton THSmith RRFox JL: Myelopathic cervical spondylotic lesions demonstrated by magnetic resonance imaging. J Neurosurg 68:2172221988


Chatley AKumar RJain VKBehari SSahu RN: Effect of spinal cord signal intensity changes on clinical outcome after surgery for cervical spondylotic myelopathy. J Neurosurg Spine 11:5625672009


Fernández de Rota JJMeschian SFernández 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


Hirabayashi KMiyakawa JSatomi KMaruyama TWakano K: Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine 6:3543641981


Houten JKNoce LA: Clinical correlations of cervical myelopathy and the Hoffmann sign. J Neurosurg Spine 9:2372422008


Ito TOyanagi KTakahashi HTakahashi HEIkuta F: Cervical spondylotic myelopathy. Clinicopathologic study on the progression pattern and thin myelinated fibers of the lesions of seven patients examined during complete autopsy. Spine 21:8278331996


Mastronardi LElsawaf ARoperto RBozzao ACaroli MFerrante M: Prognostic relevance of the postoperative evolution of intramedullary spinal cord changes in signal intensity on magnetic resonance imaging after anterior decompression for cervical spondylotic myelopathy. J Neurosurg Spine 7:6156222007


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


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


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


Mizuno JNakagawa HInoue THashizume Y: Clinicopathological study of “snake-eye appearance” in compressive myelopathy of the cervical spinal cord. J Neurosurg 99:2 Suppl1621682003


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


Ohshio IHatayama AKaneda KTakahara MNagashima K: Correlation between histopathologic features and magnetic resonance images of spinal cord lesions. Spine 18:114011491993


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


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


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


Takahashi MSakamoto YMiyawaki MBussaka H: Increased MR signal intensity secondary to chronic cervical cord compression. Neuroradiology 29:5505561987


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


Yukawa YKato FYoshihara HYanase MIto K: MR T2 image classification in cervical compression myelopathy: predictor of surgical outcomes. Spine 32:167516792007


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