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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Object

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.

Methods

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).

Results

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).

Conclusions

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: wlf7730@163.com.

© AANS, except where prohibited by US copyright law.

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Figures

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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.

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