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Do intramedullary spinal cord changes in signal intensity on MRI affect surgical opportunity and approach for cervical myelopathy due to ossification of the posterior longitudinal ligament?

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Abstract

Some controversy still exists over the optimal treatment time and the surgical approach for cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL). The aim of the current study was first to analyze the effect of intramedullary spinal cord changes in signal intensity (hyperintensity on T2-weighted imaging and hypointensity on T1-weighted imaging) on magnetic resonance imaging (MRI) on surgical opportunity and approach for cervical myelopathy due to OPLL. This was a prospective randomized controlled study. Fifty-six patients with cervical myelopathy due to OPLL were enrolled and assigned to either group A (receiving anterior decompression and fusion, n = 27) or group P (receiving posterior laminectomy, n = 29). All the patients were followed up for an average 20.3 months (12–34 months). The clinical outcomes were assessed by the average operative time, blood loss, Japanese Orthopedic Association (JOA) score, improvement rate (IR) and complication. To determine the relevant statistics, we made two factorial designs and regrouped the data of all patients to group H (with hyperintensity on MRI, n = 31), group L (with hypointensity on MRI, n = 19) and group N (no signal on MRI, n = 25), and then to further six subgroups as well: AH (with hyperintensity on MRI from group A, n = 15), PH (with hyperintensity on MRI from group P, n = 16), AL (with hypointensity on MRI from group A, n = 10), PL (with hypointensity on MRI from group P, n = 9), AN (no signal intensity on MRI from group A, n = 12) and PN (no signal intensity on MRI from group P, n = 13). Both hyperintensity on T2-weighted imaging and hypointensity on T1-weighted imaging had a close relationship with the JOA score and IR. The pre- and postoperative JOA score and postoperative IR of either group H or group L was significantly lower than that of group N (P < 0.05), regardless of whether the patients had received anterior or posterior surgery. On the other hand, both the JOA score and IR of subgroup AH were higher than those of subgroup PH at 1 week, 6 and 12 months postoperatively (P < 0.05), as well as between subgroup AL and PL; but in group N, there was no difference between the subgroup AN and PN (P > 0.05). In conclusion, regardless of hyperintensity on T2-weighted imaging or hypointensity on T1-weighted imaging in patients with OPLL, severe damage to the spinal cord is indicated. Surgical treatment should be provided before the advent of intramedullary spinal cord changes in signal intensity on MRI. The anterior approach is more effective than posterior approach for treating cervical myelopathy due to OPLL characterized by intramedullary spinal cord changes in signal intensity on MRI.

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References

  1. Epstein N (2001) Anterior approaches to cervical spondylosis and ossification of the posterior longitudinal ligament: review of operative technique and assessment of 65 multilevel circumferential procedures. Surg Neurol 55:313–324

    Article  PubMed  CAS  Google Scholar 

  2. Mizuno J, Nakagawa H (2006) Ossified posterior longitudinal ligament: management strategies and outcomes. Spine J 6:282S–288S

    Article  PubMed  Google Scholar 

  3. Macdonald RL, Fehlings MG, Tator CH et al (1997) Multilevel anterior cervical corpectomy and fibular allograft fusion for cervical myelopathy. J Neurosurg 86:990–997

    Article  PubMed  CAS  Google Scholar 

  4. Tomita K, Nomura S, Umeda S et al (1988) Cervical laminoplasty to enlarge the spinal canal in multilevel ossification of the posterior longitudinal ligament with myelopathy. Arch Orthop Trauma Surg 107:148–153

    Article  PubMed  CAS  Google Scholar 

  5. Epstein N (2002) Posterior approaches in the management of cervical spondylosis and ossification of the posterior longitudinal ligament. Surg Neurol 58:194–207 (discussion 207–208)

    Google Scholar 

  6. Iwasaki M, Kawaguchi Y, Kimura T et al (2002) Long-term results of expansive laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine: more than 10 years follow-up. J Neurosurg 96:180–189

    Article  PubMed  Google Scholar 

  7. Takahashi M, Sakamoto Y, Miyawaki M et al (1987) Increased MR signal intensity secondary to chronic cervical cord compression. Neuroradiology 29:550–556

    Article  PubMed  CAS  Google Scholar 

  8. Mehalic TF, Pezzuti RT, Applebaum BI (1990) Magnetic resonance imaging and cervical spondylotic myelopathy. Neurosurgery 26:217–226 (discussion 226–227)

    Google Scholar 

  9. Ramanauskas WL, Wilner HI, Metes JJ et al (1998) MR imaging of compressive myelomalacia. J Comput Assist Tomogr 13:399–404

    Article  Google Scholar 

  10. Al-Mefty O, Harkey LH, Middleton TH et al (1988) Myelopathic cervical spondylotic lesions demonstrated by magnetic resonance imaging. J Neurosurg 68:217–222

    Article  PubMed  CAS  Google Scholar 

  11. Morio Y, Teshima R, Nagashima H et al (2001) Correlation between operative outcomes of cervical compression myelopathy and MRI of the spinal cord. Spine 26:1238–1245

    Article  PubMed  CAS  Google Scholar 

  12. Matsuda Y, Miyazaki K, Tada K et al (1991) Increased MR signal intensity due to cervical myelopathy. Analysis of 29 surgical cases. J Neurosurg 74:887–892

    Article  PubMed  CAS  Google Scholar 

  13. Okada Y, Ikata T, Yamada H et al (1993) Magnetic resonance imaging study on the results of surgery for cervical compression myelopathy. Spine 18:2024–2029

    Article  PubMed  CAS  Google Scholar 

  14. Ogawa Y, Chiba K, Matsumoto M et al (2005) Long-term results after expansive open-door laminoplasty for the segmental-type of ossification of the posterior longitudinal ligament of the cervical spine: a comparison with nonsegmental-type lesions. J Neurosurg Spine 3:198–204

    Article  PubMed  Google Scholar 

  15. Epstein N (2002) Diagnosis and surgical management of cervical ossification of the posterior longitudinal ligament. Spine J 2:436–449

    Article  PubMed  Google Scholar 

  16. Matsumoto M, Toyama Y, Ishikawa M et al (2000) Increased signal intensity of the spinal cord on magnetic resonance images in cervical compressive myelopathy. Does it predict the outcome of conservative treatment? Spine 25:677–682

    Article  PubMed  CAS  Google Scholar 

  17. Mochizuki M, Aiba A, Hashimoto M et al (2009) Cervical myelopathy in patients with ossification of the posterior longitudinal ligament. J Neurosurg Spine 10:122–128

    Article  PubMed  Google Scholar 

  18. Matsunaga S, Kukita M, Hayashi K et al (2002) Pathogenesis of myelopathy in patients with ossification of the posterior longitudinal ligament. J Neurosurg 96:168–172

    Article  PubMed  Google Scholar 

  19. Matsuoka T, Yamaura I, Kurosa Y et al (2001) Long-term results of the anterior floating method for cervical myelopathy caused by ossification of the posterior longitudinal ligament. Spine 26:241–248

    Article  PubMed  CAS  Google Scholar 

  20. Cauthen JC, Kinard RE, Vogler JB et al (1998) Outcome analysis of noninstrumented anterior cervical discectomy and interbody fusion in 348 patients. Spine 23:188–192

    Article  PubMed  CAS  Google Scholar 

  21. Shinomiya K, Kurosa Y, Fuchioka M et al (1989) Clinical study of dissociated motor weakness following anterior cervical decompression surgery. Spine 14:1211–1214

    Article  PubMed  CAS  Google Scholar 

  22. Sakaura H, Hosono N, Mukai Y et al (2003) C5 palsy after decompression surgery for cervical myelopathy: review of the literature. Spine 28:2447–2451

    Article  PubMed  Google Scholar 

  23. Itoh T, Ohshima Y, Hayashi M et al (1995) Two cases of cervical myelopathy showing spinal cord swelling after operation in MRI. Rinsho Seikei Geka 30:755–759 (in Japanese)

    Google Scholar 

  24. Nagashima H, Morio Y, Teshima R (2002) Re-aggravation of myelopathy due to intramedullary lesion with spinal cord enlargement after posterior decompression for cervical spondylotic myelopathy: serial magnetic resonance evaluation. Spinal Cord 40:137–141

    Article  PubMed  CAS  Google Scholar 

  25. Okumura H, Homma T (1992) Tumor-like findings in MRI after decompression for cervical spondylotic myelopathy. Seikeigeka 43:41–46 (in Japanese)

    Google Scholar 

  26. Sato T, Kojima T, Ohnuma H et al (1993) Intramedullary enhanced lesion in MRI of cervical spondylotic myelopathy. Ortho Surg Traumatol 36:917–922 (in Japanese)

    Google Scholar 

  27. Yagi M, Ninomiya K, Kihara M et al (2010) Long-term surgical outcome and risk factors in patients with cervical myelopathy and a change in signal intensity of intramedullary spinal cord on magnetic resonance imaging. J Neurosurg Spine 12:59–65

    Article  PubMed  Google Scholar 

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Conflict of interest

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Authors and Affiliations

  1. Department of Orthopedics, Changzheng Hospital, Secondary Millitary Medical University of China, 415 Fengyang Road, Shanghai, 200003, People’s Republic of China

    Qizhi Sun, Ying Zhang, Yang Li, Linwei Chen, Huajiang Chen & Wen Yuan

  2. Department of Orthopedics, No. 88 Hospital of Chinese People’s Liberation Army, Taian, People’s Republic of China

    Qizhi Sun & Hongwei Hu

Authors
  1. Qizhi Sun
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  2. Hongwei Hu
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  3. Ying Zhang
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  4. Yang Li
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  5. Linwei Chen
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  6. Huajiang Chen
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  7. Wen Yuan
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Correspondence to Wen Yuan.

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Sun, Q., Hu, H., Zhang, Y. et al. Do intramedullary spinal cord changes in signal intensity on MRI affect surgical opportunity and approach for cervical myelopathy due to ossification of the posterior longitudinal ligament?. Eur Spine J 20, 1466–1473 (2011). https://doi.org/10.1007/s00586-011-1813-7

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  • DOI: https://doi.org/10.1007/s00586-011-1813-7

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