{"id":"4e7fa193-6c30-4034-8454-b48d74192926","slug":"high-cord-signals-on-magnetic-resonance-and-other-factors-predict-poor-outcomes-of-cervical-spine-surgery-a-review","title":"High cord signals on magnetic resonance and other factors predict poor outcomes of cervical spine surgery: A review","authors":["Nancy E. Epstein"],"abstract":"Background: High cord signals (HCS) on preoperative/postoperative T1, T1 gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA), and T2 magnetic resonance (MR) studies, postoperative failure of HCS to regress and/or cord re-expansion, and a triangular cord configuration are poor prognostic factors for surgical patients with cervical spondylotic myelopathy (CSM). Methods: Here, we reviewed the negative prognostic import of high Grades/Types and more extensive locations of preoperative/postoperative HCS on T1, T1 Gd-DTPA, and T2 MR studies in surgical patients with CSM. Additional predictors of poor operative outcomes included postoperative failure of HCS to regress, cord re-expansion at the site of a HCS, and the triangular vs. teardrop or boomerang cord configuration. The Types/Grades of HCS on MR follow:Type/Grade 0 – no/absent signal changes; Type/Grade 1 – mild/light/fuzzy/obscure/low cord signal (LCS) changes; Type/Grade 2 – sharp/intense/well-defined HCS; and Type/Grade 3 – mixed/HCS. The definitions of location/extent of LCS/HCS were: focal (1 level), multifocal (with skip areas), and multisegmental (continuous over >1 segment), while cord configuration was categorized as triangular, teardrop, or boomerang. Results: On MR studies, preoperative/postoperative Types/Grades 0–1 changes correlated with better prognoses (e.g., improved Japanese Orthopedic Association (JOA) scores or Nurick Grades), while Types/Grades 2–3 correlated with poorer outcomes. Multiple poor prognostic indicators also included; failure of postoperative HCS on MR to regress (particularly if multisegmental), postoperative cord re-expansion at the site of a prior HCS, and triangular cord configuration. Conclusions: Grade/Types 2–3 HCS on T1, T1 Gd-DTPA, and T2-weighted MR images on preoperative/postoperative MR studies, failure of HCS to regress (multisegmental), cord re-expansion at the site of a prior HCS, and a triangular cord configuration (atrophy) all contributed to poorer outcomes for CSM surgery.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/4e7fa193-6c30-4034-8454-b48d74192926/featured/hero-1782420832860.png","publishDate":"2018-01-16T00:00:00.000Z","doi":"10.4103/sni.sni_450_17","categories":["Spine","Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/4e7fa193-6c30-4034-8454-b48d74192926/pdf"}