• Masaaki Machino, Kei Ando, Kazuyoshi Kobayashi, Kyotaro Ota, Masayoshi Morozumi, Satoshi Tanaka, Keigo Ito, Fumihiko Kato, Naoki Ishiguro, and Shiro Imagama.
• Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
• Spine. 2019 Nov 1; 44 (21): E1241-E1247.

Study DesignA prospective comparative imaging study.ObjectiveThis study investigated whether postoperative resolution of spinal cord increased signal intensity (ISI) reflected symptom improvement and surgical outcomes in cervical spondylotic myelopathy (CSM) patients.Summary Of Background DataAlthough some CSM patients exhibit magnetic resonance imaging (MRI) ISI, its alteration and resolution have not been investigated. The association between postoperative ISI resolution and surgical outcomes in CSM patients remains controversial.MethodsA total of 505 consecutive CSM patients (311 males; 194 females) aged a mean of 66.6 years (range, 41-91) were enrolled. All were treated with laminoplasty and underwent MRI scans preoperatively and after an average of 26.5 months postoperatively (range 12-66 months). ISI was classified pre- and postoperatively based on sagittal T2-weighted magnetic resonance images into Grade 0, none; Grade 1, light (obscure); and Grade 2, intense (bright). The patients' pre- and postoperative neurological statuses were evaluated using the Japanese Orthopedic Association scoring system for cervical myelopathy [Japanese Orthopedic Association (JOA) score] and other quantifiable tests, including the 10-s grip and release (10-s G&R) test and 10-s step test.ResultsA total of 337 patients showed preoperative ISI. Among these, 42 (12.5%) showed postoperative ISI resolution, associated with better postoperative JOA score and recovery rate, 10-s G&R and 10-s step test scores than those who retained it. Patients with preoperative Grade 2 ISI had no postoperative ISI resolution. Patients with ISI improvement from Grade 1 to Grade 0 had better outcomes than those with ISI worsening from Grade 1 to Grade 2.ConclusionPostoperative ISI resolution in CSM patients reflects postoperative symptoms and surgical outcomes. Patients who exhibit ISI resolution have better clinical outcomes.Level Of Evidence3.

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