Prognostic value of magnetic resonance imaging combined with electromyography in the surgical management of cervical spondylotic myelopathy

Liu,Fa‑Jing; Sun,Ya‑Peng; Shen,Yong; Ding,Wen‑Yuan; Wang,Lin‑Feng

doi:10.3892/etm.2013.934

Prognostic value of magnetic resonance imaging combined with electromyography in the surgical management of cervical spondylotic myelopathy

Authors:
- Fa‑Jing Liu
- Ya‑Peng Sun
- Yong Shen
- Wen‑Yuan Ding
- Lin‑Feng Wang
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Affiliations: Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, P.R. China
Published online on: January 30, 2013 https://doi.org/10.3892/etm.2013.934
Pages: 1214-1218

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Abstract

The present study aimed to evaluate the value of pre‑operative magnetic resonance imaging (MRI) combined with electromyography (EMG) for predicting clinical outcome following surgical management of cervical spondylotic myelopathy (CSM). A total of 94 patients with cervical compressive myelopathy were prospectively enrolled and treated with anterior, posterior and posterior‑anterior united decompression between October 2007 and February 2009. Prior to surgery 1.5‑T MRI and EMG were performed in all patients. The patients were classified into four types based on the presence (+) or absence (-) of an increased signal intensity (ISI) on the T2‑weighted magnetic resonance (MR) images and also based on the positive (+)/negative (-) results of the EMG. The four types were as follows: Type I, MRI/EMG (-/-); Type II, MRI/EMG (+/-); Type III, MRI/EMG (-/+); and Type IV, MRI/EMG (+/+). The clinical outcome was also graded according to a modified Japanese Orthopedic Association (JOA) scoring system. Furthermore, pre‑ and post‑operative clinical data were statistically analyzed to explore the correlation between the factors. There were 36 cases (38%) of Type I, 16 (17%) of Type II, 13 (14%) of Type III and 29 (31%) of Type IV. According to the analysis of the clinical data between the four types, there were significant differences in the disability classifications, pre‑operative JOA scores and disease duration (P<0.05), but there were no significant differences in gender, age or cord compression ratios (P>0.05). Until the final follow‑up, there was a significant difference in the recovery ratio between the four study groups (Hc=27.46, P<0.05). Further comparison showed that the surgical outcome was best in Type I patients and worst in Type IV patients. In conclusion, there was a distinct correlation between classification and the rate of clinical improvement. Patients who had a negative EMG and those without an ISI on T2‑weight images tended to suffer only mild symptoms, a short disease duration and, most significantly, experience a good surgical outcome.

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