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Diffusion Tensor Imaging in a Large Longitudinal Series of Patients With Cervical Spondylotic Myelopathy Correlated With Long-Term Functional Outcome. Neurosurgery 2018 10 01;83(4):753-760

Date

03/13/2018

Pubmed ID

29529304

DOI

10.1093/neuros/nyx558

Scopus ID

2-s2.0-85068819376   8 Citations

Abstract

BACKGROUND: Fractional anisotropy (FA) of the high cervical cord correlates with upper limb function in acute cervical cord injury. We investigated the correlation between preoperative FA at the level of maximal compression and functional recovery in a group of patients after decompressive surgery for cervical spondylotic myelopathy (CSM).

OBJECTIVE: To determine the usefulness of FA as a biomarker for severity of CSM and as a prognostic biomarker for improvement after surgery.

METHODS: Patients received diffusion tensor imaging (DTI) scans preoperatively. FA values of the whole cord cross-section at the level of maximal compression and upper cervical cord (C1-2) were calculated. Functional status was measured using the modified Japanese Orthopedic Association (mJOA) scale preoperatively and at follow-up up to 2 yr. Regression analysis between FA and mJOA was performed. DTI at C4-7 was obtained in controls.

RESULTS: Forty-four CSM patients enrolled prior to decompression were compared with 24 controls. FA at the level of maximal compression correlated positively with preoperative mJOA score. Preoperative FA correlated inversely with recovery throughout the postoperative period. This was statistically significant at 12 mo postoperation and nearly so at 6 and 24 mo. Patients with preoperative FA <0.55 had a statistically significant difference in outcome compared to FA >0.55.

CONCLUSION: In the largest longitudinal study of this kind, FA promises a valid biomarker for severity of CSM and postoperative improvement. FA is an objective measure of function and could provide a basis for prognosis. FA is particularly useful if preoperative values are less than 0.55.

Author List

Rao A, Soliman H, Kaushal M, Motovylyak O, Vedantam A, Budde MD, Schmit B, Wang M, Kurpad SN

Authors

Matthew Budde PhD Associate Professor in the Neurosurgery department at Medical College of Wisconsin
Shekar N. Kurpad MD, PhD Chair, Professor in the Neurosurgery department at Medical College of Wisconsin
Brian Schmit PhD Professor in the Biomedical Engineering department at Marquette University
Hesham Soliman MBBS Assistant Professor in the Neurosurgery department at Medical College of Wisconsin
Marjorie Wang MD Chief, Professor in the Neurosurgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Anisotropy
Cervical Vertebrae
Decompression, Surgical
Diffusion Tensor Imaging
Female
Humans
Longitudinal Studies
Male
Middle Aged
Prognosis
Prospective Studies
Recovery of Function
Spinal Cord Diseases
Spondylosis
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a