Jesse Jones MD, Presenter: Nothing to Disclose

Alexander Lerner MD, Abstract Co-Author: Nothing to Disclose

Thomas Chong, Abstract Co-Author: Nothing to Disclose

Amy Lauren Cummings, Abstract Co-Author: Nothing to Disclose

Patrick Hsieh MD, Abstract Co-Author: Nothing to Disclose

Meng Law MD, Abstract Co-Author: Nothing to Disclose

Mark S. Shiroishi MD, Abstract Co-Author: Nothing to Disclose

Standard MRI protocols for evaluating the cervical spine do not adequately assess the severity of cervical spondylotic stenosis(CSS). Findings such as T2 hyperintensity within the spinal cord correlate poorly with CSS patients’ clinical performance status(CPS) and prognosis. Clinicians need reliable imaging criteria to help guide therapy for this condition. We hypothesized that diffusion tensor imaging(DTI) metrics can serve as biomarkers of disease in CSS.  We aimed to establish fractional anisotropy(FA), mean diffusivity(MD), and eigenvector(E1-3) reference values indicative of preoperative CPS and predictive of functional outcome following surgery

CPS of 12 patients with CSS was determined before and 3 months after surgery. CPS comprised 4 objective measures:Neck Disability Index(NDI), Japanese Orthopedic Association score(mJOA), Nurick scale, and SF-36. DTI was performed in all patients preoperatively. FA, MD, and E1-3 values were extracted using a workstation. Measurements were made at the C2-3 vertebral level, level of worst stenosis, and cervicothoracic junction(CTJ). Correlations were assessed between CPS and DTI variables after obtaining descriptive statistics. All correlated variables were plotted with a fitted regression line. A series of linear univariate regression analyses were then performed to analyze the relationship of the variables with observed trends.

Statistically significant relationships were found between preoperative Nurrick score and FA at C2-3 and CTJ(p=0.008 and p=0.016 respectively) as well as between 3 month postoperative Nurrick score and FA at C2-3(p=0.02).There was also a significant inverse relationship observed between the change in the SF-36 score(postoperative-preoperative) and the FA at CTJ(p=0.036). There were no significant correlations detected between CPS and FA at the stenosis. Nonsignificant trends were observed between preoperative/postoperative SF-36, NDI, and mJOA with FA at both C2-3 and CTJ. MD and E1-3 demonstrated no significant correlation with CPS.

DTI correlates with CSS patients' preoperative clinical status and postoperative functional outcome. DTI metrics may help clinicians determine the appropriate timing of intervention and counsel patients regarding surgical expectations

By indicating the optimal time for surgical intervention, DTI may improve healthcare outcomes in CSS patients

Jones, J, Lerner, A, Chong, T, Cummings, A, Hsieh, P, Law, M, Shiroishi, M, Diffusion Tensor Imaging of Spondylotic Cervical Myelopathy Correlates with Clinical Performance Score and Predicts Postoperative Functional Outcome.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11002412.html