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Surgical results for cervical spondylotic myelopathy with inconsistent between deep tendon reflex findings and magnetic resonance imaging findings

Published:November 11, 2022DOI:https://doi.org/10.1016/j.jocn.2022.11.001

      Highlights

      • We often encounter cases with inconsistent between deep tendon reflex (DTR) findings and stenosis on cervical spine MRI.
      • We evaluated the surgical results of patients with CSM with inconsistent between DTR findings and cervical MRI findings.
      • We showed that unmatched CSM was present in 46% of the cases and postoperative clinical score is significantly inferior to among unmatched CSM patients.

      Abstract

      Background

      To evaluate the surgical results of patients with cervical spondylotic myelopathy (CSM) with inconsistency between deep tendon reflex findings and cervical magnetic resonance imaging (MRI) findings and to analyze the differences between patients with good and poor surgical outcomes.

      Methods

      We evaluated 50 subjects with CSM (30 males, 20 females; mean age: 70.4 years) who underwent posterior surgery and were followed for at least 1 year postoperatively. Matched CSM was defined as a consistent preoperative neurological pattern determined by deep tendon reflex and cervical MRI T2-weighted high-signal intramedullary area or stenosis in the most cranial compression levels. A lack of consistency was classified as unmatched CSM. Recovery rate (RR) according to Japanese Orthopaedic Association (JOA) scoring preoperatively and at 1 year postoperatively were compared between the groups.

      Results

      The matched and unmatched CSM group included 27 subjects (13 males, 14 females; mean age: 68.2 years) and 23 subjects (17 males, 6 females; mean age: 72.8 years), respectively. RR was significantly higher in the matched CSM group (56.1 ± 3.7 % vs 36.8 ± 2.7 %; p = 0.002). Unmatched CSM was significantly associated with a lower RR independently of sex, patient age, surgical procedure, preoperative JOA score, diagnosis levels, and complication of diabetes.

      Conclusions

      Postoperative JOA score RR was significantly diminished among unmatched CSM patients comprising of 46% of cases. Some patients with unmatched CSM had multiple levels of spinal canal stenosis, foraminal stenosis, and peripheral neuropathy, suggesting that surgical results were poorer than those of matched CSM.

      Keywords

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