Intramedullary change on MRI in cervical spondylotic myelopathy: clinical significance

The clinical, radiological and electrophysiological features of 15 patients with intramedullary high signal intensity on spin-echo T2-weighted MRI scans and cervical spondylotic myelopathy were reviewed. Intramedullary change was present at the site of maximum cord deformity. A further examination was performed at a median interval of 7 months after surgical decompression in 10 patients. In 8, little or no improvement in symptoms had occurred. Signs of myelopathy persisted in all patients. Abnormal central somatosensory conduction was present in all patients so studied after operation. Of nine postoperative studies, seven showed persistent intramedullary change. In 2 patients the T2 changes had resolved; symptoms had not improved in 1 and sensory disturbance persisted in the other. These results suggest that the response to decompressive surgery is likely to be incomplete in patients with intramedullary change.