A morphometric analysis of the pathoanatomy of cervical spondylotic myelopathy and the correlation between magnetic resonance imaging findings and clinical presentation of patients

Background: Cervical spondylotic myelopathy (CSM) is the commonest cause of spinal cord dysfunction and MRI remains the imaging of choice for CSM. However, its findings are not completely specific for clinically significant CSM. Objectives: This cross-sectional study aimed to determine the pathoanatomy of CSM and analyze the correlation between clinical and MRI findings. Methods: Patients ages 40 to 80 years old with CSM were recruited. Clinical parameters include myelopathic signs and other specific signs. MRI findings include level of compression, degenerative pathology and parameters for cord compression. Results: Thirty patients were recruited. Commonest (60%) myelopathic signs observed were positive Hoffmann's sign and brachioradialis sign. 90% of patients had osteophyte formation, 36.7% with single-level facet hypertrophy, and 23.3% had thickening of ligamentum flavum. Myelopathic signs and other specific signs significantly correlate with the cervical cord compression and observed in patients with smaller cord diameter. Positive correlation between the clinical key features with MRI parameters observed for canal and cord diameter. The transverse cord diameter, cord compression ratio and approximate cord area were the only independent variables related to almost all the positive clinical signs. All have moderate to strong correlation with the clinical findings. Conclusions: The MRI parameters with significant correlation reflect compression of the cord, indicating their major role in the pathophysiology of CSM. They may play significant roles in predicting roles in predicting the severity and outcome of CSM