Abstract
Introduction
MRI signal changes are commonly found with myelopathy. The clinical significance of these signal changes in myelopathic patients remains debated. The purpose of this study was to perform a meta-analysis of the data to determine the effect of MRI signal change on pre-operative and post-operative Japanese Orthopaedic Association (JOA) scores and on recovery rate following surgery.
Methods
A comprehensive review of the literature was performed to identify all published studies that provided data on the presence of MRI signal change as well as JOA scores in patients with cervical spondylotic myelopathy. Data was tabulated and JOA scores were normalised to the 17-point scale. T-tests were performed to determine if there were significant differences between pre-operative and post-operative JOA scores in patients with or without MRI signal change. The recovery rate was calculated for all patients undergoing surgery. T-tests were performed to determine if significant differences occurred in recovery rate in patients with or without MRI signal change.
Results
16 studies were used for the meta-analysis. Total sample included 886 patients: 659 with signal change, and 227 without signal change. The pre-operative and post-operative JOA scores and the recovery rates were significantly better in patients without MRI signal changes (p< 0.05). The mean pre-operative JOA scores were 10.63 and 11.37 for patients with and without MRI signal changes, respectively. The mean post-operative JOA scores were 13.37 and 14.19 for patients with and without MRI signal changes, respectively. The mean recovery rates were 43.87% and 49.31% for patients with and without MRI signal change, respectively.
Conclusion
Meta-analysis revealed statistically better pre-operative and post-operative JOA scores and recovery rates following surgery in myelopathic patients without signal change. While the data were statistically significant, the clinical significance of the differences might be less due to the relatively small differences in actual values.
