Neurosurgical review
A systematic review of the spectrum of magnetic resonance imaging features of degenerative thoracic myelopathy
By White E, Rafati Fard A, Wardropper J and 10 others.
Abstract
Purpose
Degenerative thoracic myelopathy (DTM) encompasses a range of degenerative pathologies associated with symptomatic spinal cord compression. Diagnosis is achieved through clinical history, examination, and magnetic resonance imaging (MRI). A comprehensive review of the MRI features of DTM and their clinical significance is currently lacking. The objective was therefore to synthesise current evidence.
Methods
A systematic review was performed adhering to PRISMA guidelines. MEDLINE and Embase were searched. Screening, data extraction and risk of bias assessments were performed in duplicate. A qualitative synthesis was conducted following the Synthesis Without Meta-Analysis (SWiM) guidelines.
Results
Of 7937 records, 59 papers studying 2940 patients satisfied inclusion criteria, including one cross-sectional and 58 cohort studies. DTM was most common in the lower thoracic spine (62.5%, 880/1409), with a roughly equal prevalence in the upper (18.2%, 256/1409) and middle regions (19.4%, 273/1409). Ossification of the ligamentum flavum (OLF) was the most common pathology (71.4%, 2065/2893), followed by intervertebral disc herniation (20.1%, 582/2893) and ossification of the posterior longitudinal ligament (OPLL) (19.7%, 569/2893). Measurements of spinal canal compromise were described in 55.5% of patients (1631/2940) and spinal cord signal change in 30.0% (881/2940). Spinal canal compromise, spinal cord signal change, OLF, OPLL and multilevel disease were associated with greater DTM severity and poorer functional recovery.