aaMRI Signal Intensity Changes as Prognostic Indicators in Cervical Spondylotic Myelopathy Surgery: Correlation with Modified Japanese Orthopaedic Association Scores

Purpose: This study aimed to investigate the prognostic significance of Magnetic Resonance Imaging (MRI) findings—specifically the T2-weighted signal intensity increase ratio—combined with clinical and demographic variables, in predicting surgical outcomes in patients with Cervical Spondylotic Myelopathy (CSM). Method: A prospective cohort of 90 patients undergoing surgical decompression for CSM was evaluated. Neurological status and functional recovery were assessed using the modified Japanese Orthopaedic Association (mJOA) scale before and after surgery. Radiological evaluation quantified spinal cord compression and the T2-weighted MRI signal intensity increase ratio at lesion sites relative to adjacent normal cord tissue. Relationships between the recovery rate and variables, including age, symptom severity, segmental involvement, and MRI parameters, were assessed using linear regression and Pearson’s correlation. Results: The patient cohort’s mean age was 60.25 years, with an average of 3.43 spinal segments involved. Surgical treatment significantly improved mean mJOA scores from 9.98 to 14.27, yielding a mean recovery rate of 56.2%. The recovery rate demonstrated strong inverse correlations with patient age (p < 0.001), spinal cord compression ratio (p < 0.001), baseline motor dysfunction, and the ratio of MRI T2 signal intensity increase (p < 0.001). Higher T2 hyperintensity ratios were associated with poorer neurological outcomes, reflecting severe intrinsic spinal cord pathology such as edema or myelomalacia. Conclusion: The T2-weighted MRI signal intensity increase ratio is a robust predictor of surgical prognosis in CSM, alongside age and baseline clinical severity. Integrating quantitative MRI metrics with clinical assessment enhances prognostic accuracy, enabling improved patient stratification and personalized surgical planning to optimize functional recovery.