Quantitative MRI Signal Changes of the Spinal Cord as Predictors of Suboptimal Surgical Outcomes in Degenerative Cervical Myelopathy

ABSTRACT Objective There are limited data about the association between intramedullary increased signal intensity (ISI) on T2‐weighted magnetic resonance imaging and surgical outcome in degenerative cervical myelopathy (DCM) after anterior decompressive surgery. This study aimed to explore factors contributing to unsatisfactory recovery following surgical treatment for DCM, with a particular focus on evaluating whether preoperative quantitative indicators of ISI on T2‐weighted MRI could be used to forecast surgical outcomes. Methods In this retrospective analysis, 94 patients diagnosed with ISI and treated with anterior cervical decompression for DCM between January 2021 and June 2023 were reviewed. Based on a postoperative recovery rate cutoff of 50% at final follow‐up, patients were categorized into optimal and suboptimal recovery groups. Multivariate logistic regression was employed to identify independent predictors of prognosis. Results Among the 94 patients, 39 (41.5%) had a suboptimal clinical outcome with a recovery rate below 50%. Multivariate analysis identified longer duration of symptoms, higher signal change ratio (SCR) on T2‐weighted MRI, and the presence of snake‐eye appearance (SEA) as significant predictors of poor recovery. The optimal SCR cutoff value for predicting a suboptimal outcome was 1.53, yielding a sensitivity of 64.1% and a specificity of 83.6%. While somatosensory and motor evoked potentials (SEP/MEP) were associated with baseline neurological function, they did not serve as standalone predictors of recovery. Conclusions Longer symptom duration, elevated SCR on T2‐weighted MRI, and SEA features may be significant preoperative indicators of less favorable outcomes in DCM patients. Individuals exhibiting an SCR above 1.53 and SEA on imaging should be considered at increased risk for limited postoperative improvement. These insights highlight the potential benefit of earlier surgical intervention and underscore the need for prospective validation through multicenter studies.