Role of Magnetic Resonance Imaging in Predicting Surgical Outcome in Patients With Cervical Spondylotic Myelopathy
Bibliographic record
Abstract
In Brief Study Design. Ambispective, retrospective cohort study from prospectively collected data. Summary of Background Data. Cervical spondylotic myelopathy is the commonest cause of spinal cord impairment in the elderly population worldwide. Although magnetic resonance imaging (MRI) is the primary imaging modality for confirming the diagnosis, its role in predicting surgical outcome remains unclear. Methods. Two hundred seventy-eight patients with 1 or more clinical signs of myelopathy were enrolled; and they underwent decompression surgery. Complete baseline clinical and MRI data were available for 102 patients. MRI parameters measured included presence/absence of signal change on T1 and T2, T2 signal quantitative factors, and anatomical measurements. A dichotomized postoperative modified Japanese Orthopedic Association (mJOA) score at 6 months was used to characterize patients with mild myelopathy (≥16) and those with substantial residual neurological impairment (<16). Univariate analysis assessed the relationship between baseline parameters and outcome. Multivariate logistic regression was conducted after a conceptual division of variables into 3 groups: T1 signal analysis, T2 signal analysis, and anatomical measurements. Results. Baseline mJOA (P < 0.001; odds ratio [OR] = 1.644, 95% confidence interval [95% CI]: 1.326–2.037), maximum canal compromise (MCC) (P = 0.0322; OR = 0.965, 95% CI: 0.934–0.997), T2 hyperintensity region of interest area (P = 0.0422; OR = 0.67; 95% CI: 0.456–0.986), and sagittal extent (P = 0.026; OR = 0.673; 95% CI: 0.475–0.954) were significantly associated with outcome univariately. The final model was comprised of T1 hypointensity (P = 0.029; OR = 0.242; CI: 0.068–0.866), MCC (P = 0.005; OR = 0.940; CI: 0.90–0.982) and baseline mJOA (P < 0.001; OR = 1.743; CI: 1.353–2.245), yielding an area under the receiver operating characteristic curve (AUC) of 0.845. Conclusion. Baseline mJOA is a strong predictor of postsurgical outcome in cervical spondylotic myelopathy at 6 months. However, a model inclusive of MCC and T1 hypointensity assessment provides superior predictive capacity. This suggests that MRI analysis has a significant role in predicting surgical outcome. Level of Evidence: 3 The role of magnetic resonance imaging (MRI) in predicting surgical outcome in cervical spondylotic myelopathy remains unclear. MRI data for patients who underwent decompression surgery were examined. Findings indicate that baseline modified Japanese Orthopedic Association is a strong predictor of postsurgical outcome and that a model including maximum canal compromise and T1 hypointensity assessment provides superior predictive capacity.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".