Preoperative patient selection with magnetic resonance imaging, computed tomography, and electroencephalography: does the test predict outcome after cervical surgery?

Author:

Mummaneni Praveen V.1,Kaiser Michael G.2,Matz Paul G.3,Anderson Paul A.4,Groff Michael5,Heary Robert6,Holly Langston7,Ryken Timothy8,Choudhri Tanvir9,Vresilovic Edward10,Resnick Daniel11

Affiliation:

1. Department of Neurosurgery, University of California at San Francisco, California;

2. Department of Neurological Surgery, Neurological Institute, Columbia University, New York, New York;

3. Division of Neurological Surgery, University of Alabama, Birmingham, Alabama;

4. Departments of Orthopaedic Surgery and

5. Department of Neurosurgery, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts;

6. Department of Neurosurgery, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, Newark, New Jersey;

7. Division of Neurosurgery, David Geffen School of Medicine, University of California at Los Angeles, California;

8. Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa;

9. Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York; and

10. Department of Orthopaedic Surgery, Milton S. Hershey Medical Center, Pennsylvania State College of Medicine, Hershey, Pennsylvania

11. Neurological Surgery, University of Wisconsin, Madison, Wisconsin;

Abstract

Object The objective of this systematic review was to use evidence-based medicine to assess whether preoperative imaging or electromyography (EMG) predicts surgical outcomes in patients undergoing cervical surgery. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to the preoperative imaging and EMG. Abstracts were reviewed after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Preoperative MR imaging and CT myelography are successful in confirming clinical radiculopathy (Class II). Multilevel T2 hyperintensity, T1 focal hypointensity combined with T2 focal hyperintensity, and spinal cord atrophy each convey a poor prognosis (Class III). There is conflicting data concerning whether focal T2 hyperintensity or cervical stenosis are associated with a worse outcome. Electromyography has mixed utility in predicting outcome (Class III). Conclusions Magnetic resonance imaging or CT myelography are important for preoperative assessment. Magnetic resonance imaging may be helpful in assessing prognosis, whereas EMG has mixed utility in assessing outcome.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

General Medicine

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