E-ISSN:2320-8686 Publisher P-ISSN:2321-127X International Journal of Medical Research Article Research and Review Myelopathies 2020 Volume 8 Number 1 January-February www.medresearch.in Pattern recognition approach and clinico-radiological evaluation of compressive myelopathies at a tertiary care hospital Kiran J.S.1, Rao M.2, Pasha S.3* DOI: https://doi.org/10.17511/ijmrr.2020.i01.04 1 Kiran J.S., Postgraduate, Department of Medicine, NRI Medical College and General Hospital, Guntur, Andhra Pradesh, India. 2 M Nageswara Rao, Professor, Department of Neurology, NRI Medical College and General Hospital, Guntur, Andhra Pradesh, India. 3* SK Afsar Pasha, Professor, Department of Neurology, NRI Medical College and General Hospital, Guntur, Andhra Pradesh, India. Background: Neuroimaging is indicated in most instances of new-onset myelopathy for clinico- radiological correlation in terms of diagnosis, recovery, and prediction of recurrence. Aim: This study was conducted to study the clinical profile of cases of Compressive Myelopathy and the pattern of spinal cord involvement, also to compare the sites of localisation of clinical diagnosis with MRI diagnosis. Methodology: The present study was a prospective study involving 30 patients. Patients with clinical suspicion of spinal cord disease of age group 20-80 years were included as study participants. The primary pulse sequences included T1 and T2 weighted images on MRI, the location of the lesion, its margins, signal intensity on both T1 and T2 weighted images was noted. Results: The majority of 53.33% of participants were aged between 51 to 60 years. Difficulty in walking was observed in 97% of participants. Men were more often affected than women. Cervical spondylosis was the commonest cause of compressive myelopathy in 57%. A most common pattern of spinal cord involvement was combined Anterior + Posterior cord involvement. The cervical site of localisation (54%) was the commonest followed by the thoracic and lumbar spinal cord. Conclusion: Myelopathies have male preponderance. The commonest cause of compressive myelopathy was Cervical spondylosis. Anterior plus posterior cord syndrome was the commonest pattern seen, followed by posterior cord syndrome, anterior cord syndrome being the least observed. MRI correlates well with a clinical diagnosis and is useful in suggesting the location of the lesion. Keywords: Cervical spondylosis, Compressive myelopathy, Spinal cord syndromes Corresponding Author How to Cite this Article To Browse SK Afsar Pasha, Professor, Department of Neurology, Kiran JS, Rao MN, Pasha SKA. Pattern recognition NRI Medical College and General Hospital, Guntur, approach and clinico-radiological evaluation of Andhra Pradesh, India. compressive myelopathies at a tertiary care hospital. Email: Int J Med Res Rev. 2020;8(1):24-30. Available From https://ijmrr.medresearch.in/index.php/ijmrr/article/ view/1135 Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted 2019-11-26 2019-12-04 2019-12-10 2019-12-14 Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note No Nil Yes 5% © 2020 by Kiran J.S., M Nageswara Rao, SK Afsar Pasha and Published by Siddharth Health Research and Social Welfare Society. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0]. 24 International Journal of Medical Research and Review 2020;8(1) Kiran J.S. et al: Pattern recognition approach and clinico-radiological Current study was conducted to study the clinical Introduction profile of cases of compressive Myelopathy and the Spinal cord dysfunction is a common neurological pattern of spinal cord involvement, also to compare problem, which may have an obvious traumatic or the clinical diagnosis with MRI diagnosis. compressive cause. Beyond this, the lack of pathological specificity of the clinical and imaging Materials and Methods features means that patients are often treated Study setting: The study was conducted on empirically, based on the prevalence and the patients admitted in the departments of neurology treatability of the differential diagnoses; multiple and neurosurgery with clinical suspicion of spinal sclerosis (MS) and isolated inflammatory myelitis cord disease. are the most likely diagnoses in the western world [1]. Study design: The current study was a prospective study. Myelopathy describes any neurologic deficit related to the spinal cord. Myelopathy is usually due to Study period: The study was conducted between compression of the spinal cord by osteophyte or January 2017 to December 2017. extruded disc material in the cervical spine. Osteophytic spurring and disc herniation may also Sample size: The present prospective study produce myelopathy localised to the thoracic spine, included 30 patients admitted in the departments of though less commonly [2]. Myelopathy, the rapid or neurology and neurosurgery with clinical suspicion insidious onset of motor and sensory abnormalities of spinal cord disease. referable to the spinal cord, occurs as a result of a Inclusion criteria: Inclusion criteria include variety of causes that may be classified on the basis patients with clinical suspicion of spinal cord disease of their location of origin (intramedullary, intradural- of age group 20-80 years were included as study extramedullary, and extradural) [3]. participants in the present study Degenerative cervical myelopathy (DCM) is a Exclusion criteria: The current study excluded progressive spine disease and the most common patients with seizures, abnormal higher mental cause of spinal cord dysfunction in adults worldwide functions, and children. [4]. With the aging of the global population, clinicians will be required to manage an increasing Data collection procedure: Collection of complete number of patients with degenerative changes to data regarding the history of the patient, age, sex, their spine and varying stages of myelopathy [5]. MRI and relevant investigations. A complete Cervical spondylotic myelopathy is the result of the physical examination was also conducted and narrowing of the cervical spinal canal by systemic examination. MRI was performed on a 1.5- degenerative and congenital changes [6]. Cervical tesla machine. The primary pulse sequences spondylotic myelopathy (CSM) is the leading cause included T1 and T2 weighted images on MRI, the of myelopathy in subjects above 55 years old and location of the lesion, its margins, signal intensity the major cause of spasticity acquired in the aged on both T1 and T2 was noted. MRI was done in all population [7]. cases and the findings were as follows: - Vertebral changes, disc space changes, bony canal changes, Although a survey of the entire spinal cord can be ligamentous changes, thecal indentation, pressure performed with imaging, it is more appropriate to changes over the spinal cord. define from the clinical findings what levels of the spine and spinal cord should be imaged. This Ethical consideration and permission: The study approach helps limit the likelihood of false-positive was approved by the institutional human ethical imaging findings that may encourage needless committee. All the included participants have attempts to fix what is not broken [8]. For most provided informed written consent for participation patients presenting with a spinal cord syndrome, MR in the study. Care was taken to maintain the scanning has become the key investigation in confidentiality of the personal information of establishing the diagnosis. However, myelopathy participants. with normal spinal imaging remains a common Data analysis: Statistical analysis was performed clinical conundrum [9]. Hence a using MS Excel software and data was International Journal of Medical Research and Review 2020;8(1) 25 Kiran J.S. et al: Pattern recognition approach and clinico-radiological Parameter No. of patients Percentage Expressed as frequencies and percentages for Signs/symptoms categorical variables. IBM SPSS version 22 was used Difficulty in walking 29 97 for statistical analysis [10]. Tingling and numbness 26 87 Results Pains 25 83 The weakness of upper and lower limbs 21 70 In the present series, the patient’s age ranged from Loss of muscle mass 14 47 20 years to 80 years. The maximum incidence is in The weakness of lower limbs alone 9 30 the third to sixth decade constituting 72% of cases. Bowel and bladder 9 30 The majority of 53.33% of participants were aged The weakness of one upper limb 1 3 between 51 to 60 years, followed by 61 to 70 years ONSET was 13.33%, 21 to 30 years and 41 to 50 was 10% Sub-acute and Chronic 27 90 for each. In the present series, 28 (93%) Acute onset 3 10 participants were male and 2 (7%) participants Motor Power were female (Table 1). Grade 0 4 13.33 Clinical Features: Clinical features of spinal cord Grade 1-2 4 13.33 compression vary depending upon the sources of Grade 3 5 16.66 compression and the tracts involved in the spinal Grade 4 16 53.33 cord. The incidence of various symptoms and signs Grade 5 1 3.33 are shown in the following table. The highest number is with weakness of all 4 limbs. The Table-3: Distribution of cases according to majority of 97% of participants had difficulty in etiology (MRI imaging diagnosis). walking, followed by tingling and numbness, pain Etiology No. of cases Percentage weakness of upper and lower limbs, and loss of Cervical spondylosis 17 57 muscle mass was 87%, 83%, 70%, and 47% Caries Spine 4 13 respectively. ONSET: The onset in the present series Vertebral Fracture 3 10 varied from a few hours to 2 years. Onset varied Fluorosis 2 7 with the site of involvement and the nature of Spinal tumor 1 3 etiology onset was rapid whenever there is Others 3 10 associated factor-like trauma. The onset was acute in 30 % of cases. Motor Power: Grading of motor power was done according to the medical research council. In the present series grade ‘0’ power was present in four cases grade 1-2 in four cases, grade 3 power in five cases, grade 4 power in sixteen cases, grade 5 in one case.