Spinal Cord Changes After Laminoplasty in Cervical Compressive Myelopathy: A Diffusion Tensor Imaging Study.

Purpose: Validation of the efficacy of decompression surgery in patients with cervical myelopathy (CM) is important in terms of the recovery of the integrity of the spinal cord. However, to date, no longitudinal study has addressed the underlying pathological changes using diffusion tensor imaging (DTI) in CM patients. This study aimed to determine the diffusion metrics at the lesion as well as below the lesion level longitudinally in CM patients following laminoplasty using DTI. Methods: Twenty CM patients were analyzed and compared with 20 age-matched healthy controls. The primary outcome measure was the changes in the diffusion metrics [fractional isotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD)]. The secondary outcome measure was the changes in the modified Japanese Orthopedic Association (mJOA) score. Diffusion metrics obtained from six region-of-interests (ROIs; 2 anterior, 2 posterior, 2 lateral) at the lesion and below the lesion level (C7/T1) in preoperative and 6 months postoperative conditions were compared longitudinally. Results: The CM patients showed significant changes in their postoperative diffusion metrics for the anterior ROIs compared with the preoperative measures both at and below the lesion level. In the lateral and posterior cord, the preoperative AD value decreased after laminoplasty to the control at the lesion level. In contrast, MD and RD values at the lesion level and FA value at below the lesion level remained unchanged postoperatively. In addition, the postoperative anterior FA value was positively correlated with the postoperative mJOA score below the lesion level. Conclusion: This would be the first study showing changes in the spinal cord at the lesion as well as below the lesion level after laminoplasty in CM patients, which may be associated with functional recovery.

The functional relevance of diffusion tensor imaging in comparison to conventional MRI in patients with cervical compressive myelopathy.

OBJECTIVE: To determine the functional relevance of diffusion tensor imaging (DTI) metrics and conventional MRI (signal intensity change in T2, compression ratio) by measuring the correlation of these parameters with clinical outcome measured by the modified Japanese Orthopedic Association (mJOA) score. MATERIALS AND METHODS: A total of 20 cervical myelopathy (CM) patients participated in this prospective cohort study. The severities of CM were assessed using the mJOA score. Conventional MRIs (T2-weighted images) measuring the signal changes of spinal cords and the degree of compression at the lesion level and DTI metrics [fractional anisotropy (FA), apparent diffusion coefficient (ADC)] at each lesion and below each lesion (C7/T1) level were acquired using a 3-T Achieva MRI. These parameters were correlated with the mJOA scores to determine the functional relevance. RESULTS: Ninety percent of CM patients showed signal changes and 30 % of patients noted a more than 40% canal compression ratio in conventional MRIs at the lesion level; however, these findings were not correlated with the mJOA score (p < 0.05). In contrast, FA values on DTI showed high sensitivity to CM (100%), which was well correlated with the mJOA score (p = 0.034, r = 0.475) below the lesion level (C7/T1). CONCLUSIONS: This study showed a meaningful symptomatic correlation between mJOA scores and FA values below the lesion levels in CM patients. It could give us more understanding of the pathological changes in spinal cords matched with various clinical findings in CM patients than the results from conventional MRI.

Lived Experience of the Mother's Caring of Adult Children with Persistent Vegetative State.

PURPOSE: The purpose of this study was to deepen understanding the nature of the care experience by the mothers with adult children in persistent vegetative state. METHODS: Participants were 7 mothers caring for their adult children in persistent vegetative state. Data were collected individually through in-depth interviews on their lived experiences. Also texts were included as data from literary works, novels, movies, essays, and arts containing on patients with persistent vegetative state and their mothers. Data were analyzed by van Manen's phenomenological methodology. RESULTS: The essential themes of caring experiences of the mothers were as follows. The theme in relation to lived time has shown as back to the past and caring experience related lived body has emerged as locked the body in children. The theme related lived space was getting into the swamp and the theme in lived others was derived as lonely struggle into. CONCLUSION: The nature of mothers' caring experiences for adult children in persistent vegetative state is summarized as 'Do not off hand of hope in a locked state'. This study suggests long-term supports are necessary for mothers to care persistent vegetative state children.

Correlation of magnetic resonance diffusion tensor imaging and clinical findings of cervical myelopathy.

BACKGROUND CONTEXT: Despite significant advances in the development of diagnostic technology, the diagnosis of cervical myelopathy (CM) still remains based on the clinical findings, which do not provide the means for a sufficiently accurate diagnosis. Furthermore, conventional magnetic resonance imaging (MRI) using T1- and T2-weighted sequences lacks sensitivity to detect and characterize spinal cord lesions. Considering these uncertainties, several investigators have assessed the diagnostic value of diffusion tensor imaging (DTI), an advanced MRI technique that measures the diffusion of water molecules. PURPOSE: To determine the diagnostic value of DTI in CM in reliably characterizing spinal lesions and in associating them with the clinical findings. STUDY DESIGN/SETTING: Prospective cohort study. PATIENT SAMPLE: Fifteen CM patients and five healthy volunteers without a history of neurological disorders or of symptoms as controls. OUTCOME MEASURES: Symptoms and signs of CM were evaluated by the use of a modified Japanese Orthopedic Score and the other clinical findings. T2-weighed MRI was used to note the number of compressed levels. Diffusion tensor imaging results were measured according to two parameters, fractional anisotropy (FA) and apparent diffusion coefficient (ADC), at anterior, lateral, and posterior regions of interest (ROIs) in each of five cervical vertebrae, C3-C7. METHODS: On diagnosis of CM by clinical evaluation and findings from T2-weighted MRI, the 15 subjects were assigned to two subgroups based on complaints, symptoms, and signs. The nine subjects who had typical CM symptoms such as motor weakness, gait disturbance, clumsiness of the hands, and unilateral hypesthesia were assigned to the paralysis subgroup. The other six subjects, whose main symptom was pain and who had vague signs of upper motor neuron injury despite a definitive finding of CM by T2-weighted MRI, were assigned to the pain subgroup. Once assignments had been made, subjects underwent DTI done by the use of the same scanner as for T2-weighted MRI. Results of DTI for each subgroup and controls were averaged, and the mean was used for comparisons. Diffusion tensor imaging results from the paralysis subgroup were sorted into affected and unaffected sides according to the presence or the absence of symptoms. RESULTS: The paralysis subgroup and the pain subgroup had similar findings from T2-weighted MRI on presentation. The paralysis subgroup had statistically significantly decreased FA values in the anterior and lateral ROIs on the affected side and in the anterior ROIs on the unaffected side, compared with controls. The paralysis subgroup also had statistically significantly increased ADC values in the anterior ROIs of the affected side, compared with controls. The pain subgroup showed significantly increased ADC values in anterior, lateral, and posterior ROIs. CONCLUSIONS: Use of DTI to quantitatively compare compression in the cervical spinal cords of CM subjects and healthy controls explained individual differences in the clinical findings in the subjects. These findings even applied to CM subjects whose compressed spinal cords looked similar on conventional T2-weighted MRI. Therefore, DTI provided more accurate and reliable information than did conventional T2-weighted MRI about the relationship between spinal cord structure and clinical presentation of CM. Based on our DTI findings, we hypothesized that different clinical findings in CM are attributable to the stage of progression and the severity of pathologic change at presentation. We anticipate that the use of DTI to quantify the extent of myelopathological changes in CM could be more reliable than any other existing diagnostic tools and might provide invaluable information about selecting the optimal treatment for CM and predicting surgical outcomes and prognosis.