Gadolinium Enhancement in Cervical Spondylosis Patients with Spinal Cord Swelling

Abstract

  Spinal cord swelling with abnormal gadolinium enhancement is a rare preoperative radiological finding in cervical myelopathy patients. Timely cervical decompression can be performed for compressive myelopathy. Here, we report three cases of cervical spondylotic myelopathy. Preoperative magnetic resonance imaging revealed cervical cord swelling with high intensity on T2-weighted imaging and abnormal gadolinium enhancement on MRI. Laminoplasty resulted in marked improvement in the patients' neurological condition, and postoperative MRI revealed gradual regression of the intramedullary lesions within approximately 1 to 3 years. We summarized the course of intramedullary gadolinium enhancement in 16 case reports, including our 3 cases. Postoperative gadolinium enhancement disappeared or remarkably regressed within 1 to 3 years in 61% of cases. The mechanism of spinal cord swelling is considered to be as follows : 1) venous vascular circulation disturbance due to spinal cord compression results in local vascular hypertension at the affected level, and 2) disturbed CSF circulation may play a role in the development of spinal cord edema. Dynamic factors, such as neck hyperextension, may also cause spinal cord edema and gadolinium enhancement.