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Purpose <p>Magnetic resonance imaging (MRI) is regarded as the reference standard for evaluating soft-tissue pathology in degenerative cervical spondylosis (DCS), whereas computed-tomography myelography with multiplanar reconstruction (CTM-MPR) offers superior depiction of osseous and calcified structures. Because their comparative value in planning percutaneous endoscopic cervical discectomy (PECD) is unclear, we assessed the diagnostic performance of MRI and CTM-MPR in the preoperative work-up of DCS patients scheduled for PECD.</p> Methods <p>We retrospectively analysed 81 consecutive patients (96 operative segments) treated with PECD between February 2016 and March 2018 who underwent both preoperative MRI and CTM. Neural compression severity was graded on a four-point Likert scale, and compression location was categorised into four patterns based on the anatomical site of cord and/or root impingement. Inter-modality concordance and agreement with intra-operative findings were calculated.</p> Results <p>CTM-MPR assigned higher compression grades than MRI in 19 segments, producing a 76. % concordance for grade (κ = 0.62, <i>p</i> = 0.003) and 84. % for location (κ = 0.56, <i>p</i> = 0.118). Mean protrusion/hypertrophy was significantly larger on CTM than on MRI (5.5 ± 1.3&#xa0;mm vs. 4.9 ± 1.3&#xa0;mm, <i>p</i> &lt; 0.001), with identical trends in males and females. Neither imaging-based size metric correlated with compression severity (<i>p</i> &gt; 0.01).</p> Conclusions <p>While MRI remains essential for evaluating soft tissue pathology in DCS, CTM-MPR provides enhanced anatomical detail, especially in cases involving osseous or calcified lesions. CTM-MPR may serve as a valuable adjunct or alternative when MRI findings are inconclusive or contraindicated, improving surgical planning and clinical outcomes in PECD.</p>

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Computed-tomography myelography with multiplanar reconstruction (CTM-MPR) improves diagnostic accuracy and surgical planning in percutaneous endoscopic cervical discectomy: a comparative study with MRI

  • 期刊论文

  • 发表日期：

    2026年1月28日

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  • Chang-Ming Xiao,
  • Hao-Zhong Wang,
  • Qing-Shuai Yu,
  • Yang Lei,
  • Hao-Ping Dai,
  • Kai-Quan Zhang,
  • Zheng-Jian Yan,
  • Ming-Zhong Xie

摘要

Purpose

Magnetic resonance imaging (MRI) is regarded as the reference standard for evaluating soft-tissue pathology in degenerative cervical spondylosis (DCS), whereas computed-tomography myelography with multiplanar reconstruction (CTM-MPR) offers superior depiction of osseous and calcified structures. Because their comparative value in planning percutaneous endoscopic cervical discectomy (PECD) is unclear, we assessed the diagnostic performance of MRI and CTM-MPR in the preoperative work-up of DCS patients scheduled for PECD.

Methods

We retrospectively analysed 81 consecutive patients (96 operative segments) treated with PECD between February 2016 and March 2018 who underwent both preoperative MRI and CTM. Neural compression severity was graded on a four-point Likert scale, and compression location was categorised into four patterns based on the anatomical site of cord and/or root impingement. Inter-modality concordance and agreement with intra-operative findings were calculated.

Results

CTM-MPR assigned higher compression grades than MRI in 19 segments, producing a 76. % concordance for grade (κ = 0.62, p = 0.003) and 84. % for location (κ = 0.56, p = 0.118). Mean protrusion/hypertrophy was significantly larger on CTM than on MRI (5.5 ± 1.3 mm vs. 4.9 ± 1.3 mm, p < 0.001), with identical trends in males and females. Neither imaging-based size metric correlated with compression severity (p > 0.01).

Conclusions

While MRI remains essential for evaluating soft tissue pathology in DCS, CTM-MPR provides enhanced anatomical detail, especially in cases involving osseous or calcified lesions. CTM-MPR may serve as a valuable adjunct or alternative when MRI findings are inconclusive or contraindicated, improving surgical planning and clinical outcomes in PECD.