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

Abstract

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.