gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Patterns of normal and locally impaired glucose utilisation in degenerative monosegmental compressive myelopathy with predictive value for clinical recovery using 18F-FDG PET

Meeting Abstract

  • F.W. Floeth - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf; Klinik für Wirbelsäule und Schmerz, St.-Vinzenz Krankenhaus, Düsseldorf
  • G. Stoffels - Institut für Medizin, Neurowissenschaften und Biophysik, Forschungszentrum Jülich; Institut für Nuklearchemie, Forschungszentrum Jülich
  • J. Herdmann - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf; Klinik für Wirbelsäule und Schmerz, St.-Vinzenz Krankenhaus, Düsseldorf
  • S. Eicker - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf
  • H.J. Steiger - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf
  • K.J. Langen - Institut für Medizin, Neurowissenschaften und Biophysik, Forschungszentrum Jülich; Institut für Nuklearchemie, Forschungszentrum Jülich

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMI.02.11

DOI: 10.3205/11dgnc186, URN: urn:nbn:de:0183-11dgnc1860

Published: April 28, 2011

© 2011 Floeth et al.
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Outline

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Objective: Results of a prospective study investigating cervical spinal cord recovery in patients with degenerative stenosis and cord compression using high-resolution [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET).

Methods: 16 patients with monosegmental spondylotic stenosis of the middle cervical spine (C 3/4 or C 4/5) with an intramedullary hyperintensity on T2-weighted MR imaging and clinical symptoms of myelopathy (myelopathics) were compared to 10 individuals without cervical spine pathology (controls). All subjects were investigated by 18F-FDG PET and the Maximum Standardized Uptake values (SUVmax) were measured at all levels of the cervical spine (C1-C7) with special attention to regional variations of SUVmax data along the cervical cord. Decompression and anterior cervical fusion was performed in all myelopathics and their clinical outcome (JOA-score) was evaluated after 6 months.

Results: The FDG uptake curves along the cervical spinal cord showed clear differences between the controls and the myelopathics with a strict correlation to the level of stenosis. A nearly linear FDG uptake curve was the typical pattern of the controls (SUV 1.87 ± 0.13).

In myelopathics, two groups of impaired glucose metabolism with a high correlation to the outcome (r = 0.87) were differentiated: Type 1 exhibited a FDG uptake peak at the level of stenosis followed by an uptake decrease below and – due to the peak – an overall elevated glucose utilisation of the cervical cord (SUV 1.93 ± 0.34). Their postoperative course was characterized by good clinical recovery (JOA pre- to postoperative: 9.7 - 13.8). Type 2 showed a normal FDG uptake above and a progressive uptake decrease below the individual level of stenosis with an overall reduced glucose utilisation (SUV 1.78 ± 0.23). In these patients, there was none or only modest clinical improvement after decompression (JOA pre- to postoperative: 11.6 - 12.0).

Conclusions: Compressive myelopathy leads to regional changes of glucose utilisation strictly related to the level of stenosis. The profile of the FDG uptake curve along the cervical cord can serve for the evaluation of expected clinical recovery after decompression: While a simple crack of the curve below the stenosis is a predictor for poor outcome, patients with a peak at the level of stenosis can expect a good recovery.