There is a relative equipoise with regards to surgical management of degenerative compressive myelopathy. The natural history of this disease is not completely understood and, as such, it is difficult to assess the potential benefit of surgical decompression. As such, any predictive factors that might correlate with outcome are useful.
In a well-designed systematic review, Karpova et al. (2013a) assessed magnetic resonance imaging characteristics that might be predictive of outcome in individuals undergoing surgical management of degenerative compressive myelopathy. They identified a mix of excellent and good-quality evidence, including 13 prospective cohort studies, that assessed imaging findings and possible associations with clinical outcomes as judged by common scoring tools included the modified Japanese Orthopedic Association scale. Overall, they found that transverse area of the spinal cord correlated with postoperative recovery but that other radiological measures were not. In addition, the absence of spinal cord hyperintensity on magnetic resonance imaging was correlated with improved post-surgical outcome as measured by the modified Japanese Orthopedic Association scale and other scales.
There is level 2 evidence (from one studies included in a systematic review; Karpova et al. 2013) that radiological features such as spinal cord transverse area, and absence of spinal cord hyperintensity of MRI, both correlate with improved clinical outcome after decompressive surgery for degenerative compressive myelopathy.
While it is difficult to predict the effectiveness of surgical decompression in degenerative compressive myelopathy, there is good evidence that some MRI findings, including absence of spinal cord hyperintensity on MRI, can predict surgical outcomes.