The objective of this study was to evaluate the usefulness of T2 high signal intensity (T2-HSI) and decreased anteroposterior diameter (APD), diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) in evaluating postoperative cervical cord function.

The study included 57 postoperative cervical spondylotic myelopathy patients. Clinical evaluation and functional recovery assessments were performed using the modified Japanese Orthopaedic Association (mJOA) score and recovery rate. The presence of T2-HSI and decreased APD was recorded for exploring the relevance. Spearman correlation was applied to investigate the relationships between DTI and NODDI metrics and mJOA score. Multiple comparisons of T2 signal intensity, APD and diffusion metrics were evaluated by using multiple linear regression.

Only the recovery rate was significantly different between T2-HSI and non-T2-HSI (nT2-HSI) patients (χ² = 4.466, p = 0.045). Significant differences were not observed between cervical cords with and without decreased APD. Diffusion metrics, including fractional anisotropy ( p = 0.0005), mean diffusivity ( p = 0.0008), radial diffusivity ( p = 0.0003) and intracellular volume fraction ( p = 0.001), were significantly correlated with mJOA score. The ability of T2 signal intensity ( p = 0.421) and APD ( p = 0.420) to evaluate the postoperative function was inferior to that of fractional anisotropy ( p = 0.002), mean diffusivity ( p = 0.001), radial diffusivity ( p = 0.001) and intracellular volume fraction ( p = 0.004).

Conventional magnetic resonance imaging signs could be considered as a reference to make an approximate assessment, whereas DTI and NODDI could be better quantitative tools for evaluating the postoperative function and may help in interpreting residual symptoms.

DTI and NODDI could provide reliable postoperative evaluation and analysis for cervical spondylotic myelopathy patients.