Tominaga Teiji, Watabe Noriaki, Takahashi Toshiyuki, Shimizu Hiroaki, Yoshimoto Takashi
Department of Neurosurgery, Kohnan Hospital, Tohoku University School of Medicine, Sendai, Japan.
Neurosurgery. 2002 Apr;50(4):791-5; discussion 796. doi: 10.1097/00006123-200204000-00020.
We measured cerebrospinal fluid flow velocity by use of cine phase contrast magnetic resonance imaging to quantitate the effectiveness of surgical decompression in patients with cervical myelopathy.
Forty-seven patients with cervical myelopathy attributable to either spondylosis or ossification of the posterior longitudinal ligament were studied. Thirty-five patients underwent anterior cervical decompression and fusion; 12 others underwent expansive laminoplasty. Patients were examined preoperatively and postoperatively by use of a 1.5-T scanner with a pulse-gated cine phase contrast sequence. Cerebrospinal fluid flow direction and velocity in the ventral subarachnoid space were determined at the C1 and T1 levels. Forty-four healthy control subjects were examined to determine normal flow velocity parameters. Severity of cervical myelopathy was evaluated preoperatively and postoperatively by use of Japan Orthopedic Association scores to calculate the extent of recovery.
Preoperatively, cerebrospinal fluid flow velocity in the caudal direction was significantly lower at both C1 and T1 than velocities measured in healthy controls. Both decompressive procedures essentially returned patient velocities to control values. Clinical recovery from myelopathy did not differ between anterior and posterior decompression. Postoperative increase in flow velocity correlated with clinical recovery after posterior (P < 0.0008) but not anterior decompression.
Cine phase contrast magnetic resonance imaging provides quantitative assessment of cervical spine decompression, with particularly good clinical applicability to posterior procedures.
我们采用电影相位对比磁共振成像测量脑脊液流速，以量化脊髓型颈椎病患者手术减压的效果。
对47例因颈椎病或后纵韧带骨化导致脊髓型颈椎病的患者进行研究。35例患者接受了颈椎前路减压融合术；另外12例接受了扩大椎板成形术。术前和术后使用配备脉冲门控电影相位对比序列的1.5-T扫描仪对患者进行检查。在C1和T1水平测定蛛网膜下腔腹侧的脑脊液流动方向和流速。对44名健康对照者进行检查以确定正常流速参数。术前和术后使用日本骨科协会评分评估脊髓型颈椎病的严重程度，以计算恢复程度。
术前，C1和T1水平尾侧方向的脑脊液流速均显著低于健康对照者的测量值。两种减压手术均基本使患者的流速恢复到对照值。前路减压和后路减压后脊髓病的临床恢复情况无差异。后路减压术后流速增加与临床恢复相关（P < 0.0008），但前路减压后无此相关性。
电影相位对比磁共振成像可对颈椎减压进行定量评估，对后路手术具有特别好的临床适用性。
