Alafifi T, Kern R, Fehlings M
Stroke Department, University of Alberta Hospital, University of Alberta, Edmonton, Alberta, Canada.
J Neuroimaging. 2007 Oct;17(4):315-22. doi: 10.1111/j.1552-6569.2007.00119.x.
Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in older individuals. Controversy remains in terms of the optimal timing and indications for surgical intervention. In this context, it would be of benefit to define clinical and magnetic resonance imaging (MRI) predictors of outcome after intervention for CSM.
We studied subjects with clinically documented cervical myelopathy to evaluate the relationship among preoperative MRI signal change, clinical findings, and outcome after surgical intervention.
We performed a retrospective case study of 76 CSM patients who underwent cervical decompressive surgery and who had pre- and postoperative MRI studies available for review. Preoperative clinical findings and MRI abnormalities on T1- (T1WI) and T2-weighted (T2WI) images were correlated with outcomes (Nurick scores; Odom's criteria) following surgical intervention. Postoperative MRIs were performed 2-4 months postsurgery to assess for adequacy of decompression and resolution of preoperative signal changes. The pattern of spinal cord signal intensity was classified as: Group A (MRI N/N), no intramedullary signal intensity abnormality on T1WI or T2WI; Group B (MRI N/Hi), no intramedullary signal intensity abnormality on T1WI and high intramedullary signal intensity on T2WI; Group C (MRI Lo/Hi), low intensity intramedullary signal abnormality on T1WI and high intensity intramedullary signal abnormality on T2WI. Statistical analyses were performed using SAS (version 8.2).
We evaluated 76 patients (57% males, mean age 62 years, range 30-89) who experienced preoperative symptoms for an average of 6.5 months (range 1 month to 9 years). Preoperative MRI studies demonstrated the following: Group A (MRI N/N) = 45; Group B (MRI N/Hi) = 23; and Group C (MRI Lo/Hi) = 8. The mean postoperative follow-up period was 2.5 years (range 2 months to 8.5 years). A positive Babinski sign and the presence of intrinsic hand muscle atrophy showed the greatest association with abnormal preoperative MRI signal change. High preoperative Nurick score, clonus, and leg spasticity were associated with a less favorable postoperative outcome. In Group B (MRI N/Hi), 11/23 (52.17%) patients had recovery to MRI N/N (P < .0001) at their follow-up scan.
Patients with high intramedullary signal change on T2WI who do not have clonus or spasticity may experience a good surgical outcome and may have reversal of the MRI abnormality. A less favorable surgical outcome is predicted by the presence of low intramedullary signal on T1WI, clonus, or spasticity. These data suggest that there may be a window of opportunity to obtain optimal surgical outcomes in patients with CSM.
脊髓型颈椎病（CSM）是老年个体脊髓功能障碍最常见的原因。手术干预的最佳时机和指征仍存在争议。在此背景下，明确CSM干预后预后的临床和磁共振成像（MRI）预测指标将有所帮助。
我们研究有临床记录的颈椎病患者，以评估术前MRI信号变化、临床发现与手术干预后预后之间的关系。
我们对76例接受颈椎减压手术且有术前和术后MRI检查可供复查的CSM患者进行了一项回顾性病例研究。术前临床发现以及T1加权（T1WI）和T2加权（T2WI）图像上的MRI异常与手术干预后的预后（Nurick评分；奥多姆标准）相关。术后MRI在术后2 - 4个月进行，以评估减压是否充分以及术前信号变化是否消退。脊髓信号强度模式分为：A组（MRI N/N），T1WI或T2WI上无髓内信号强度异常；B组（MRI N/Hi），T1WI上无髓内信号强度异常，T2WI上有高髓内信号强度；C组（MRI Lo/Hi），T1WI上有低强度髓内信号异常，T2WI上有高强度髓内信号异常。使用SAS（8.2版）进行统计分析。
我们评估了76例患者（57%为男性，平均年龄62岁，范围30 - 89岁），他们术前症状平均持续6.5个月（范围1个月至9年）。术前MRI检查显示如下：A组（MRI N/N） = 45例；B组（MRI N/Hi） = 23例；C组（MRI Lo/Hi） = 8例。术后平均随访期为2.5年（范围2个月至8.5年）。巴宾斯基征阳性和手部固有肌萎缩与术前MRI信号异常变化的关联最大。术前Nurick评分高、阵挛和腿部痉挛与术后预后较差相关。在B组（MRI N/Hi）中，11/23（52.17%）患者在随访扫描时恢复为MRI N/N（P <.0001）。
T2WI上有高髓内信号变化但无阵挛或痉挛的患者可能有良好的手术预后，且MRI异常可能会逆转。T1WI上有低髓内信号、阵挛或痉挛提示手术预后较差。这些数据表明，CSM患者可能存在获得最佳手术预后的机会窗口。
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