Mummaneni Praveen V, Kaiser Michael G, Matz Paul G, Anderson Paul A, Groff Michael, Heary Robert, Holly Langston, Ryken Timothy, Choudhri Tanvir, Vresilovic Edward, Resnick Daniel
Department of Neurosurgery, University of California at San Francisco, California, USA.
J Neurosurg Spine. 2009 Aug;11(2):119-29. doi: 10.3171/2009.3.SPINE08717.
The objective of this systematic review was to use evidence-based medicine to assess whether preoperative imaging or electromyography (EMG) predicts surgical outcomes in patients undergoing cervical surgery.
The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to the preoperative imaging and EMG. Abstracts were reviewed after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I-III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons.
Preoperative MR imaging and CT myelography are successful in confirming clinical radiculopathy (Class II). Multilevel T2 hyperintensity, T1 focal hypointensity combined with T2 focal hyperintensity, and spinal cord atrophy each convey a poor prognosis (Class III). There is conflicting data concerning whether focal T2 hyperintensity or cervical stenosis are associated with a worse outcome. Electromyography has mixed utility in predicting outcome (Class III).
Magnetic resonance imaging or CT myelography are important for preoperative assessment. Magnetic resonance imaging may be helpful in assessing prognosis, whereas EMG has mixed utility in assessing outcome.
本系统评价的目的是运用循证医学评估术前影像学检查或肌电图（EMG）能否预测接受颈椎手术患者的手术结局。
使用与术前影像学检查和肌电图相关的医学主题词和关键词检索美国国立医学图书馆和考克兰数据库。对摘要进行审查，之后选取符合纳入标准的研究。指南制定小组编制了一个证据表，总结证据质量（I - III级）。关于证据水平的分歧通过专家共识会议解决。该小组根据苏格兰校际指南网络制定了包含推荐强度的建议。通过美国神经外科医师协会/神经外科医师大会联合指南委员会的同行评审进行验证。
术前磁共振成像（MR）和CT脊髓造影能成功确诊临床神经根病（II级）。多节段T2高信号、T1局灶性低信号合并T2局灶性高信号以及脊髓萎缩均提示预后不良（III级）。关于局灶性T2高信号或颈椎管狭窄是否与更差的结局相关，存在相互矛盾的数据。肌电图在预测结局方面作用不一（III级）。
磁共振成像或CT脊髓造影对术前评估很重要。磁共振成像可能有助于评估预后，而肌电图在评估结局方面作用不一。
