Chatley Anooj, Kumar Raj, Jain Vijendra K, Behari Sanjay, Sahu Rabi Narayan
Department of Neurosurgery, Sanjay Gandhi Institute of Postgraduate Medical Sciences, Lucknow, India.
J Neurosurg Spine. 2009 Nov;11(5):562-7. doi: 10.3171/2009.6.SPINE091.
The presence of intramedullary T2 high signal intensity changes in patients with cervical spondylotic myelopathy (CSM) indicates the existence of a chronic spinal cord compressive lesion. However, the prognostic significance of signal intensity changes remains controversial. The purpose of this study was to evaluate the effect of spinal cord T2 signal intensity changes on the outcome after surgery for CSM.
In a prospective study, 64 patients with CSM who underwent surgical treatment between October 2006 and April 2008 using an anterior approach were included. Based on the clinical symptoms and signs present, the severity of neurological deficits of all patients was scored according to a modified Japanese Orthopaedic Association scale score for CSM just before the surgery and at 6 months follow-up. Recovery rates were calculated at 6 months.
There were 22 patients who did not have spinal cord intensity changes on MR imaging and 44 who demonstrated high-intensity signal changes on T2-weighted images (focal or segmental). No statistically significant differences were found in recovery rates between cases with T2 signal intensity changes and those with no signal intensity changes. However, the postoperative modified Japanese Orthopaedic Association scale scores and the recovery rates were much lower in patients with multisegmental signal intensity changes compared with those without these changes or those with focal signal intensity change, and ANOVA demonstrated this difference to be statistically significant (p < 0.05).
Multisegmental spinal cord signal intensity changes on T2-weighted MR imaging are predictors of a poor outcome in terms of functional recovery rate in patients undergoing operations for CSM.
脊髓型颈椎病（CSM）患者髓内T2高信号强度改变提示存在慢性脊髓压迫性病变。然而，信号强度改变的预后意义仍存在争议。本研究的目的是评估脊髓T2信号强度改变对CSM手术预后的影响。
在一项前瞻性研究中，纳入了2006年10月至2008年4月间采用前路手术治疗的64例CSM患者。根据术前及术后6个月出现的临床症状和体征，采用改良日本骨科协会CSM量表对所有患者的神经功能缺损严重程度进行评分。计算6个月时的恢复率。
22例患者在磁共振成像上脊髓信号强度无改变，44例在T2加权图像上显示高强度信号改变（局灶性或节段性）。T2信号强度改变组与无信号强度改变组的恢复率无统计学差异。然而，与无这些改变或有局灶性信号强度改变的患者相比，多节段信号强度改变的患者术后改良日本骨科协会量表评分和恢复率要低得多，方差分析显示这种差异具有统计学意义（p < 0.05）。
对于接受CSM手术的患者，T2加权磁共振成像上多节段脊髓信号强度改变是功能恢复率预后不良的预测指标。
