Department of Spine Surgery, The Third Hospital of HeBei Medical University, 159 Ziqiang Road, Shijiazhuang, China.
Spine (Phila Pa 1976). 2010 May 1;35(10):E396-9. doi: 10.1097/BRS.0b013e3181c6dbc4.
STUDY DESIGN: A retrospective imaging study of 73 patients who underwent surgery for cervical spondylotic myelopathy (CSM) between April 2005 and July 2007. OBJECTIVE: To investigate whether magnetic resonance (MR) T2 image signal intensity (SI) ratio and clinical manifestation can assess the prognosis in patients with CSM. SUMMARY OF BACKGROUND DATA: The association between intramedullary high SI on T2-weighted MR images and surgical outcome in CSM remains controversial. The means of quantizing SI ratio for the disease has not been discussed. METHODS: A total of 73 patients with cervical compressive myelopathy were retrospectively enrolled and were treated with anterior, posterior, and posterior-anterior united decompression. A total of 1.5-T magnetic resonance imaging was performed in all patients before surgery. T2-weighted images of sagittal increased SI on the cervical spinal cord were obtained, and the regions of interest (ROIs) are taken by 0.05 cm. T2-weighted MR images of sagittal normal cord SI on the cervical between C7-T1 disc levels were obtained, and the ROIs are taken by 0.3 cm. SI value is measured by computer, and the SI ratio between the regions 0.05 cm and 0.3 cm has been calculated. If no intramedullary high SI was noted on T2-weighted MR images, the ROIs were taken by 0.05 cm of the severe compression cord. All patients had been divided into 3 groups by hierarchical clustering analysis with SI ratio (Group 1: low SI ratio, Group 2: middle SI ratio, and Group 3: high SI ratio). Statistical analyses were performed with SPSS 11.0. RESULTS: There are significant differences between 3 groups by comparing the recovery rate (P < 0.001), age (P = 0.003), duration of disease (P = 0.001), Babinski sign (P < 0.001), preoperative JOA score (P = 0.006), and postoperative JOA score (P < 0.001). There are no significant differences on sex among 3 groups (P = 0.387). By using the multiple comparison analysis, the above results are further shown. CONCLUSION: Patients with low SI ratio who were not too old and had a shorter duration of disease experienced a good surgical outcome. However, with the increase of SI ratio and the occurrence of pyramidal sign, a poor prognosis after surgery will show. SI ratio and clinical manifestation can be a predictor of surgical outcome.
研究设计：对 2005 年 4 月至 2007 年 7 月间因颈椎病性脊髓病（CSM）而行手术治疗的 73 例患者进行回顾性影像学研究。 目的：探讨磁共振（MR）T2 图像信号强度（SI）比值和临床表现是否能评估 CSM 患者的预后。 背景资料概要：CSM 患者脊髓内高 T2 加权 MR 图像信号与手术结果之间的关系仍存在争议。用于量化疾病 SI 比值的方法尚未讨论。 方法：共回顾性纳入 73 例颈椎压迫性脊髓病患者，行前路、后路和前后联合减压治疗。所有患者术前均行 1.5-T 磁共振成像。获取颈椎脊髓矢状位 T2 加权像上 SI 增加的区域，并以 0.05cm 的 ROI 测量。获取颈椎 C7-T1 椎间盘水平之间的正常颈髓矢状位 T2 加权 MR 图像，并以 0.3cm 的 ROI 测量。通过计算机测量 SI 值，并计算 0.05cm 和 0.3cm 之间的 ROI 比值。如果 T2 加权 MR 图像上未见脊髓内高 SI，则以严重受压脊髓的 0.05cm 的 ROI 测量。根据 SI 比值（低 SI 比值组、中 SI 比值组和高 SI 比值组），采用层次聚类分析将所有患者分为 3 组。使用 SPSS 11.0 进行统计学分析。 结果：通过比较恢复率（P<0.001）、年龄（P=0.003）、病程（P=0.001）、巴宾斯基征（P<0.001）、术前 JOA 评分（P=0.006）和术后 JOA 评分（P<0.001），3 组之间存在显著差异。3 组间的性别差异无统计学意义（P=0.387）。通过多重比较分析，进一步显示了上述结果。 结论：低 SI 比值且年龄不大、病程较短的患者手术效果良好。然而，随着 SI 比值的增加和锥体束征的出现，术后预后较差。SI 比值和临床表现可以作为手术结果的预测指标。
Zhonghua Yi Xue Za Zhi. 2008-11-25
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