Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Nowon-gu, Seoul, South Korea.
Acta Neurochir (Wien). 2010 Oct;152(10):1687-94. doi: 10.1007/s00701-010-0692-8. Epub 2010 May 29.
The neurological outcome of cervical spondylotic myelopathy (CSM) may depend on multiple factors, including age, symptom duration, cord compression ratio, cervical curvature, canal stenosis, and factors related to magnetic resonance (MR) signal intensity (SI). Each factor may act independently or interactively with others. To clarify the factors in prognosis, we prospectively analyzed the outcomes of patients with myelopathy caused by soft disc herniation in correlation with magnetic resonance imaging (MRI) findings and other clinical parameters.
From June 2006 to July 2009, we performed surgical operations in 137 patients with CSM. Of these patients, 70 (51.1%), including 45 men and 25 women with ventral cord compression at one or two levels, underwent anterior cervical discectomy and fusion. The mean duration of follow-up was 32.7 months. We surveyed the cervical curvature index (CCI), canal stenosis (Torg-Pavlov ratio), cord compression ratio, the length of SI change on T2WI, and clinical outcome using the Japanese Orthopedic Association (JOA) score for cervical myelopathy. The MRI SI was evaluated by grade: grade 0, no change in signal intensity; grade 1, light signal change; and grade 2, bright signal change on the T2WI. Multifactorial effects were identified by regression analysis.
The mean preoperative and postoperative JOA scores were 10.5 ± 2.9 and 14.9 ± 2.1, respectively (p < 0.05). The mean recovery rate based on the JOA score was 70.0 ± 20.1%. The respective preoperative JOA scores and recovery ratios(%) were 11.6 ± 2.3 and 81.5 ± 17.0% in 20 patients with SI grade 0; 10.8 ± 2.3 and 70.1 ± 17.3% in 25 patients with grade 1; and 9.2 ± 3.6 and 60.7 ± 20.9% in 25 patients with grade 2, respectively. Post-surgical neurological outcome showed no significant relationship to age, symptom duration, cervical alignment, stenosis, or cord compression.
Among the variables tested, preoperative neurological status and intramedullary signal intensity were significantly related to neurological outcome. The better the preoperative neurological status was, the better the post-operative neurological outcome. The SI grade on the preoperative T2WI was negatively related to neurological outcome. Hence, the severity of SI change and preoperative neurological status emerged as significant prognostic factors in post-operative CSM.
颈椎病性脊髓病（CSM）的神经预后可能取决于多种因素，包括年龄、症状持续时间、脊髓压迫比、颈椎曲度、椎管狭窄以及与磁共振（MR）信号强度（SI）相关的因素。每个因素可能独立或相互作用。为了阐明预后因素，我们前瞻性分析了与 MRI 发现和其他临床参数相关的由软椎间盘突出引起的脊髓病患者的治疗结果。
自 2006 年 6 月至 2009 年 7 月，我们对 137 例 CSM 患者进行了手术治疗。其中 70 例（51.1%）患者，包括 45 例男性和 25 例女性，存在一个或两个水平的前侧脊髓压迫，接受了前路颈椎间盘切除术和融合术。平均随访时间为 32.7 个月。我们使用日本矫形协会（JOA）颈椎脊髓病评分调查颈椎曲度指数（CCI）、椎管狭窄（Torg-Pavlov 比）、脊髓压迫比、T2WI 上 SI 变化的长度以及临床结果。通过分级评估 MRI SI：0 级，信号强度无变化；1 级，信号轻度变化；2 级，T2WI 上信号明亮变化。通过回归分析确定多因素影响。
术前和术后平均 JOA 评分分别为 10.5±2.9 和 14.9±2.1（p<0.05）。根据 JOA 评分的平均恢复率为 70.0±20.1%。在 20 例 SI 分级 0 的患者中，术前 JOA 评分和恢复率（%）分别为 11.6±2.3 和 81.5±17.0%；在 25 例 SI 分级 1 的患者中，分别为 10.8±2.3 和 70.1±17.3%；在 25 例 SI 分级 2 的患者中，分别为 9.2±3.6 和 60.7±20.9%。术后神经功能预后与年龄、症状持续时间、颈椎排列、狭窄或脊髓压迫无显著关系。
在所测试的变量中，术前神经状态和脊髓内信号强度与神经预后显著相关。术前神经状态越好，术后神经预后越好。术前 T2WI 的 SI 分级与神经预后呈负相关。因此，SI 变化的严重程度和术前神经状态是术后 CSM 的重要预后因素。
