Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, Nagoya, Aichi, Japan.
Spine (Phila Pa 1976). 2011 Nov 15;36(24):E1568-72. doi: 10.1097/BRS.0b013e31821273c0.
This is a prospective imaging study of adult patients with cervical spinal cord injury without radiographic abnormality (SCIWORA).
The purpose of this study was to investigate the occurrence rate of intramedullary high-signal intensity (increased signal intensity [ISI]) and prevertebral hyperintensity (PVH) in patients with SCIWORA, and examine their relationship to symptom severity and surgical outcome.
SCIWORA is accompanied by the presence of neurologic symptoms in the absence of positive radiographic findings before the emergence of magnetic resonance imaging (MRI). There are few reports regarding the image features on MRI in these patients.
One-hundred consecutive patients with SCIWORA who had undergone expansive laminoplasty were enrolled. There were 79 men and 21 women; the mean age was 55 years (range, 16-87 years). All patients underwent functional x-ray and MRI in the acute phase. On MR T2-weighted imaging sagittal view, occurrence of ISI and PVH was evaluated. Range of ISI and PVH was measured relative to C3 vertebral height. Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy (JOA score), it's recovery rate, and ASIA impairment scale were used to evaluate neurological status.
ISI was observed in 92 patients and PVH in 90 patients on MRI preoperatively. The range of ISI and PVH tended to increase with scores on the preoperative ASIA scale. ISI and PVH were seen in all patients with ASIA A and B. There was a significant negative correlation between the range of ISI and preoperative JOA score. A significant negative correlation between the range of ISI and recovery rate of JOA score was also seen.
ISI and PVH occurred in more than 90% of patients with SCIWORA. The range of ISI significantly reflected symptom severity and prognosis for neurologic outcome.
本研究为前瞻性颈椎脊髓损伤无放射影像学异常（SCIWORA）成年患者的影像学研究。
本研究旨在探讨 SCIWORA 患者脊髓内高信号（高信号强度[ISI]）和椎体前高信号（PVH）的发生率，并研究其与症状严重程度和手术结果的关系。
SCIWORA 是指在出现磁共振成像（MRI）之前，患者存在神经症状但影像学检查未见阳性结果。目前关于这些患者 MRI 图像特征的报道较少。
纳入 100 例行广泛椎板成形术的 SCIWORA 患者。男 79 例，女 21 例；平均年龄 55 岁（16-87 岁）。所有患者在急性期均行功能 X 线和 MRI 检查。在 MRI T2 加权矢状位图像上，评估 ISI 和 PVH 的发生情况。测量 ISI 和 PVH 相对于 C3 椎体高度的范围。采用日本矫形协会（JOA）颈椎脊髓病评分（JOA 评分）、恢复率和 ASIA 损伤量表评估神经功能状态。
术前 MRI 显示 92 例患者存在 ISI，90 例患者存在 PVH。ISI 和 PVH 的范围随术前 ASIA 量表评分的升高而增大。所有 ASIA A 和 B 型患者均存在 ISI 和 PVH。ISI 范围与术前 JOA 评分呈显著负相关。ISI 范围与 JOA 评分恢复率之间也存在显著负相关。
超过 90%的 SCIWORA 患者存在 ISI 和 PVH。ISI 范围显著反映了症状严重程度和神经功能预后。
