Department of Neurosurgery, Queens Hospital, Romford Essex, United Kingdom.
Neurosurgery. 2011 Aug;69(2):362-8. doi: 10.1227/NEU.0b013e31821a418c.
Factors that can predict the recovery of cervical spondylotic myelopathy (CSM) patients postoperatively are of significant interest to physicians and patients and their families. Magnetic resonance imaging (MRI) scans are a common method of examination after surgery, and thus of interest as a predictor of outcome.
To investigate whether findings on MRI at 6 months postoperatively could predict recovery at 1 year in CSM patients.
In 52 consecutive prospective patients, MRI was performed preoperatively and 6 months postoperatively. T1 and T2 signal change (area, height, and segmentation) and spinal cord re-expansion were measured. Outcome measures evaluated at 1 year postoperatively were compared with preoperative values. Univariate and stepwise multiple regressions were undertaken.
Using univariate analysis, patients whose cord failed to re-expand had poorer outcome according to the modified Japanese Orthopedic Association score and Nurick score (P = .014) and grip test (P = .006) postoperatively. Stepwise multivariate regression showed lack of cord re-expansion to be predictive of prognosis postoperatively in the modified Japanese Orthopedic Association score (P = .013) and Berg Balance Scale (P = .014), and walking test (P = .011). Postoperative hyperintense T2 signal change was predictive of worse outcome on the Berg Balance Scale (P = .014) and walking test (P = .020), Nurick score (P = .001), and Short Form-36 scores (P = .020). In cases in which the T2 signal intensified, there was a poorer outcome on Nurick scores (P = .013), grip test (P = .017), and Short Form-36 scores (P = .030).
Findings on postoperative MRI at 6 months is of predictive value in determining outcomes in CSM patients. The persistence and type of T2 signal change and lack of re-expansion of the cord correlate with poorer recovery and likely reflect irreversible structural changes in the spinal cord.
能够预测颈椎脊髓病（CSM）患者术后恢复的因素对医生、患者及其家属都非常重要。磁共振成像（MRI）扫描是术后常见的检查方法，因此作为一种预测结果的方法很有意义。
探讨术后 6 个月的 MRI 结果是否可以预测 CSM 患者 1 年后的恢复情况。
对 52 例连续前瞻性患者进行术前和术后 6 个月的 MRI 检查。测量 T1 和 T2 信号变化（面积、高度和分段）和脊髓再扩张情况。术后 1 年评估的疗效评估指标与术前值进行比较。进行单变量和逐步多元回归分析。
单变量分析显示，脊髓未再扩张的患者术后日本矫形协会评分和 Nurick 评分（P =.014）、握力测试（P =.006）的改善情况较差。逐步多元回归显示，脊髓未再扩张是术后日本矫形协会评分（P =.013）和 Berg 平衡量表（P =.014）、步行试验（P =.011）预后的预测因素。术后 T2 高信号改变与 Berg 平衡量表（P =.014）、步行试验（P =.020）、Nurick 评分（P =.001）和 SF-36 评分（P =.020）的预后较差相关。在 T2 信号增强的情况下，Nurick 评分（P =.013）、握力测试（P =.017）和 SF-36 评分（P =.030）的预后较差。
术后 6 个月的 MRI 检查结果对预测 CSM 患者的疗效具有预测价值。T2 信号变化的持续时间和类型以及脊髓的再扩张缺失与恢复较差相关，可能反映了脊髓的不可逆结构变化。
