磁共振成像中的改良K线可预测脊髓型颈椎病椎板成形术后非前凸排列患者的临床结局。

Modified K-line in magnetic resonance imaging predicts clinical outcome in patients with nonlordotic alignment after laminoplasty for cervical spondylotic myelopathy.

作者信息

Taniyama Takashi, Hirai Takashi, Yoshii Toshitaka, Yamada Tsuyoshi, Yasuda Hiroaki, Saito Masanori, Inose Hiroyuki, Kato Tsuyoshi, Kawabata Shigenori, Okawa Atsushi

机构信息

*Department of Orthopaedic and Spinal Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan †Section of Regenerative Therapeutics for Spine and Spinal Cord, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan ‡Division of Oral Biology and Medicine, School of Dentistry, University of California, Los Angeles, Los Angeles, CA; and §Global Center of Excellence (GCOE) Program for International Research Center for Molecular Science in Tooth and Bone Disease, Tokyo Medical and Dental University, Tokyo, Japan.

出版信息

Spine (Phila Pa 1976). 2014 Oct 1;39(21):E1261-8. doi: 10.1097/BRS.0000000000000531.

DOI:10.1097/BRS.0000000000000531

PMID:25077905

Abstract

STUDY DESIGN

Retrospective single-center study.

OBJECTIVE

To investigate whether a preoperative index predicts clinical outcome after laminoplasty for cervical spondylotic myelopathy.

SUMMARY OF BACKGROUND DATA

This is the first study using the modified K-line, which connects the midpoints of the spinal cord at the C2 and C7 levels on midsagittal magnetic resonance imaging, to assess the relationship between postoperative clinical outcome and anticipated degree of spinal cord shifting.

METHODS

Sixty-one consecutive patients who underwent laminoplasty for the treatment of cervical spondylotic myelopathy between 2000 and 2011 at our hospital were retrospectively reviewed. The interval between the preoperative mK-line and the anterior structure of the spinal canal at each segment of the C3 to C6 levels (INTn, n = 3-6) were measured on sagittal T1-weighted magnetic resonance imaging, and the sum of the INTn (INTsum) was then calculated. The degree of posterior cord shift was defined as follows: %Csum = ΣCn; Cn = (Bn-An) × 100/An (n = 3-6; An and Bn represent the preoperative and postoperative intervals between the midpoint of the spinal cord and the anterior impingement at each segment on sagittal T1-weighted magnetic resonance imaging, respectively). In addition, we defined INTmin as the minimum interval of the INTn in each patient. All patients were divided into lordotic and nonlordotic groups on the basis of lateral neutral radiography. The Japanese Orthopaedic Association (JOA) scoring system and recovery rate of the JOA score for cervical myelopathy was evaluated as clinical outcomes.

RESULTS

The recovery rate of the JOA score was 48.1%. The lordotic and nonlordotic groups contained 38 and 23 patients, respectively. Linear regression analysis revealed that INTmin was significantly correlated with the recovery rate of the patients in the nonlordotic group, whereas INTsum was not associated with recovery of the JOA score.

CONCLUSION

We identified INTmin as a predictive factor for clinical outcomes in patients with nonlordotic alignment after laminoplasty.

LEVEL OF EVIDENCE

摘要

研究设计

回顾性单中心研究。

目的

探讨术前指标能否预测脊髓型颈椎病椎板成形术后的临床疗效。

背景资料总结

这是第一项使用改良K线的研究，该线连接矢状位磁共振成像上C2和C7水平脊髓中点，以评估术后临床疗效与预期脊髓移位程度之间的关系。

方法

回顾性分析2000年至2011年在我院接受椎板成形术治疗脊髓型颈椎病的61例连续患者。在矢状位T1加权磁共振成像上测量术前改良K线与C3至C6各节段椎管前部结构之间的间距（INTn，n = 3 - 6），然后计算INTn的总和（INTsum）。脊髓后移程度定义如下：%Csum = ΣCn；Cn = (Bn - An) × 100/An（n = 3 - 6；An和Bn分别代表矢状位T1加权磁共振成像上各节段脊髓中点与前部压迫之间的术前和术后间距）。此外，我们将INTmin定义为每位患者INTn中的最小间距。所有患者根据中立位X线片分为前凸组和非前凸组。采用日本骨科学会（JOA）评分系统评估颈椎病患者的JOA评分恢复率作为临床疗效。