Al-Habib Amro F, AlAqeel Ahmed M, Aldakkan Abdulrahman S, AlBadr Fahad B, Shaik Shaffi A
Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, PO Box 59220, Riyadh 11525, Kingdom of Saudi Arabia. E-mail:
Neurosciences (Riyadh). 2015 Jan;20(1):41-7.
To study clinical and radiological factors that may correlate with independent walking (IW) following advanced cervical spondylotic myelopathy (CSM) surgery.
A retrospective case series including all advanced CSM patients (Nurick 4 and 5) who underwent surgery from 2003-2010 in the Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University and King Khalid University Hospital, Riyadh, Saudi Arabia. Only patients with 6 months or more follow-up were included. A neuroradiologist who was blinded to the clinical data reviewed all MRI studies.
Forty-three patients were included (83% males, mean follow-up 29 months). A better preoperative neurological status was a positive predictor of IW after surgery (85.7% Nurick 4 versus 36.4% Nurick 5, p=0.001). Independent walking was less likely in patients with the following MRI features: longer T2-weighted image (T2WI) signal changes (p=0.001), well-circumscribed T2WI signal changes (p=0.028), T1WI hypointensity (p=0.001), and narrow spinal canal diameter (p=0.048). Multivariate regression revealed that both an increased T2WI signal change length and T1WI hypointensity were independent predictors. The risk of dependent walking increased by 1.35 times as the T2WI signal intensity length increased by one mm, and by 14-times with T1WI hypointensity.
Regaining IW after surgery in patients with advanced CSM was less likely for cases showing MRI features of longer T2WI signal changes and T1WI hypointensity. Better baseline walking, less defined T2WI signal change, and a wider spinal canal were good prognostic factors.
研究与晚期脊髓型颈椎病（CSM）手术后独立行走（IW）相关的临床和影像学因素。
一项回顾性病例系列研究，纳入了2003年至2010年在沙特阿拉伯利雅得国王沙特大学医学院外科系神经外科及国王哈立德大学医院接受手术的所有晚期CSM患者（Nurick 4级和5级）。仅纳入随访6个月或更长时间的患者。一名对临床数据不知情的神经放射科医生对所有MRI研究进行了评估。
共纳入43例患者（83%为男性，平均随访29个月）。术前神经功能状态较好是术后IW的阳性预测指标（Nurick 4级患者为85.7%，Nurick 5级患者为36.4%，p=0.001）。具有以下MRI特征的患者独立行走的可能性较小：T2加权像（T2WI）信号改变时间更长（p=0.001）、T2WI信号改变边界清晰（p=0.028）、T1WI低信号（p=0.001）以及椎管直径狭窄（p=0.048）。多因素回归分析显示，T2WI信号改变长度增加和T1WI低信号均为独立预测因素。T2WI信号强度长度每增加1毫米，依赖行走的风险增加1.35倍，T1WI低信号时则增加14倍。
对于表现出T2WI信号改变时间更长和T1WI低信号等MRI特征的晚期CSM患者，术后恢复IW的可能性较小。基线行走能力较好、T2WI信号改变不明显以及椎管较宽是良好的预后因素。
