对前瞻性收集的北美和国际AO脊柱数据合并后的MRI分析：全球退行性颈椎脊髓病患者队列中的病理患病率及谱系
MRI Analysis of the Combined Prospectively Collected AOSpine North America and International Data: The Prevalence and Spectrum of Pathologies in a Global Cohort of Patients With Degenerative Cervical Myelopathy.
作者信息
Nouri Aria, Martin Allan R, Tetreault Lindsay, Nater Anick, Kato So, Nakashima Hiroaki, Nagoshi Narihito, Reihani-Kermani Hamed, Fehlings Michael G
机构信息
Division of Neurosurgery and Spine Program, University of Toronto, Toronto, Ontario, Canada.
Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
出版信息
Spine (Phila Pa 1976). 2017 Jul 15;42(14):1058-1067. doi: 10.1097/BRS.0000000000001981.
STUDY DESIGN
An ambispective analysis.
OBJECTIVE
The aim of this study was to report the global prevalence of specific degenerative cervical pathologies in patients with degenerative cervical myelopathy (DCM) through detailed review of magnetic resonance imaging (MRIs).
SUMMARY OF BACKGROUND DATA
DCM encompasses a spectrum of age-related conditions that result in progressive spinal cord injury.
METHODS
MRIs of 458 patients (age 56.4 ± 11.8, 285 male, 173 female) were reviewed for specific degenerative features, directionality of cord compression, levels of spinal cord compression, and signal changes on sagittal T2-weighted imaging (T2WI) and sagittal T1-weighted imaging (T1WI). Data were analyzed for differences between sex using Chi-square tests and geographic variations using Kruskal-Wallis tests.
RESULTS
Spondylosis was frequently present (89.7%) and was commonly accompanied by enlargement of the ligamentum flavum (LF) (59.9%). Single-level disc pathology, ossification of posterior longitudinal ligament (OPLL), and spondylolisthesis had a prevalence of ∼10% each. OPLL was accompanied by spondylosis in 91.7%. Klippel-Feil syndrome was observed in 2.0%. The Asia-Pacific region had more OPLL (29%, P = 3 × 10) and less spondylolisthesis (1.9%, P = 0.002). Females presented more commonly with single-level disc pathology (13.9% vs. 6.7%; P = 0.013), and males with spondylosis (92.3% vs. 85.6%; P = 0.02) and enlargement of LF (61.4% vs. 49.1%; P = 0.01). C5 to C6 was the most frequent maximum compressed site (39.5%) and region for T2WI hyperintensity (38.9%). T2WI hyperintensity more commonly presented in males (82.4% vs. 66.7%; P < 0.001).
CONCLUSION
This is the largest report on the prevalence and spectrum of pathology in patients with DCM. Herein, it has been demonstrated that degenerative features are highly interrelated, that females presented with milder MRI evidence of DCM, and that variations exist in the prevalence of pathologies between geographical regions.
LEVEL OF EVIDENCE
研究设计
前瞻性分析。
目的
本研究旨在通过详细回顾磁共振成像（MRI）报告退行性颈椎脊髓病（DCM）患者特定退行性颈椎病变的全球患病率。
背景数据总结
DCM包括一系列与年龄相关的疾病，可导致进行性脊髓损伤。
方法
对458例患者（年龄56.4±11.8岁，男性285例，女性173例）的MRI进行回顾，以观察特定的退行性特征、脊髓压迫的方向、脊髓压迫的节段以及矢状面T2加权成像（T2WI）和矢状面T1加权成像（T1WI）上的信号变化。使用卡方检验分析性别差异，使用Kruskal-Wallis检验分析地理差异。
结果
脊柱退变很常见（89.7%），且常伴有黄韧带（LF）增厚（59.9%）。单节段椎间盘病变、后纵韧带骨化（OPLL）和椎体滑脱的患病率均约为10%。91.7%的OPLL伴有脊柱退变。观察到2.0%的患者患有Klippel-Feil综合征。亚太地区的OPLL更多见（29%，P = 3×10），椎体滑脱较少见（1.9%，P = 0.002）。女性更常见单节段椎间盘病变（13.9%对6.7%；P = 0.013），男性更常见脊柱退变（92.3%对85.6%；P = 0.02）和LF增厚（61.4%对49.1%；P = 0.01）。C5至C6是最常见的最大受压节段（39.5%）和T2WI高信号区域（38.9%）。T2WI高信号在男性中更常见（82.4%对66.7%；P < 0.001）。
结论
这是关于DCM患者患病率和病变谱的最大规模报告。在此已证明，退行性特征高度相关，女性的DCM MRI证据较轻，且不同地理区域的病变患病率存在差异。
证据级别
2级。
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