用于评估单节段颈椎前路椎间盘切除及关节成形术后相邻节段疾病的3特斯拉颈椎运动MRI：2年随访结果
3-Tesla Kinematic MRI of the Cervical Spine for Evaluation of Adjacent Level Disease After Monosegmental Anterior Cervical Discectomy and Arthroplasty: Results of 2-Year Follow-Up.
作者信息
Fleck Steffen K, Langner Soenke, Rosenstengel Christian, Kessler Rebecca, Matthes Marc, Müller Jan-Uwe, Langner Inga, Marx Sascha, Schroeder Henry W S
机构信息
Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany.
Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany.
出版信息
Spine (Phila Pa 1976). 2017 Feb 15;42(4):224-231. doi: 10.1097/BRS.0000000000001705.
STUDY DESIGN
We prospectively evaluated adjacent disc levels after anterior cervical discectomy and arthroplasty (ACDA) using kinematic magnetic resonance imaging (MRI) and plain functional radiographs.
OBJECTIVE
ACDA is an established treatment for degenerative cervical disc disease. The objective of this study was to evaluate the use of kinematic MRI for assessing the range of motion (ROM) before and after ACDA compared with plain functional radiographs and to evaluate adjacent degenerative disc disease (aDDD) at mid-term follow-up.
SUMMARY OF BACKGROUND DATA
Twenty patients (12 females, 8 males; median age 45.6 ± 6.9 yrs) treated by ACDA (BryanDisc; Medtronic, MN) underwent plain functional radiography and kinematic MRI of the cervical spine at 3 T before and 6 and 24 months after surgery.
METHODS
A sagittal T2-weighted (T2w) 2D turbo spin echo (TSE) sequence and a 3D T2w dataset with secondary axial reconstruction were acquired. Signal intensity of all nonoperated discs was measured in regions of interest (ROI). Disc heights adjacent to the operated segment were measured. ROM was evaluated and compared with plain functional radiographs. Clinical outcome was evaluated using the visual analog scale (VAS) for head, neck and radicular pain, and the neck disability index (NDI).
RESULTS
Mean ROM of the cervical spine on functional plain radiographs was 21.25 ± 8.19°, 22.29 ± 4.82°, and 26.0 ± 6.9° preoperatively and at 6-month and 24-month follow-up, respectively. Mean ROM at MRI was 27.1 ± 6.78°, 29.45 ± 9.51°, and 31.95 ± 9.58°, respectively. There was a good correlation between both techniques. Follow-up examinations demonstrated no signs of progressive degenerative disc disease of adjacent levels. All patients had clinical improvement up to 24 months after surgery.
CONCLUSION
After ACDA, kinematic MRI allows evaluation of the ROM with excellent correlation to plain functional radiographs. Mid-term follow-up after ACDA is without evidence of progressive DDD of adjacent segments.
LEVEL OF EVIDENCE
研究设计
我们采用动态磁共振成像（MRI）和平片功能影像学方法，对颈椎前路椎间盘切除及椎间关节成形术（ACDA）后的相邻椎间盘节段进行了前瞻性评估。
目的
ACDA是治疗退行性颈椎间盘疾病的一种既定疗法。本研究的目的是评估动态MRI与平片功能影像学相比，在评估ACDA前后活动范围（ROM）方面的应用，并在中期随访时评估相邻节段退变椎间盘疾病（aDDD）情况。
背景资料总结
20例接受ACDA治疗（使用BryanDisc；美敦力公司，明尼苏达州）的患者（12例女性，8例男性；中位年龄45.6±6.9岁）在术前以及术后6个月和24个月接受了颈椎平片功能影像学检查和3T动态MRI检查。
方法
采集矢状位T2加权（T2w）二维快速自旋回波（TSE）序列以及具有二次轴向重建的三维T2w数据集。在感兴趣区（ROI）测量所有未手术椎间盘的信号强度。测量手术节段相邻椎间盘的高度。评估ROM并与平片功能影像学结果进行比较。使用视觉模拟量表（VAS）评估头部、颈部和神经根性疼痛的临床结局，并使用颈部功能障碍指数（NDI）进行评估。
结果
颈椎平片功能影像学上的平均ROM在术前、术后6个月和24个月随访时分别为21.25±8.19°、22.29±4.82°和26.0±6.9°。MRI上的平均ROM分别为27.1±6.78°、29.45±9.51°和31.95±9.58°。两种技术之间具有良好的相关性。随访检查未发现相邻节段椎间盘疾病进展的迹象。所有患者在术后24个月时临床症状均有改善。
结论
ACDA术后，动态MRI能够评估ROM，与平片功能影像学具有极好的相关性。ACDA术后中期随访未发现相邻节段椎间盘退变进展的证据。
证据级别
3级。
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