脊髓线可预测多节段脊髓型颈椎病的术后恢复情况。

The Spinal Cord Line Can Predict Postoperative Recovery for Multilevel Cervical Spondylotic Myelopathy.

作者信息

Tong Min-Ji, Hu Yuan-Bo, Wang Xiang-Yang, Zhu Si-Pin, Tian Nai-Feng, Fang Ming-Qiao, Xu Hua-Zi, Xiang Guang-Heng

机构信息

Zhejiang Spine Research Center, Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.

出版信息

World Neurosurg. 2017 Aug;104:361-366. doi: 10.1016/j.wneu.2017.03.105. Epub 2017 May 3.

DOI:10.1016/j.wneu.2017.03.105

PMID:28478247

Abstract

OBJECTIVE

To report a new index, the spinal cord (SC) line, and a new classification to predict postoperative recovery effect in patients with multilevel cervical spondylotic myelopathy (CSM).

METHODS

On T2-weighted magnetic resonance imaging (MRI) of the cervical spine, point A is the posteroinferior point of the spinal cord at C2, and point B is the posterosuperior point of the spinal cord at C7. The SC line is defined as a line connecting A and B. The posterior surface of the compressor at the compression level does not exceed the line in SC line type I, touches the line in type II, and exceeds the line in type III. Between January 2010 and January 2015, 121 patients with multilevel CSM who underwent surgery through an anterior approach (anterior cervical corpectomy with fusion or anterior cervical discectomy and fusion) or a posterior approach (laminoplasty or laminectomy) in our hospital were studied retrospectively. The patients were classified into 3 groups according to SC line type (I, II, or III).

RESULTS

In the anterior surgical approach group, the Japanese Orthopaedic Association (JOA) recovery rate at the last follow-up was 84.88 ± 3.06% for SC line type I, 78.05 ± 2.89% for type II, and 68.69 ± 3.21% for type III. In the posterior surgical approach group, the JOA recovery rate at last follow-up was 69.35 ± 8.73% for type I, 58.05 ± 5.88% for type II, and 47.98 ± 4.31% for type III. The anterior surgery approach was associated with a higher postoperative recovery rate than the posterior surgery approach in type II and type III groups (type II anterior vs. type II posterior: 78.05 ± 2.89% vs. 58.05 ± 5.88%, P = 0.003; type III anterior vs. type III posterior: 68.69 ± 3.21% vs. 47.98 ± 4.31%, P = 0.001). In contrast, the anterior and posterior surgery were associated with similar postoperative recovery rates in the type I group (84.88 ± 3.06% vs. 69.35 ± 8.73%; P = 0.820).

CONCLUSIONS

The SC line and its classifications can predict postoperative recovery in patients with multilevel CSM.

摘要

目的

报告一种新的指标——脊髓（SC）线，以及一种新的分类方法，以预测多节段脊髓型颈椎病（CSM）患者的术后恢复效果。

方法

在颈椎的T2加权磁共振成像（MRI）上，点A为C2水平脊髓的后下点，点B为C7水平脊髓的后上点。SC线定义为连接A和B的线。在SC线I型中，受压节段压迫物的后表面不超过该线；II型中，压迫物后表面接触该线；III型中，压迫物后表面超过该线。回顾性研究2010年1月至2015年1月期间在我院接受前路手术（颈椎椎体次全切除融合术或颈椎间盘切除融合术）或后路手术（椎板成形术或椎板切除术）的121例多节段CSM患者。根据SC线类型（I型、II型或III型）将患者分为3组。

结果

在前路手术组中，末次随访时日本骨科协会（JOA）恢复率在SC线I型为84.88±3.06%，II型为78.05±2.89%，III型为68.69±3.21%。在后路手术组中，末次随访时JOA恢复率I型为69.35±8.73%，II型为58.05±5.88%，III型为47.98±4.31%。在II型和III型组中，前路手术的术后恢复率高于后路手术（II型前路与II型后路：78.视情况而定。05±2.89%对58.05±5.88%，P = 0.003；III型前路与III型后路：68.69±3.21%对47.98±4.31%，P = 0.001）。相比之下，I型组前路和后路手术的术后恢复率相似（84.88±3.06%对69.35±8.73%；P =视情况而定。820）。