Wu Shiyang, Chandoo Suraj, Zhu Minyu, Huang Kelun, Wang Yu, Wang Zhenzhang, Teng Hong Lin
Department of Spine Surgery, first Affliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Department of Radiology, first Affliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
World Neurosurg. 2018 Jul;115:e152-e159. doi: 10.1016/j.wneu.2018.03.217. Epub 2018 Apr 9.
Cervical myelopathy is a common, acquired cause of spinal cord dysfunction in older patients. It is postulated that a hypoxic or ischemic environment secondary to chronic spinal cord compression plays an important role in the pathogenesis of myelopathy. This study aims to use dual-energy computed tomography (DECT) to assess the altered blood flow to the spinal cord in patients with cervical spondylotic myelopathy (CSM). To our knowledge, this study is the first to use DECT in identifying comprised anterior spinal artery blood flow in patients with CSM.
Fifty patients with single disc level CSM and 10 volunteers without CSM underwent DECT of the cervical spine to analyze and compare the ASA. The neurologic status of each patient was evaluated preoperatively and postoperatively at 5 days, 1 month, and 6 months using the Japanese Orthopedic Association (JOA) score. All the patients with CSM underwent single-level anterior cervical discectomy and fusion, and at postoperative day 5, each patient underwent repeated DECT. The anterior spinal artery before and after surgery was compared in patients with CSM. The blood flow in terms of iodine content at a specific region of interest was measured in the axial CT of the volunteers group and in the preoperative and postoperative axial CT of patients with CSM. Correlations between change in blood flow and clinical improvement at each follow-up point were analyzed statistically.
Iodine content (100 mg/mL) was 14.2800 ± 1.89527 at the C3/C4 disc level, 14.8280 ± 1.83820 at the C4/C5 disc level, and 15.5000 ± 2.41048 at the C5/C6 level. In patients with CSM, the preoperative iodine content (100 mg/mL) measured was 10.2621 ± 2.37396 in C3/C4 disc-level compression, 12.1438 ± 1.63447 in C4/C5 disc-level compression, and 14.0620 ± 2.44390 in C5/C6 disc-level compression. Postoperative iodine content (100 mg/mL) measurement changed to 13.78 ± 2.77 for the C3/C4 disc level, 14.16 ± 1.90 for the C4/C5 disc level, and 15.14 ± 2.62 for the C5/C6 disc level. The JOA score was 13.650 preoperatively, 14.010 at 5 days postoperatively, 14.630 at 1 month postoperatively, and 15.000 at 6 months postoperatively. The 1- and 6-month correlation ratios between the JOA and change in blood flow were statistically significant, with an r value of 0.746 (P < 0.05) and 0.760 (P < 0.05), respectively.
This study provided evidence for the benefit of DECT as a radiographic tool for identifying the compromised cervical anterior spinal artery in patients with CSM. We believe that DECT is the one of the best radiographic tools available to provide an objective screening tool to detect compromised blood flow in patients with CSM.
脊髓型颈椎病是老年患者脊髓功能障碍常见的后天性病因。据推测，慢性脊髓压迫继发的缺氧或缺血环境在脊髓病的发病机制中起重要作用。本研究旨在使用双能计算机断层扫描（DECT）评估脊髓型颈椎病（CSM）患者脊髓血流的改变。据我们所知，本研究是首次使用DECT识别CSM患者脊髓前动脉血流受损情况。
50例单节段CSM患者和10名无CSM的志愿者接受颈椎DECT检查，以分析和比较脊髓前动脉（ASA）。使用日本骨科协会（JOA）评分在术前以及术后5天、1个月和6个月对每位患者的神经功能状态进行评估。所有CSM患者均接受单节段颈椎前路椎间盘切除融合术，术后第5天，每位患者再次接受DECT检查。比较CSM患者手术前后的脊髓前动脉情况。在志愿者组的轴向CT以及CSM患者术前和术后的轴向CT中，测量感兴趣特定区域的碘含量血流情况。对每个随访点血流变化与临床改善之间的相关性进行统计学分析。
C3/C4椎间盘水平的碘含量（100 mg/mL）为14.2800±1.89527，C4/C5椎间盘水平为14.8280±1.83820，C5/C6水平为15.5000±2.41048。在CSM患者中，C3/C4椎间盘水平压迫时术前测量的碘含量（100 mg/mL）为10.2621±2.37396，C4/C5椎间盘水平压迫时为12.1438±1.63447，C5/C6椎间盘水平压迫时为14.0620±2.44390。术后碘含量（100 mg/mL）测量值在C3/C4椎间盘水平变为13.78±2.77，C4/C5椎间盘水平为14.16±1.90，C5/C6椎间盘水平为15.14±2.62。JOA评分术前为13.650，术后5天为14.010，术后1个月为14.630，术后6个月为15.000。JOA与血流变化之间1个月和6个月的相关系数具有统计学意义，r值分别为0.746（P<0.05）和0.760（P<0.05）。
本研究为DECT作为一种影像学工具用于识别CSM患者受损的颈脊髓前动脉的益处提供了证据。我们认为DECT是现有的最佳影像学工具之一，可提供一种客观的筛查工具来检测CSM患者的血流受损情况。
