Li Xiang-Yu, Lu Shi-Bao, Sun Xiang-Yao, Kong Chao, Guo Ma-Chao, Sun Si-Yuan, Ding Jun-Zhe, Yang Yi-Ming
Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China; National Clinical Research Center for Geriatric Diseases, China; Capital Medical University, China.
Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China; National Clinical Research Center for Geriatric Diseases, China.
Clin Neurol Neurosurg. 2018 Nov;174:137-143. doi: 10.1016/j.clineuro.2018.09.003. Epub 2018 Sep 5.
To determine whether clinical characteristics and signal and morphologic changes on magnetic resonance (MR) images of the spinal cord (SC) are associated with surgical outcomes for cervical spondylotic myelopathy (CSM).
A total of 113 consecutive patients with cervical myelopathy underwent cervical decompression surgery in our hospital from January 2015 to January 2018. All patients with preoperative MR images available for review were recruited for this study. Research data included patient sex, age, duration of symptoms, surgical approach, compression level, preoperative mJOA (modified Japanese Orthopaedic Association) score, postoperative mJOA recovery rate, and complications. Imaging data included signal changes on T2-weighted MRI images (grade and extension on sagittal images, four types of signal changes on axial images according to the Ax-CCM system), SC compression, transverse area of the SC, and compression ratio. The t-test, Mann-Whitney U-test, Kruskal-Wallis H - test, analysis of variance, and regression analysis were used to evaluate the effects of individual predictors on surgical outcomes.
The study cohort included 85 males and 27 females with a mean age of 60.92 ± 8.93 years. The mean mJOA score improved from 10.24 ± 1.69 preoperatively to 15.11 ± 2.05 at the final follow-up (p < 0.001). Patients in the poor outcome group were more likely to present with a longer duration of symptoms (p < 0.001) and smaller transverse area of the SC (p < 0.001). Bright T2-weighted high signal changes (T2HSCs), multisegmental high signal changes on sagittal MR images, and fuzzy focal T2HSCs on axial MR images were associated with a poor outcome (p < 0.001, p = 0.005, p < 0.001, respectively). The maximum SC compression and compression ratio were not reliable predictors of surgical outcomes (p = 0.375, p = 0.055, respectively). The result of multivariate stepwise logistic regression showed that a longer duration of symptoms, multisegmental T2HSCs on sagittal MR images and fuzzy focal T2HSCs on axial MR images were significant risk factors of poor outcomes (p < 0.001, p = 0.049, p = 0.016, respectively).
A longer duration of symptom, multisegmental T2HSCs on sagittal MR images, and fuzzy focal T2HSCs on axial MR images were highly predictive of a poor surgical outcome for CSM. Smaller transverse area of the SC and bright T2HSCs were also associated with the prognosis of CSM.
确定脊髓（SC）磁共振（MR）图像的临床特征以及信号和形态学改变是否与脊髓型颈椎病（CSM）的手术疗效相关。
2015年1月至2018年1月期间，我院共有113例连续性脊髓型颈椎病患者接受了颈椎减压手术。纳入所有术前有MR图像可供复查的患者进行本研究。研究数据包括患者性别、年龄、症状持续时间、手术方式、压迫节段、术前改良日本骨科学会（mJOA）评分、术后mJOA恢复率及并发症。影像数据包括T2加权MRI图像上的信号改变（矢状位图像上的分级和范围，根据Ax - CCM系统，轴位图像上的四种信号改变类型）、脊髓受压情况、脊髓横截面积及压迫率。采用t检验、Mann - Whitney U检验、Kruskal - Wallis H检验、方差分析及回归分析来评估各预测因素对手术疗效的影响。
研究队列包括85例男性和27例女性，平均年龄为60.92±8.93岁。mJOA评分均值从术前的10.24±1.69提高至末次随访时的15.11±2.05（p<0.001）。预后不良组患者更可能有较长的症状持续时间（p<0.001）和较小的脊髓横截面积（p<0.001）。T2加权高信号改变（T2HSCs）、矢状位MR图像上的多节段高信号改变以及轴位MR图像上的模糊局灶性T2HSCs与预后不良相关（分别为p<0.001、p = 0.005、p<0.001）。最大脊髓压迫和压迫率并非手术疗效的可靠预测指标（分别为p = 0.375、p = 0.055）。多因素逐步逻辑回归结果显示，较长的症状持续时间、矢状位MR图像上的多节段T2HSCs以及轴位MR图像上的模糊局灶性T2HSCs是预后不良的显著危险因素（分别为p<0.001、p = 0.049、p = 0.016）。
较长的症状持续时间、矢状位MR图像上的多节段T2HSCs以及轴位MR图像上的模糊局灶性T2HSCs对CSM手术预后不良具有高度预测性。较小的脊髓横截面积和明显的T2HSCs也与CSM的预后相关。
