Wei Leixin, Cao Peng, Xu Chen, Liu Yang, Chen Huajiang, Wang Xinwei, Tian Ye, Yuan Wen
Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Clin Neurol Neurosurg. 2019 Mar;178:1-6. doi: 10.1016/j.clineuro.2019.01.006. Epub 2019 Jan 14.
To investigate preoperative factors affecting the presence of intramedullary increased signal intensity (ISI) on T2-weighted magnetic resonance imaging (MRI) in patients with cervical spondylotic myelopathy (CSM) and the impact of ISI on clinical manifestations.
Eighty-nine patients with CSM were retrospectively reviewed from January 2013 to December 2016 in our hospital. Based on the presence or absence of ISI on axial and sagittal T2-weighted MRI, patients were divided into ISI group (48 cases) and non-ISI group (41 cases). Factors such as age, sex, body mass index (BMI), duration of symptoms, clinical symptoms and signs, number and distribution of spinal cord compression levels, preoperative Japanese Orthopedic Association (JOA) score, preoperative C2-C7 lordotic angle, preoperative C2-C7 range of motion (ROM), maximal canal compromise (MCC) and maximal spinal cord compression (MSCC) were initially compared using univariate analysis. Factors with significant result in univariate analysis were included in multivariate logistic regression analysis. Receiver operating characteristic (ROC) curve and the area under the curve (AUC) were applied to evaluate the reliability of multivariate logistic regression model.
Univariate analysis showed that the number of spinal cord compression levels, preoperative JOA score, MCC and MSCC might be related to the presence of ISI (P < 0.05). Furthermore, multivariate logistic regression analysis revealed that the number of spinal cord compression levels (OR = 0.203, P < 0.05), preoperative JOA score (OR = 4.274, P < 0.05) and MSCC (OR = 0.250, P < 0.05) were independent preoperative risk factors associated with the presence of ISI, yielding an AUC of 0.9558. Patients with ISI showed a trend of increasing clinical symptoms and signs, and also exhibited statistically significantly increased frequencies of clumsy hands, lower limb spasticity, impairment of gait, broad-based, unstable gait, weakness and motor deficits (P < 0.05).
Multilevel spinal cord compression, lower preoperative JOA score and greater MSCC are independent preoperative risk factors related to the presence of ISI on T2-weighted MRI in patients with CSM. Patients with ISI tend to have more clinical symptoms and signs, especially in lower limb manifestations and motor deficits.
探讨影响脊髓型颈椎病（CSM）患者术前T2加权磁共振成像（MRI）上髓内信号增强（ISI）出现的因素以及ISI对临床表现的影响。
回顾性分析2013年1月至2016年12月我院收治的89例CSM患者。根据轴位和矢状位T2加权MRI上有无ISI，将患者分为ISI组（48例）和非ISI组（41例）。首先采用单因素分析比较年龄、性别、体重指数（BMI）、症状持续时间、临床症状和体征、脊髓受压节段数量及分布、术前日本矫形外科学会（JOA）评分、术前C2-C7前凸角、术前C2-C7活动度（ROM）、最大椎管狭窄（MCC）和最大脊髓受压（MSCC）等因素。单因素分析中有显著结果的因素纳入多因素逻辑回归分析。应用受试者工作特征（ROC）曲线及曲线下面积（AUC）评估多因素逻辑回归模型的可靠性。
单因素分析显示，脊髓受压节段数量、术前JOA评分、MCC和MSCC可能与ISI的出现有关（P < 0.05）。此外，多因素逻辑回归分析显示脊髓受压节段数量（OR = 0.203，P < 0.05）、术前JOA评分（OR = 4.274，P < 0.05）和MSCC（OR = 0.250，P < 0.05）是与ISI出现相关的独立术前危险因素，AUC为0.9558。ISI患者临床症状和体征有增加趋势，手部笨拙、下肢痉挛、步态障碍、宽基不稳步态、无力和运动功能障碍的发生频率也有统计学显著增加（P < 0.05）。
多节段脊髓受压、术前JOA评分较低和MSCC较大是CSM患者术前T2加权MRI上ISI出现相关的独立术前危险因素。ISI患者往往有更多临床症状和体征，尤其是下肢表现和运动功能障碍方面。
