Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Shatin, N.T., Hong Kong, SAR, China.
Neurosurg Rev. 2020 Jun;43(3):967-976. doi: 10.1007/s10143-019-01106-3. Epub 2019 May 3.
The three-grade classification of increased signal intensity (ISI) on T2-weighted magnetic resonance imaging (MRI) is used extensively in patients with cervical compressive myelopathy (CCM). However, the efficacy and value in the prediction of this classification are still unclear and no systematic review and meta-analysis have been conducted on this topic. The objective of this study is to investigate the efficacy and value in prediction of the three-grade classification of ISI on the severity of myelopathy and surgical outcomes. Randomized or non-randomized controlled studies using three-grade classification of ISI (grade 0, none; grade 1, light or obscure; and grade 2, intense or bright) in patients with CCM were sought in the following databases: PubMed, Embase, and Cochrane Library. The pooled Japanese Orthopedic Association (JOA)/modified JOA (mJOA) score, neuro-functional recovery rate, C2-C7 lordotic angle, and range of motion (ROM) were calculated. A total of 8 studies containing 1101 patients were included in this review. Patients in grade 0 had the highest preoperative and postoperative JOA/mJOA score and recovery rate, while those parameters for patients in grade 2 were the lowest. Nevertheless, no statistically significant difference was found regarding the preoperative C2-C7 lordotic angle and ROM among three grades. Our meta-analysis suggests that the three-grade classification of ISI on T2-weighted MRI can reflect the severity of myelopathy and surgical outcomes in patients with CCM. The higher ISI grade indicates more severe myelopathy and surgical outcomes. Overall, the three-grade classification of ISI is instructive and should be used universally.
在颈椎压迫性脊髓病（CCM）患者中，广泛使用 T2 加权磁共振成像（MRI）上的信号强度增加（ISI）三级分类。然而，这种分类的疗效和预测价值尚不清楚，也没有对此主题进行系统评价和荟萃分析。本研究的目的是探讨 ISI 三级分类对脊髓病严重程度和手术结果的预测效果和价值。在以下数据库中搜索了使用 ISI 三级分类（0 级，无；1 级，轻度或模糊；2 级，强烈或明亮）的 CCM 患者的随机或非随机对照研究：PubMed、Embase 和 Cochrane Library。计算了汇总的日本骨科协会（JOA）/改良 JOA（mJOA）评分、神经功能恢复率、C2-C7 前凸角和活动范围（ROM）。本综述共纳入 8 项研究，共 1101 例患者。0 级患者的术前和术后 JOA/mJOA 评分和恢复率最高，而 2 级患者的评分和恢复率最低。然而，三组之间术前 C2-C7 前凸角和 ROM 无统计学差异。我们的荟萃分析表明，T2 加权 MRI 上的 ISI 三级分类可以反映 CCM 患者脊髓病的严重程度和手术结果。ISI 等级越高，脊髓病越严重，手术结果越差。总体而言，ISI 三级分类具有指导意义，应普遍使用。
