Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China.
Department of Radiology, Peking University Third Hospital, Beijing, People's Republic of China.
BMC Musculoskelet Disord. 2020 Feb 7;21(1):83. doi: 10.1186/s12891-020-3106-y.
BACKGROUND: Cervical spondylotic myelopathy (CSM) is the most severe type of cervical spondylosis and the most common cause of spinal cord dysfunction among adults over 55 years old. MRI plays an important role in the diagnosis and evaluation of CSM, which can directly demonstrate the correlation between disc, spinal cord, posterior structures and abnormal signal in spinal cord. Static MRI can only show the static and neutral position of spinal cord, which is not enough to understand the pathogenesis of CSM. Dynamic MRI demonstrating the extension and flexion position of spinal cord can be a better tool for the treatment of CSM, especially the surgical decision making. METHOD: A total of 180 CSM patients who have indications for surgery will be recruited in outpatient of Peking University Third Hospital and assigned to three groups (Group A, B and C) based on their static MRI after consent. Group A (incomplete dura compression) means the signal of cerebral spinal fluid (CSF) is still visible. Group B (complete dura compression) means no CSF signal and no shape change of spinal cord. Group C (spinal cord compression) means shape change of spinal cord. Two surgical plans will be made for each participant by one professional surgeon according to the static MRI and dynamic MRI respectively and we will randomly choose one to perform via a random number system. Follow-up will be maintained at 3, 6, and 12 months after surgery through outpatient or telephone interview, including mJOA score, 10-s G&R (grip and release) and 10-s step test, SF-36 score, radiographic examination and complications. Finally, data collection and statistical analysis will be finished by researchers who are blinded to recruitment and treatment. DISCUSSION: This study will help us to explore the indication of dynamic MRI and the value of dynamic MRI in the treatment of CSM, especially the surgical decision making. Dynamic MRI can be a useful tool in the treatment of CSM patients. TRIAL REGISTRATION: ChiCTR1900023014. Registered on May 7th, 2019.
背景：颈椎脊髓病（CSM）是最严重的颈椎病类型，也是 55 岁以上成年人脊髓功能障碍最常见的原因。MRI 在 CSM 的诊断和评估中发挥着重要作用，它可以直接显示椎间盘、脊髓、后结构与脊髓异常信号之间的相关性。静态 MRI 只能显示脊髓的静态和中立位置，不足以了解 CSM 的发病机制。显示脊髓伸展和弯曲位置的动态 MRI 可以成为治疗 CSM 的更好工具，特别是在手术决策方面。
方法：共招募 180 例有手术指征的 CSM 患者，经门诊同意后，根据静态 MRI 将其分为三组（A、B 和 C 组）。A 组（不完全硬脊膜压迫）表示脑脊液（CSF）信号仍可见。B 组（完全硬脊膜压迫）表示无 CSF 信号，脊髓形状无变化。C 组（脊髓压迫）表示脊髓形状改变。每位参与者由一位专业外科医生根据静态 MRI 和动态 MRI 分别制定两种手术方案，然后通过随机数字系统随机选择一种进行手术。通过门诊或电话访谈，在术后 3、6 和 12 个月对患者进行随访，包括 mJOA 评分、10 秒握力和释放（G&R）以及 10 秒步距测试、SF-36 评分、影像学检查和并发症。最后，由对招募和治疗均不知情的研究人员完成数据收集和统计分析。
讨论：本研究将有助于我们探讨动态 MRI 的适应证及动态 MRI 在 CSM 治疗中的价值，特别是在手术决策方面。动态 MRI 可以成为 CSM 患者治疗的有用工具。
试验注册：ChiCTR1900023014。注册于 2019 年 5 月 7 日。
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