Severino Rocco, Nouri Aria, Tessitore Enrico
Division of Neurosurgery, IRCCS Neuromed, 86077 Pozzilli (IS), Italy.
Department of Neurosurgery, Hôpitaux Universitaires de Genève (HUG), 1205 Geneva, Switzerland.
J Clin Med. 2020 Mar 11;9(3):759. doi: 10.3390/jcm9030759.
Surgery is the only definitive treatment for degenerative cervical myelopathy (DCM), however, the degree of neurological recovery is often unpredictable. Here, we assess the utility of a multidimensional diagnostic approach, consisting of clinical, neurophysiological, and radiological parameters, to identify patients likely to benefit most from surgery. Thirty-six consecutive patients were prospectively analyzed using the modified Japanese Orthopedic Association (mJOA) score, MEPs/SSEPs and advance and conventional MRI parameters, at baseline, and 3- and 12-month postoperatively. Patients were subdivided into "normal" and "best" responders (<50%, ≥50% improvement in mJOA), and correlation between Diffusion Tensor Imaging (DTI) parameters, mJOA, and MEP/SSEP latencies were examined. Twenty patients were "best" responders and 16 were "normal responders", but there were no statistical differences in age, T2 hyperintensity, and midsagittal diameter between them. There was a significant inverse correlation between the MEPs central conduction time and mJOA in the preoperative period ( = 0.0004), and a positive correlation between fractional anisotropy (FA) and mJOA during all the phases of the study, and statistically significant at 1-year (r = 0.66, = 0.0005). FA was significantly higher amongst "best responders" compared to "normal responders" preoperatively and at 1-year ( = 0.02 and = 0.009). A preoperative FA > 0.55 was predictor of a better postoperative outcome. Overall, these results support the concept of a multidisciplinary approach in the assessment and management of DCM.
手术是退行性颈椎脊髓病（DCM）的唯一确定性治疗方法，然而，神经功能恢复的程度往往难以预测。在此，我们评估一种多维诊断方法的效用，该方法由临床、神经生理学和放射学参数组成，以识别可能从手术中获益最大的患者。对36例连续患者进行前瞻性分析，在基线、术后3个月和12个月时使用改良日本骨科协会（mJOA）评分、运动诱发电位/体感诱发电位（MEPs/SSEPs）以及先进和传统的磁共振成像（MRI）参数。患者被分为“正常”和“最佳”反应者（mJOA改善<50%、≥50%），并检查弥散张量成像（DTI）参数、mJOA和MEP/SSEP潜伏期之间的相关性。20例患者为“最佳”反应者，16例为“正常反应者”，但他们在年龄、T2高信号和矢状径方面无统计学差异。术前运动诱发电位的中枢传导时间与mJOA之间存在显著负相关（=0.0004），在研究的所有阶段，分数各向异性（FA）与mJOA之间存在正相关，在1年时具有统计学意义（r=0.66，=0.0005）。术前和1年时，“最佳反应者”的FA显著高于“正常反应者”（=0.02和=0.009）。术前FA>0.55是术后更好结果的预测指标。总体而言，这些结果支持在DCM的评估和管理中采用多学科方法的理念。
