Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Bone Joint J. 2020 Sep;102-B(9):1210-1218. doi: 10.1302/0301-620X.102B9.BJJ-2020-0468.R1.
The aim of this study was to use diffusion tensor imaging (DTI) to investigate changes in diffusion metrics in patients with cervical spondylotic myelopathy (CSM) up to five years after decompressive surgery. We correlated these changes with clinical outcomes as scored by the Modified Japanese Orthopedic Association (mJOA) method, Neck Disability Index (NDI), and Visual Analogue Scale (VAS).
We used multi-shot, high-resolution, diffusion tensor imaging (ms-DTI) in patients with cervical spondylotic myelopathy (CSM) to investigate the change in diffusion metrics and clinical outcomes up to five years after anterior cervical interbody discectomy and fusion (ACDF). High signal intensity was identified on T2-weighted imaging, along with DTI metrics such as fractional anisotropy (FA). MJOA, NDI, and VAS scores were also collected and compared at each follow-up point. Spearman correlations identified correspondence between FA and clinical outcome scores.
Significant differences in mJOA scores and FA values were found between preoperative and postoperative timepoints up to two years after surgery. FA at the level of maximum cord compression (MCL) preoperatively was significantly correlated with the preoperative mJOA score. FA postoperatively was also significantly correlated with the postoperative mJOA score. There was no statistical relationship between NDI and mJOA or VAS.
ms-DTI can detect microstructural changes in affected cord segments and reflect functional improvement. Both FA values and mJOA scores showed maximum recovery two years after surgery. The DTI metrics are significantly associated with pre- and postoperative mJOA scores. DTI metrics are a more sensitive, timely, and quantifiable surrogate for evaluating patients with CSM and a potential quantifiable biomarker for spinal cord dysfunction. Cite this article: 2020;102-B(9):1210-1218.
本研究旨在使用弥散张量成像（DTI）来研究颈椎脊髓病（CSM）患者减压手术后五年内弥散指标的变化。我们将这些变化与改良日本骨科协会（mJOA）评分、颈部残疾指数（NDI）和视觉模拟评分（VAS）的临床结果相关联。
我们使用多-shot、高分辨率弥散张量成像（ms-DTI）对颈椎脊髓病（CSM）患者进行研究，以探讨前路颈椎椎体间融合术（ACDF）后 5 年内弥散指标的变化与临床结果的关系。在 T2 加权成像上识别出高信号强度，以及弥散张量成像指标如各向异性分数（FA）。还收集了 mJOA、NDI 和 VAS 评分，并在每个随访点进行比较。Spearman 相关分析确定了 FA 与临床结果评分之间的对应关系。
在手术后两年内，mJOA 评分和 FA 值在术前和术后时间点之间存在显著差异。术前最大脊髓压迫（MCL）水平的 FA 值与术前 mJOA 评分显著相关。术后 FA 值与术后 mJOA 评分也显著相关。NDI 与 mJOA 或 VAS 之间没有统计学关系。
ms-DTI 可以检测受影响脊髓节段的微观结构变化，并反映功能改善。FA 值和 mJOA 评分在手术后两年达到最大恢复。DTI 指标与术前和术后 mJOA 评分显著相关。DTI 指标是评估 CSM 患者的一种更敏感、及时和量化的替代方法，也是脊髓功能障碍的潜在量化生物标志物。
