Yin Li-Qiang, Zhang Jian, Wu Yong-Gui, Li Jin-Hui, Yang Qing
Second Department of Orthopedics, Jincheng People's Hospital, Jincheng City, Shanxi Province, China.
Medicine (Baltimore). 2020 Dec 4;99(49):e23098. doi: 10.1097/MD.0000000000023098.
To investigate the risk factors for progression of increased signal intensity (ISI) on T2W magnetic resonance imaging (MRI) and its prognostic value in patients with cervical spondylotic myelopathy (CSM).A total of 109 patients with CSM were included in this study. All the patients were treated with anterior cervical discectomy and fusion. MRI was performed for all 109 patients preoperatively and at the final follow-up. Radiological evaluation included ISI, anterior compression (AC) of dural and spinal cord, hyperintensity region (HR) at the involved level. Clinical data including Japanese Orthopedic Association (JOA) score, Neck Disability Index (NDI) score, and Visual Analogue Scale were collected and evaluated. Patients were divided into 2 groups according to ISI grades (Group A: no hyper-intensity; Group B: presence of ISI). Then all patients presented with ISI were divided into 2 subgroups based on the range of HR (Group B1: hyper-intensity diameter accounts for less than half of the spinal cord diameter at the involved level; Group B2, hyper-intensity diameter accounts for more than half of the spinal cord diameter at the involved level). AC, disease duration, age, and gender were analyzed as potential risk factors.Significantly better JOA and NDI scores were observed in Group A preoperatively and at the final follow-up, compared to Group B (P < .05). Disease duration was found significantly longer in patients with ISI (P < .05). Notably better JOA and NDI scores were noticed in Group B1 rather than Group B2 (P < .05). Logistical regression showed that disease duration was the only factor that significantly correlated with the progress of ISI (P < .001).CSM patients with ISI on T2W MR images had poorer surgical outcomes compared to others, while the increased range of HR may deteriorate preoperative neurological function. Moreover, patients with longer disease duration had greater risk of ISI in spinal cord.
探讨颈椎脊髓病（CSM）患者T2加权磁共振成像（MRI）上信号强度增加（ISI）进展的危险因素及其预后价值。本研究共纳入109例CSM患者。所有患者均接受颈椎前路椎间盘切除融合术。对109例患者术前及末次随访时均进行了MRI检查。影像学评估包括ISI、硬脊膜和脊髓的前方压迫（AC）、受累节段的高信号区域（HR）。收集并评估包括日本骨科协会（JOA）评分、颈部功能障碍指数（NDI）评分和视觉模拟量表在内的临床数据。根据ISI分级将患者分为2组（A组：无高信号；B组：存在ISI）。然后将所有出现ISI的患者根据HR范围分为2个亚组（B1组：高信号直径占受累节段脊髓直径的不到一半；B2组，高信号直径占受累节段脊髓直径的一半以上）。将AC、病程、年龄和性别作为潜在危险因素进行分析。与B组相比，A组术前及末次随访时JOA和NDI评分明显更好（P<0.05）。发现ISI患者的病程明显更长（P<0.05）。值得注意的是，B1组的JOA和NDI评分比B2组更好（P<0.05）。逻辑回归显示病程是与ISI进展显著相关的唯一因素（P<0.001）。与其他患者相比，T2加权MR图像上有ISI的CSM患者手术效果较差，而HR增加的范围可能会使术前神经功能恶化。此外，病程较长的患者脊髓发生ISI的风险更大。
