Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
Clin Neurol Neurosurg. 2021 Aug;207:106802. doi: 10.1016/j.clineuro.2021.106802. Epub 2021 Jul 8.
A retrospective study of prospectively collected date.
The present study aimed to identify patient characteristics, radiological factors, the neurological status, and postoperative outcomes associated with MRI signal intensity changes in degenerative cervical myelopathy (DCM).
One hundred and fourteen DCM patients who underwent posterior decompression surgeries were enrolled. Pre- and postoperative (12 months) Japanese Orthopedic Association (JOA) scores, cervical alignment and balance on X rays, the cross-sectional area of the spinal cord (CSA) in kinematic CT myelography (CTM). The recovery rate (RR) of the total JOA score and those specific for the upper and lower limb items were evaluated. MRI included T1-weighted imaging (WI) and T2WI. Patients were classified into two groups for a univariate analysis according to the presence or absence of a high signal intensity (HIS) in the sagittal view on T2WI, a low signal intensity (LSI) in the sagittal view on T1WI, the distribution of HSI at a single or multiple levels, and the presence or absence of the snake eye appearance. A multiple logistic regression analysis (MLRA) was performed to identify factors associated with signal intensity changes on MRI.
Ninety-six patients (84.3%) were classified into HIS changes in the sagittal view on T2WI. The group with multilevel HSI showed significantly lower RR specific for the lower extremity JOA score (30.8% vs 47.7%; P = 0.016). The snake eye-positive group showed a significantly inferior RR specific for the upper extremity JOA score (40.1% vs 53.2%; P = 0.04). In MLRA, LSI changes on T1WI revealed small CSAF (P = 0.02, Odds ratio; 0.77, 95%CI:0.61-0.97), while HSI changes on T2WI revealed a small CSAF (P = 0.008, Odds ratio;1.36, 95%CI:1.08-1.72) and large C2-7 angle during extension (P = 0.009, Odds ratio;0.73, 95%CI:0.58-0.92). CSAF correlated with multilevel HSI changes (P = 0.006, Odds ratio;0.78, 95%CI:0.66-0.93). The snake eye appearance correlated with CSAF (P = 0.006, Odds ratio;0.78, 95%CI:0.66-0.93) and the duration of disease (P = 0.05, Odds ratio;1.01, 95%CI:1.0-1.03).
Severe and poorly compensated spinal cord compression during neck flexion may cause signal intensity changes. The snake eye appearance may be useful as a sign of the inferior postoperative recovery of upper limb function, and multilevel HSI as a sign of the inferior postoperative recovery of lower limb function.
前瞻性收集数据的回顾性研究。
本研究旨在确定与退行性颈椎病（DCM）的 MRI 信号强度变化相关的患者特征、影像学因素、神经状态和术后结果。
纳入了 114 例接受后路减压手术的 DCM 患者。评估术前和术后（12 个月）日本骨科协会（JOA）评分、颈椎曲度和 X 线平衡、运动 CT 脊髓造影（CTM）的脊髓横截面积（CSA）。评估总 JOA 评分和上、下肢特定项目的恢复率（RR）。MRI 包括 T1 加权成像（WI）和 T2WI。根据 T2WI 矢状位的高信号强度（HIS）、T1WI 矢状位的低信号强度（LSI）、单个或多个水平的 HIS 分布以及是否存在蛇眼外观，将患者分为两组进行单变量分析。采用多变量逻辑回归分析（MLRA）确定与 MRI 信号强度变化相关的因素。
96 例（84.3%）患者 T2WI 矢状位出现 HIS 改变。多节段 HIS 组下肢 JOA 评分的 RR 明显较低（30.8%比 47.7%；P=0.016）。蛇眼阳性组上肢 JOA 评分的 RR 明显较低（40.1%比 53.2%；P=0.04）。在 MLRA 中，T1WI 的 LSI 改变显示 CSAF 较小（P=0.02，比值比；0.77，95%CI：0.61-0.97），而 T2WI 的 HIS 改变显示 CSAF 较小（P=0.008，比值比；1.36，95%CI：1.08-1.72）和伸展时 C2-7 角较大（P=0.009，比值比；0.73，95%CI：0.58-0.92）。CSA 与多节段 HIS 改变相关（P=0.006，比值比；0.78，95%CI：0.66-0.93）。蛇眼外观与 CSAF 相关（P=0.006，比值比；0.78，95%CI：0.66-0.93）和疾病持续时间相关（P=0.05，比值比；1.01，95%CI：1.0-1.03）。
颈椎伸展时严重且代偿不良的脊髓压迫可能导致信号强度变化。蛇眼外观可能是上肢功能术后恢复不良的有用标志，多节段 HIS 是下肢功能术后恢复不良的标志。
