Medical School of Nankai University, No. 94, Weijin Road, Naikai District, 300071 Tianjin, People's Republic of China; Department of Neurosurgery, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing 100853, People's Republic of China.
Medical School of Nankai University, No. 94, Weijin Road, Naikai District, 300071 Tianjin, People's Republic of China; Department of Neurosurgery, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing 100853, People's Republic of China.
J Clin Neurosci. 2021 Aug;90:171-177. doi: 10.1016/j.jocn.2021.05.034. Epub 2021 Jun 10.
Cervical and thoracic or lumbar intramedullary spinal cavernous malformations (ISCMs) may behave differently. We conducted this retrospective study by using data from adult ISCMs to compare their natural histories and explore prognostic factors for improved clinical outcomes. Neurological functions were assessed by using the Modified McCormick Scale (MMCS) and Aminoff-Logue Disability Scale. A total of 111 study-eligible adult patients were included in this study. Patients with cervical ISCMs mostly demonstrated a shorter duration of symptoms (P = 0.026), an acute onset pattern with some recovery (P = 0.026), and a larger lesion size (P = 0.033) than their thoracic or lumbar counterparts. Thoracic or lumbar lesions had a higher proportion of motor symptoms (P = 0.001) and sphincter problems (P = 0.005), and they were usually associated with an aggressive clinical course (P = 0.001, OR = 9.491, 95% CI = 2.555-35.262) in multivariate analysis. There was no difference in age, sex distribution, hemorrhage risk between the cervical and thoracic-lumbar groups. A better preoperative neurological status (P = 0.034, OR = 2.768, 95% CI = 1.081-7.177) and improvement immediately after surgery (P < 0.001, OR = 8.756, 95% CI = 4.837-72.731) were identified as indicators for long-term improvement by multivariate analysis. Cervical lesions had a high proportion for long-term improvement, but it was not a predictor for improvement in multivariate analysis. ISCMs in the thoracic or lumbar location should be considered for surgical removal more aggressively than those in the cervical location. Surgical removal of symptomatic ISCMs can avoid further neurological deterioration and usually result in satisfactory long-term outcomes.
颈椎和胸腰椎髓内海绵状血管畸形（ISCM）的表现可能不同。我们对成人 ISCM 数据进行了回顾性研究，以比较其自然病史并探讨改善临床结局的预后因素。神经功能采用改良 McCormick 量表（MMCS）和 Aminoff-Logue 残疾量表进行评估。共有 111 例符合研究条件的成年患者纳入本研究。颈椎 ISCM 患者的症状持续时间较短（P=0.026），发病模式多为急性发作伴部分恢复（P=0.026），病变体积较大（P=0.033）。胸椎或腰椎病变中运动症状（P=0.001）和括约肌问题（P=0.005）比例较高，且多呈侵袭性临床病程（P=0.001，OR=9.491，95%CI=2.555-35.262）。多因素分析显示，两组间在年龄、性别分布、出血风险方面无差异。术前神经功能较好（P=0.034，OR=2.768，95%CI=1.081-7.177）和术后即刻改善明显（P<0.001，OR=8.756，95%CI=4.837-72.731）是长期改善的独立预后因素。颈椎病变长期改善比例较高，但多因素分析未将其作为改善的预测因素。与颈椎位置相比，胸腰椎位置的 ISCM 更应积极考虑手术切除。手术切除症状性 ISCM 可避免进一步神经恶化，通常可获得满意的长期预后。
