Han C F, Hai Y, Liu Y Z, Zhang X N, Pan A X, Ding H T, Zhang H W, Li Y, Guan L
Orthopedic Department, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Zhonghua Yi Xue Za Zhi. 2021 Nov 23;101(43):3594-3599. doi: 10.3760/cma.j.cn112137-20210429-01030.
To analyze the correlation between the parameters of diffusion tensor imaging (DTI) and the clinical function scores before and 5 years after anterior cervical discectomy and fusion (ACDF) by measuring the DTI signal of the maximum compression level (MCL) of the cervical spinal cord in patients with cervical spondylotic myelopathy (CSM). A prospective study was conducted and clinical data of 37 patients with CSM treated by ACDF in Beijing Chaoyang Hospital from February 2014 to February 2020 were analyzed. The MCL was studied with diffusion tensor imaging (DTI) of MRI. The changes of diffusion indexes (fractional anisotropy (FA)), and clinical function score including Modified Japanese Orthopedic Association (mJOA), neck disability index (NDI) and visual analog scale (VAS) of pain were compared among each follow-up point. The FA value and clinical function score were collected and the data was analyzed to determine whether the high signal intensity could be observed in T-weighted imaging (TWI) at each follow-up point. The changes of preoperative and postoperative data were compared, and the correlation between FA value and other two clinical function score were analyzed at each follow-up point. There were 14 males and 23 females with a mean age of (55±10) years in this study. All patients received the surgery and the medullary symptoms improved significantly postoperatively. After 3 months, the mJOA and FA value were improved by 2.62±1.41 and 0.14±0.11 on average, respectively (both <0.05); and there were significant differences in these two indexes between each follow-up point in two years after the operation (all <0.05). At the MCL, there were strong correlations between the FA value and mJOA score pre-and postoperatively (=0.770, 0.729, both <0.01). There was no significant correlation between mJOA, NDI and VAS (both >0.05). The DTI sensitively reflects the improvement of spinal cord function and can be used as an important tool to predict and evaluate the state of spinal cord dysfunction in patients with CSM.
通过测量脊髓型颈椎病（CSM）患者颈髓最大受压水平（MCL）的扩散张量成像（DTI）信号，分析颈椎前路椎间盘切除融合术（ACDF）术前及术后5年DTI参数与临床功能评分之间的相关性。进行了一项前瞻性研究，分析了2014年2月至2020年2月在北京朝阳医院接受ACDF治疗的37例CSM患者的临床资料。采用MRI的扩散张量成像（DTI）对MCL进行研究。比较各随访点扩散指数（分数各向异性（FA））的变化以及包括改良日本骨科协会（mJOA）、颈部残疾指数（NDI）和疼痛视觉模拟量表（VAS）在内的临床功能评分。收集FA值和临床功能评分并进行数据分析，以确定在各随访点的T加权成像（TWI）中是否能观察到高信号强度。比较术前和术后数据的变化，并分析各随访点FA值与其他两项临床功能评分之间的相关性。本研究共纳入14例男性和23例女性，平均年龄（55±10）岁。所有患者均接受了手术，术后髓性症状明显改善。术后3个月，mJOA和FA值平均分别提高了2.62±1.41和0.14±0.11（均P<0.05）；术后两年各随访点这两项指标均有显著差异（均P<0.05）。在MCL处，术前和术后FA值与mJOA评分之间均存在强相关性（r=0.770、0.729，均P<0.01）。mJOA、NDI和VAS之间无显著相关性（均P>0.05）。DTI能敏感地反映脊髓功能的改善，可作为预测和评估CSM患者脊髓功能障碍状态的重要工具。
