非创伤性与创伤性脊髓损伤的腰骶部扩大的脊髓病理范围。
Extent of Cord Pathology in the Lumbosacral Enlargement in Non-Traumatic versus Traumatic Spinal Cord Injury.
机构信息
Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
出版信息
J Neurotrauma. 2022 May;39(9-10):639-650. doi: 10.1089/neu.2021.0389. Epub 2022 Feb 8.
This study compares remote neurodegenerative changes caudal to a cervical injury in degenerative cervical myelopathy (DCM; i.e., non-traumatic) and incomplete traumatic spinal cord injury (tSCI) patients, using magnetic resonance imaging (MRI)-based tissue area measurements and diffusion tensor imaging (DTI). Eighteen mild-to-moderate DCM patients with sensory impairments (modified Japanese Orthopedic score: 16.2 ± 1.9), 14 incomplete tetraplegic tSCI patients (American Spinal Injury Association Impairment Scale C and D), and 20 healthy controls were recruited. All participants received DTI and T2*-weighted scans in the lumbosacral enlargement (caudal to injury) and at C2/C3 (rostral to injury). MRI readouts included DTI metrics in the white matter (WM) columns and cross-sectional WM and gray matter area. One-way analysis of variance with Tukey's comparison ( < 0.05) was used to assess group differences. In the lumbosacral enlargement, compared with DCM, tSCI patients exhibited decreased fractional anisotropy in the lateral (tSCI vs. DCM, -11.9%, = 0.007) and ventral WM column (-8.0%, = 0.021), and showed a trend toward lower values in the dorsal column (-8.9%, = 0.068). At C2/C3, compared with controls, fractional anisotropy was lower in both groups in the dorsal (DCM vs. controls, -7.9%, = 0.024; tSCI vs. controls, -10.0%, = 0.007) and in the lateral column (DCM: -6.2%, = 0.039; tSCI: -13.3%, < 0.001), while tSCI patients had lower fractional anisotropy than DCM patients in the lateral column (-7.6%, = 0.029). WM areas were not different between patient groups but were lower compared with controls in the lumbosacral enlargement (DCM: -16.9%, < 0.001; tSCI: -10.5%, = 0.043) and at C2/C3 (DCM: -16.0%, < 0.001; tSCI: -18.1%, < 0.001). In conclusion, mild-to-moderate DCM and incomplete tSCI lead to similar degree of degeneration of the dorsal and lateral columns at C2/C3, but tSCI results in more widespread white matter damage in the lumbosacral enlargement. These remote changes are likely to contribute to the patients' impairment and recovery. DTI is a sensitive tool to assess remote pathological changes in DCM and tSCI patients.
本研究比较了退行性颈椎脊髓病（DCM；即非外伤性）和不完全性外伤性脊髓损伤（tSCI）患者颈椎损伤后尾部的远隔神经退行性改变，使用基于磁共振成像（MRI）的组织面积测量和弥散张量成像（DTI）。招募了 18 名有感觉障碍的轻度至中度 DCM 患者（改良日本矫形评分：16.2±1.9）、14 名不完全性四肢瘫痪 tSCI 患者（美国脊髓损伤协会损伤量表 C 和 D）和 20 名健康对照者。所有参与者均在腰骶部（损伤尾部）和 C2/C3 （损伤头侧）接受 DTI 和 T2*-加权扫描。MRI 读值包括白质（WM）柱的 DTI 指标和横截面积 WM 和灰质面积。使用方差分析（ANOVA）和 Tukey 比较（<0.05）来评估组间差异。在腰骶部，与 DCM 相比，tSCI 患者的外侧（tSCI 与 DCM，-11.9%，=0.007）和腹侧 WM 柱的各向异性分数降低（-8.0%，=0.021），并且背侧 WM 柱的各向异性分数呈下降趋势（-8.9%，=0.068）。在 C2/C3，与对照组相比，两组的背侧（DCM 与对照组，-7.9%，=0.024；tSCI 与对照组，-10.0%，=0.007）和外侧 WM 柱的各向异性分数均降低（DCM：-6.2%，=0.039；tSCI：-13.3%，<0.001），而 tSCI 患者的外侧 WM 柱各向异性分数比 DCM 患者低（-7.6%，=0.029）。与对照组相比，患者组的 WM 面积无差异，但在腰骶部（DCM：-16.9%，<0.001；tSCI：-10.5%，=0.043）和 C2/C3（DCM：-16.0%，<0.001；tSCI：-18.1%，<0.001）均降低。总之，轻度至中度 DCM 和不完全性 tSCI 导致 C2/C3 的背侧和外侧 WM 柱退变程度相似，但 tSCI 导致腰骶部更广泛的 WM 损伤。这些远隔变化可能导致患者的损伤和恢复。DTI 是评估 DCM 和 tSCI 患者远隔性病理改变的敏感工具。
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