Department of Orthopaedic Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Boulevard, Changchun, 130033, China.
Department of Orthopaedic Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Boulevard, Changchun, 130033, China.
Spine J. 2022 Dec;22(12):1964-1973. doi: 10.1016/j.spinee.2022.07.097. Epub 2022 Jul 22.
BACKGROUND CONTEXT: High cord signals (HCS) are common in patients undergoing surgery for degenerative cervical myelopathy (DCM). Few studies have investigated the prognostic effects of postoperative HCS changes. PURPOSE: To investigate whether different changes in the postoperative magnetic resonance imaging (MRI) T2-weighted images (T2WIs) signal intensity ratio (SIR) is related to patient outcomes, predictors of unsatisfactory recovery, and the factors associated with changes in postoperative SIR. STUDY DESIGN: A retrospective chart review at a single institution. PATIENT SAMPLE: The study population included all consecutive patients who showed HCS in preoperative MRI T2WIs and underwent double-door laminoplasty for DCM from December 2017 to December 2020. OUTCOME MEASURES: Patient self-reported measures included the Japanese Orthopedic Association (JOA) score, 36-Item Short Form Survey (SF-36) physical component score, and SF-36 mental component score. Imaging measures included SIR, length of HCS, and canal narrowing ratio (CNR). METHODS: We reviewed patient records and analyzed the statistical associations of MRI T2WI measures with the JOA score, SF-36 physical, and mental component scores. RESULTS: Fifty-three patients were categorized into three groups based on the postoperative HCS changes, identified from MRI T2WI before and after surgery: reduced (Group A, N=26); unchanged (Group B, N=12); and increased (Group C, N=15). The neurological recovery rates 12 months after surgery were 67.72%±17.45% in Group A, 51.53%±16.00% in Group B, and 13.35%±21.35% in Group C (p<.001). Significant differences across the three groups were found in symptom duration, postoperative SIR and length of HCS, pre- and postoperative CNR, recovery rate, JOA, SF-36 scores, with patients in Group C having the worst outcomes. Longer DCM symptom duration, greater preoperative CNR, and increased postoperative HCS were prognostic factors for a recovery rate<50%. Preoperative CNR, with an optimal threshold of 57.303%, was an independent risk factor for increased postoperative HCS. CONCLUSIONS: Less than one-third of DCM patients with preoperative HCS exhibited an increase in HCS after double-door laminoplasty and reported worse outcomes at the 12-month follow-up when compared to patients with decreased or unchanged postoperative HCS.
背景：高脊髓信号（HCS）在接受退行性颈椎脊髓病（DCM）手术的患者中很常见。很少有研究调查术后 HCS 变化的预后影响。
目的：研究术后磁共振成像（MRI）T2 加权图像（T2WI）信号强度比（SIR）的不同变化是否与患者结局、恢复不良的预测因素以及与术后 SIR 变化相关的因素有关。
研究设计：单机构回顾性图表审查。
患者样本：研究人群包括所有在术前 MRI T2WI 中出现 HCS 并于 2017 年 12 月至 2020 年 12 月期间因 DCM 接受双开门椎板成形术的连续患者。
结局测量：患者自我报告的测量包括日本矫形协会（JOA）评分、36 项简短健康调查（SF-36）生理成分评分和 SF-36 心理成分评分。影像学测量包括 SIR、HCS 长度和管腔狭窄比（CNR）。
方法：我们回顾了患者记录，并分析了 MRI T2WI 测量值与 JOA 评分、SF-36 生理和心理成分评分的统计学关联。
结果：根据术后 MRI T2WI ，53 名患者被分为三组：减少（A 组，n=26）；不变（B 组，n=12）；和增加（C 组，n=15）。术后 12 个月时的神经恢复率分别为 A 组 67.72%±17.45%，B 组 51.53%±16.00%，C 组 13.35%±21.35%（p<.001）。三组间症状持续时间、术后 SIR 和 HCS 长度、术前和术后 CNR、恢复率、JOA、SF-36 评分均存在显著差异，C 组患者的结局最差。较长的 DCM 症状持续时间、较大的术前 CNR 和术后 HCS 增加是恢复率<50%的预测因素。术前 CNR，最佳阈值为 57.303%，是术后 HCS 增加的独立危险因素。
结论：与术后 HCS 减少或不变的患者相比，术前 HCS 的 DCM 患者中不到三分之一的患者在双开门椎板成形术后出现 HCS 增加，并且在 12 个月随访时报告的结局更差。
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