Scalia Gianluca, Costanzo Roberta, Brunasso Lara, Garufi Giada, Bonosi Lapo, Ricciardo Giuseppe, Graziano Francesca, Nicoletti Giovanni Federico, Cardali Salvatore Massimiliano, Iacopino Domenico Gerardo, Maugeri Rosario, Umana Giuseppe Emmanuele
Neurosurgery Unit, Head and Neck Surgery Department, Garibaldi Hospital, 95123 Catania, Italy.
Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy.
Brain Sci. 2023 Feb 10;13(2):301. doi: 10.3390/brainsci13020301.
(1) Background: The "snake-eyes" sign represents a unique finding characterized by bilateral hyperintense symmetric, circular, or ovoid foci on T2-weighted MRI sequences in the anterior horn cells of the spinal cord. There are conflicting opinions as some authors affirm that it does not affect the prognosis of cervical myelopathy while other papers emphasize the opposite, stating how the "snake-eyes" sign constitutes an irreversible lesion and a predictor of poor prognosis. This systematic review evaluates the correlation between the "snake-eyes" sign and the prognosis of cervical myelopathy after surgery including anterior and/or posterior approaches; (2) Methods: A systematic literature review was conducted following the PRISMA statement and a total of seven papers were included; (3) Results: A total of 419 patients were evaluated, with a mean age of 55.72 ± 14.38 years. After surgery, 26.01% of patients experienced a significant clinical improvement, while in 61.81%, there was no significant improvement. In particular, 144 of 196 patients (73.5%) treated through an anterior approach and 114 of 223 (51.1%) that underwent a posterior approach, did not present a significant improvement. Furthermore, in 12.17% of patients, the postoperative outcome was not reported, leading to a high risk of bias in the assessment of the prognostic significance of the "snake-eyes" appearance; (4) Conclusions: The "snake-eyes" sign is usually considered as an unfavorable predictive marker for myelopathic surgical patients, but the pathophysiology is still unclear, and the results have not yet reached unified levels of evidence.
（1）背景：“蛇眼”征是一种独特的表现，其特征为脊髓前角细胞在T2加权磁共振成像（MRI）序列上出现双侧对称的高信号圆形或椭圆形病灶。目前存在相互矛盾的观点，一些作者认为它不影响颈椎病的预后，而其他论文则持相反观点，指出“蛇眼”征是一种不可逆的病变，是预后不良的预测指标。本系统评价评估了“蛇眼”征与手术（包括前路和/或后路）治疗颈椎病预后之间的相关性；（2）方法：按照PRISMA声明进行系统的文献综述，共纳入7篇论文；（3）结果：共评估了419例患者，平均年龄为55.72±14.38岁。术后，26.01%的患者临床症状显著改善，而61.81%的患者无显著改善。特别是，196例接受前路手术的患者中有144例（73.5%）和223例接受后路手术的患者中有114例（51.1%）没有显著改善。此外，12.17%的患者未报告术后结果，这导致在评估“蛇眼”外观的预后意义时存在较高的偏倚风险；（4）结论：“蛇眼”征通常被认为是脊髓病手术患者预后不良的预测指标，但病理生理学仍不清楚，结果尚未达到统一的证据水平。
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