Liao Wei-Jie, Sun Bo-Lin, Wu Jia-Bao, Zhang Ning, Zhou Rong-Ping, Huang Shan-Hu, Liu Zhi-Li, Liu Jia-Ming
Department of Orthopaedic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, 330006, PR China.
Institute of Spine and Spinal Cord, Nanchang University, Nanchang, 330006, PR China.
Spinal Cord. 2023 Jun;61(6):323-329. doi: 10.1038/s41393-023-00886-2. Epub 2023 Mar 10.
A retrospective study.
Traumatic cervical spinal cord injury (TSCI) is often associated with disc rupture. It was reported that high signal of disc and anterior longitudinal ligament (ALL) rupture on magnetic resonance imaging (MRI) were the typical signs of ruptured disc. However, for TSCI with no fracture or dislocation, there is still difficult to diagnose disc rupture. The purpose of this study was to investigate the diagnostic efficiency and localization method of different MRI features for cervical disc rupture in patient with TSCI but no any signs of fracture or dislocation.
Affiliated hospital of University in Nanchang, China.
Patients who had TSCI and underwent anterior cervical surgery between June 2016 and December 2021 in our hospital were included. All patients received X-ray, CT scan, and MRI examinations before surgery. MRI findings such as prevertebral hematoma, high-signal SCI, high-signal posterior ligamentous complex (PLC), were recorded. The correlation between preoperative MRI features and intraoperative findings was analyzed. Also, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of these MRI features in diagnosing the disc rupture were calculated.
A total of 140 consecutive patients, 120 males and 20 females with an average age of 53 years were included in this study. Of these patients, 98 (134 cervical discs) were intraoperatively confirmed with cervical disc rupture, but 59.1% (58 patients) of them had no definite evidence of an injured disc on preoperative MRI (high-signal disc or ALL rupture signal). For these patients, the high-signal PLC on preoperative MRI had the highest diagnostic rate for disc rupture based on intraoperative findings, with a sensitivity of 97%, specificity of 72%, PPV of 84% and NPV of 93%. Combined high-signal SCI with high-signal PLC had higher specificity (97%) and PPV (98%), and a lower FPR (3%) and FNR (9%) for the diagnosis of disc rupture. And combination of three MRI features (prevertebral hematoma, high-signal SCI and PLC) had the highest accuracy in diagnosing traumatic disc rupture. For the localization of the ruptured disc, the level of the high-signal SCI had the highest consistency with the segment of the ruptured disc.
MRI features, such as prevertebral hematoma, high-signal SCI and PLC, demonstrated high sensitivities for diagnosing cervical disc rupture. High-signal SCI on preoperative MRI could be used to locate the segment of ruptured disc.
一项回顾性研究。
创伤性颈脊髓损伤（TSCI）常伴有椎间盘破裂。据报道，磁共振成像（MRI）上椎间盘高信号及前纵韧带（ALL）破裂是椎间盘破裂的典型征象。然而，对于无骨折或脱位的TSCI，诊断椎间盘破裂仍有困难。本研究的目的是探讨不同MRI特征对无任何骨折或脱位征象的TSCI患者颈椎间盘破裂的诊断效能及定位方法。
中国南昌某大学附属医院。
纳入2016年6月至2021年12月在我院接受颈前路手术的TSCI患者。所有患者术前均接受X线、CT扫描和MRI检查。记录MRI表现，如椎前血肿、脊髓高信号、后韧带复合体（PLC）高信号等。分析术前MRI特征与术中所见的相关性。同时，计算这些MRI特征诊断椎间盘破裂的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
本研究共纳入140例连续患者，其中男性患者120例，女性患者20例，平均年龄53岁。这些患者中，98例（134个颈椎间盘）术中证实存在颈椎间盘破裂，但其中59.1%（58例）术前MRI（椎间盘高信号或ALL破裂信号）无明确的椎间盘损伤证据。对于这些患者，术前MRI上的PLC高信号基于术中所见对椎间盘破裂的诊断率最高，敏感性为97%，特异性为72%，PPV为84%，NPV为93%。脊髓高信号与PLC高信号联合诊断椎间盘破裂具有更高的特异性（97%）和PPV（98%），以及更低的假阳性率（FPR，3%）和假阴性率（FNR，9%）。三种MRI特征（椎前血肿、脊髓高信号和PLC）联合诊断创伤性椎间盘破裂的准确性最高。对于破裂椎间盘的定位，脊髓高信号的节段与破裂椎间盘的节段一致性最高。
椎前血肿、脊髓高信号和PLC等高信号MRI特征对诊断颈椎间盘破裂具有较高的敏感性。术前MRI上的脊髓高信号可用于定位破裂椎间盘的节段。
