Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA; Department of Medical Sciences, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden.
Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
Neuroimage Clin. 2023;38:103372. doi: 10.1016/j.nicl.2023.103372. Epub 2023 Mar 10.
Cervical spinal cord atrophy occurs after spinal cord injury. The atrophy and how level of injury affects atrophy differs between studies. A systematic review and metaanalysis were done after systematic searches of PubMed, CINAHL, APA PsycInfo and Web of Science. English language original studies analyzing MRI cervical spinal cord cross-sectional area in adults with spinal cord injury were included. Atrophy and correlation between injury level and atrophy were estimated with random-effects models, standardized mean differences, and 95% confidence intervals. 24 studies were identified. 13/24 studies had low risk of bias. Cord atrophy meta-analysis of 18 articles corresponded to a standardized mean difference of -1.48 (95% CI -1.78 to -1.19) with moderate to large interstudy heterogeneity. Logarithmic time since injury influenced heterogeneity. Longitudinal atrophy was best described by a logarithmic model, indicating that rate of spinal atrophy decreases over time. Meta-correlation of eight studies indicated more severe atrophy in more rostral injuries (0.41, 95% CI 0.20-0.59). Larger and preferably longitudinal studies, data sharing, and standardized protocols are warranted.
脊髓损伤后会发生颈椎脊髓萎缩。不同研究中，萎缩的程度以及损伤水平对萎缩的影响存在差异。对 PubMed、CINAHL、APA PsycInfo 和 Web of Science 进行系统检索后，进行了系统评价和荟萃分析。纳入了分析脊髓损伤成年人 MRI 颈椎脊髓横截面积的英文原始研究。使用随机效应模型、标准化均数差和 95%置信区间来估计萎缩和损伤水平与萎缩之间的相关性。确定了 24 项研究。13/24 项研究的偏倚风险较低。18 篇文章的脊髓萎缩荟萃分析的标准化均数差为-1.48（95%CI-1.78 至-1.19），研究间存在中度至高度异质性。对数损伤时间影响了异质性。对数模型最能描述纵向萎缩，表明脊髓萎缩的速度随着时间的推移而降低。8 项研究的荟萃相关性表明，损伤越靠近头部，萎缩越严重（0.41，95%CI0.20-0.59）。需要更大、最好是纵向研究、数据共享和标准化方案。
