Orthopaedic Department, Peking University Third Hospital, Beijing, China.
Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Beijing, China.
BMC Musculoskelet Disord. 2024 Jun 6;25(1):445. doi: 10.1186/s12891-024-07554-3.
T2-weighted increased signal intensity (ISI) is commonly recognized as a sign of more severe spinal cord lesions, usually accompanied by worse neurological deficits and possibly worse postoperative neurological recovery. The combined approach could achieve better decompression and better neurological recovery for multilevel degenerative cervical myelopathy (MDCM). The choice of surgical approach for MDCM with intramedullary T2-weighted ISI remains disputed. This study aimed to compare the neurological outcomes of posterior and one-stage combined posteroanterior approaches for MDCM with T2-weighted ISI.
A total of 83 consecutive MDCM patients with confirmed ISI with at least three intervertebral segments operated between 2012 and 2014 were retrospectively enrolled. Preoperative demographic, radiological and clinical condition variables were collected, and neurological conditions were evaluated by the Japanese Orthopedic Assessment score (JOA) and Neck Disability Index (NDI). Propensity score matching analysis was conducted to produce pairs of patients with comparable preoperative conditions from the posterior-alone and combined groups. Both short-term and mid-term surgical outcomes were evaluated, including the JOA recovery rate (JOARR), NDI improvements, complications, and reoperations.
A total of 83 patients were enrolled, of which 38 and 45 patients underwent posterior surgery alone and one-stage posteroanterior surgery, respectively. After propensity score matching, 38 pairs of comparable patients from the posterior and combined groups were matched. The matched groups presented similar preoperative clinical and radiological features and the mean follow-up duration were 111.6 ± 8.9 months. The preoperative JOA scores of the posterior and combined groups were 11.5 ± 2.2 and 11.1 ± 2.3, respectively (p = 0.613). The combined group presented with prolonged surgery duration(108.8 ± 28.0 and 186.1 ± 47.3 min, p = 0.028) and greater blood loss(276.3 ± 139.1 and 382.1 ± 283.1 ml, p<0.001). At short-term follow-up, the combined group presented a higher JOARR than the posterior group (posterior group: 50.7%±46.6%, combined group: 70.4%±20.3%, p = 0.024), while no significant difference in JOARR was observed between the groups at long-term follow-up (posterior group: 49.2%±48.5%, combined group: 59.6%±47.6%, p = 0.136). No significant difference was found in the overall complication and reoperation rates.
For MDCM patients with ISI, both posterior and one-stage posteroanterior approaches could achieve considerable neurological alleviations in short-term and long-term follow-up. With greater surgical trauma, the combined group presented better short-term JOARR but did not show higher efficacy in long-term neurological function preservation in patients with comparable preoperative conditions.
T2 加权高信号强度（ISI）通常被认为是脊髓病变更严重的标志，通常伴有更严重的神经功能缺损，可能导致术后神经功能恢复更差。对于多节段退行性颈脊髓病（MDCM），联合入路可实现更好的减压和更好的神经功能恢复。对于伴有 T2 加权 ISI 的 MDCM 患者，选择手术入路仍存在争议。本研究旨在比较后路和一期前后联合入路治疗 T2 加权 ISI 的 MDCM 的神经功能预后。
回顾性纳入 2012 年至 2014 年间接受至少三个节段脊髓病变手术的 83 例 MDCM 患者，所有患者均经证实存在 ISI。收集术前人口统计学、影像学和临床状况变量，并采用日本骨科评估评分（JOA）和颈部残疾指数（NDI）评估神经状况。采用倾向评分匹配分析，从后路单独组和联合组中产生具有可比性的术前条件的配对患者。评估短期和中期手术结果，包括 JOA 恢复率（JOARR）、NDI 改善、并发症和再次手术。
共纳入 83 例患者，其中 38 例和 45 例分别接受后路单独手术和一期前后联合手术。在进行倾向评分匹配后，从后路和联合组中匹配了 38 对可比患者。匹配组的术前临床和影像学特征相似，平均随访时间为 111.6±8.9 个月。后路和联合组的术前 JOA 评分分别为 11.5±2.2 和 11.1±2.3（p=0.613）。联合组手术时间较长（108.8±28.0 和 186.1±47.3 min，p=0.028），失血量较多（276.3±139.1 和 382.1±283.1 ml，p<0.001）。短期随访时，联合组的 JOARR 高于后路组（后路组：50.7%±46.6%，联合组：70.4%±20.3%，p=0.024），但两组在长期随访时的 JOARR 无显著差异（后路组：49.2%±48.5%，联合组：59.6%±47.6%，p=0.136）。两组总体并发症和再次手术率无显著差异。
对于伴有 ISI 的 MDCM 患者，后路和一期前后联合入路均可在短期和长期随访中获得显著的神经缓解。联合组手术创伤较大，短期 JOARR 较好，但在术前状况可比的患者中，长期神经功能保存方面的疗效并不更高。
