Zhang Justin K, Javeed Saad, Greenberg Jacob K, Yakdan Salim, Kaleem Muhammad I, Botterbush Kathleen S, Benedict Braeden, Dibble Christopher F, Sun Peng, Sherrod Brandon, Dailey Andrew T, Bisson Erica F, Mahan Mark, Mazur Marcus, Song Sheng-Kwei, Ray Wilson Z
Department of Neurological Surgery, Washington University School of Medicine, Saint Louis , Missouri , USA.
Department of Neurological Surgery, University of Utah, Salt Lake City , Utah , USA.
Neurosurgery. 2025 Jan 1;96(1):69-77. doi: 10.1227/neu.0000000000003037. Epub 2024 Jun 21.
BACKGROUND AND OBJECTIVES: Advanced diffusion-weighted MRI (DWI) modeling, such as diffusion tensor imaging (DTI) and diffusion basis spectrum imaging (DBSI), may help guide rehabilitation strategies after surgical decompression for cervical spondylotic myelopathy (CSM). Currently, however, postoperative DWI is difficult to interpret, owing to signal distortions from spinal instrumentation. Therefore, we examined the relationship between postoperative DTI/DBSI-extracted from the rostral C3 spinal level-and clinical outcome measures at 2-year follow-up after decompressive surgery for CSM. METHODS: Fifty patients with CSM underwent complete clinical and DWI evaluation-followed by DTI/DBSI analysis-at baseline and 2-year follow-up. Clinical outcomes included the modified Japanese Orthopedic Association score and comprehensive patient-reported outcomes. DTI metrics included apparent diffusion coefficient, fractional anisotropy, axial diffusivity, and radial diffusivity. DBSI metrics evaluated white matter tracts through fractional anisotropy, fiber fraction, axial diffusivity, and radial diffusivity as well as extra-axonal pathology through restricted and nonrestricted fraction. Cross-sectional Spearman's correlations were used to compare postoperative DTI/DBSI metrics with clinical outcomes. RESULTS: Twenty-seven patients with CSM, including 15, 7, and 5 with mild, moderate, and severe disease, respectively, possessed complete baseline and postoperative DWI scans. At 2-year follow-up, there were 10 significant correlations among postoperative DBSI metrics and postoperative clinical outcomes compared with 3 among postoperative DTI metrics. Of the 13 significant correlations, 7 involved the neck disability index (NDI). The strongest relationships were between DBSI axial diffusivity and NDI (r = 0.60, P < .001), DBSI fiber fraction and NDI (r s = -0.58, P < .001), and DBSI restricted fraction and NDI (r s = 0.56, P < .001). The weakest correlation was between DTI apparent diffusion coefficient and NDI (r = 0.35, P = .02). CONCLUSION: Quantitative measures of spinal cord microstructure after surgery correlate with postoperative neurofunctional status, quality of life, and pain/disability at 2 years after decompressive surgery for CSM. In particular, DBSI metrics may serve as meaningful biomarkers for postoperative disease severity for patients with CSM.
背景与目的：先进的扩散加权磁共振成像（DWI）模型，如扩散张量成像（DTI）和扩散基谱成像（DBSI），可能有助于指导脊髓型颈椎病（CSM）手术减压后的康复策略。然而，目前术后DWI由于脊柱内固定装置导致的信号失真而难以解释。因此，我们研究了在CSM减压手术后2年随访时，从C3脊髓头端水平提取的术后DTI/DBSI与临床结局指标之间的关系。 方法：50例CSM患者在基线和2年随访时接受了完整的临床和DWI评估，随后进行DTI/DBSI分析。临床结局包括改良日本骨科协会评分和患者报告的综合结局。DTI指标包括表观扩散系数、各向异性分数、轴向扩散率和径向扩散率。DBSI指标通过各向异性分数、纤维分数、轴向扩散率和径向扩散率评估白质束，以及通过受限分数和非受限分数评估轴外病变。采用横断面Spearman相关性分析比较术后DTI/DBSI指标与临床结局。 结果：27例CSM患者，包括15例、7例和5例分别患有轻度、中度和重度疾病的患者，拥有完整的基线和术后DWI扫描。在2年随访时，术后DBSI指标与术后临床结局之间有10个显著相关性，而术后DTI指标之间有3个显著相关性。在这13个显著相关性中，7个涉及颈部残疾指数（NDI）。最强的关系是DBSI轴向扩散率与NDI之间（r = 0.60，P <.001）、DBSI纤维分数与NDI之间（r s = -0.58，P <.001）以及DBSI受限分数与NDI之间（r s = 0.56，P <.001）。最弱的相关性是DTI表观扩散系数与NDI之间（r = 0.35，P =.02）。 结论：CSM减压手术后2年，脊髓微观结构的定量测量与术后神经功能状态、生活质量以及疼痛/残疾相关。特别是，DBSI指标可能作为CSM患者术后疾病严重程度的有意义生物标志物。
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