扩散张量成像预测颈椎后路椎管扩大成形术后脊髓功能波动的价值

背景:颈椎后路椎管扩大成形术后脊髓功能波动会影响患者的远期疗效,但关于如何预测术后出现脊髓功能波动的研究较少。目的:探讨扩散张量成像(DTI)预测颈椎后路椎管扩大成形术后脊髓功能波动的价值。方法:前瞻性选择2017年1~12月收治的行颈椎后路椎管扩大成形术的颈椎退行性疾病患者。术前采集患者日本骨科协会(JOA)评分及脊髓压迫最重节段(LMC)与C2椎体后方正常脊髓的DTI参数;术后3个月、1年随访采集患者JOA评分并进行常规MRI扫描。比较术后脊髓功能波动组与无波动组患者术前DTI参数差异,并绘制术前DTI参数预测术后脊髓功能波动的受试者操作特征(ROC)曲线。结果:本研究最终纳入65例患者。术后11例患者(16.9%)发生脊髓功能波动(术后脊髓功能波动组),而54例患者(83.1%)未发生(术后脊髓功能无波动组)。术后脊髓功能波动组患者术前C2椎体后方正常脊髓的轴向扩散系数(AD)值低于无波动组患者,且差异有统计学意义(P<0.05)。ROC曲线显示,C2椎体后方正常脊髓的AD值预测术后脊髓功能波动的阈值为1.4×10^-3 mm^2/s,敏感度为90.0%,特异度为56.9%。结论:AD值能够在术前提示颈椎后路椎管扩大成形术后患者脊髓功能波动。

Value of diffusion tensor imaging in predicting spinal cord function fluctuation after posterior cervical laminoplasty

Background:The occurrence of spinal cord function fluctuation after posterior cervical laminoplasty may affect the long-term efficacy,but there are few of reports on how to predict spinal cord function fluctuation after surgery.Objective:To evaluate the value of diffusion tensor imaging(DTI)in predicting spinal cord function fluctuations after posterior cervical laminoplasty.Methods:The patients with degenerative cervical myelopathy undergoing posterior cervical laminoplasty from January 2017 to December 2017 were prospectively recruited in this study.Japanese Orthopaedic Association(JOA)score was recorded before surgery,3 and 12 months after surgery.Preoperative DTI scans were acquired at the level of maximal compressed(LMC)and C2 non-compressed level.MRI was performed at 3-month and 1-year follow-up.The difference of DTI parameters between patients with and without postoperative spinal cord function fluctuation was compared.The receiver operating characteristic(ROC)curve of preoperative DTI parameters to predict postoperative spinal cord function fluctuation was drawn.Results:A total of 65 patients were included in this study.Postoperative spinal cord function fluctuation occurred in 11 patients(16.9%),but not in the other 54 patients(83.1%).Axial diffusivity(AD)at C2 level in the patients with postoperative spinal cord function fluctuation were significantly lower than that in the patients without fluctuation(P<0.05).ROC curve showed that AD less than 1.4×10^-3 mm^2/s at C2 level was able to predict postoperative spinal cord function fluctuation with sensitivity of being 90.0%and specificity of being 56.9%.Conclusions:Preoperative AD can be able to predict postoperative spi nal cord function fluctuation.