脊髓型颈椎病动态脊髓受压变化与疾病严重程度及预后的关系

目的 探讨MRI检查中过伸位与过屈位脊髓矢状径变化幅度与脊髓型颈椎病临床严重程度及预后之间的关系.方法 2006年2月至2008年11月,共53例颈椎病患者术前行高分辨率1.5 TMR中立位及过伸过屈位成像并量化脊髓T2信号强度值,所有患者随访时间11个月～3年,平均14.6个月.分别记录患者年龄、性别、病程、病变脊髓信号强度、颈椎活动度等不同指标.将患者按动态脊髓受压程度分为两组,分析两组间各观察指标的差异.并运用统计学相关性分析方法检验动态脊髓受压幅度与术前JOA评分及改善率的关系.结果 所有患者术前JOA评分为(9.2±2.5),末次随访为(13.8±2.8),末次随访改善率为(57.02±16.23)%.经两样本t检验,两组患者年龄、改善率差异无统计学意义;高动态受压变化组患者在颈椎活动度、脊髓T2信号强度方面高于低动态受压变化组,在术前JOA评分及病程方面小于低动态受压变化组.改善率、术前JOA评分与动态脊髓受压幅度的相关系数分别为0.07、P=0.643及-0.27、P=0.04.结论 在病程较短的前提下,脊髓神经动态受压变化的程度与脊髓型颈椎病的临床病情严重程度有一定相关关系,而与颈椎病预后的关系不密切.

Relationship of dynamic cord impingement with disease severity and prognosis in cervical spondilotic myelopathy

Objective To investigate the relationship of dynamic cord impingement of sagittal diameter on flexion-extension cervical magnetic resonance(MR)imaging with disease severity and prognosis in cervical spondilotic myelopathy. Methods A total of 53 patients with cervical degenerative disease were evaluated with regards to the dynamic cord changes of sagittal diameter at neutral and flexion-extension 1.5 T MR imaging from February 2006 to November 2008.The mean follow-up period was 14.6(11-36)months. The factors of age, sex, duration of disease, cervical range of motion and cord signal intensity were considered. The patients were divided into two groups according to the extent of dynamic cord changes of sagittal diameter on MRI(groups of high and low dynamic cord changes).Statistical analyses were performed with SPSS 13.0.Results The preoperative JOA scores were 9.17±2.45 and 13.76±2.81respectively with a recovery rate of 57.02%±16.23% at the final follow-up. There was no significant difference between the two groups in terms of recovery rate and age. The cervical range of motion and cord signal intensity in group of high dynamic cord changes were higher than those in group of low dynamic cord changes. The preoperative JOA score and duration of disease were lower than those in group of low dynamic cord changes. According to linear regression test between the recovery rate, the preoperative JOA score and the extent of dynamic cord changes, the correlation coefficient were 0.07(P=0.643)and-0.27(P=0.04)respectively. Conclusion With the precondition of a short disease duration in cervical spondilotic myelopathy, the extent of dynamic cord changes is correlated with disease severity but shows no relationship with prognosis.