Prognostic relevance of the postoperative evolution of intramedullary spinal cord changes in signal intensity on magnetic resonance imaging after anterior decompression for cervical spondylotic myelopathy

OBJECT: Areas of intramedullary signal intensity changes (hypointensity on T1-weighted magnetic resonance [MR] images and hyperintensity on T2-weighted MR images) in patients with cervical spondylotic myelopathy (CSM) have been described by several investigators. The role of postoperative evolution of these alterations is still not well known. METHODS: A total of 47 patients underwent MR imaging before and at the end of the surgical procedure (intraoperative MR imaging [iMRI]) for cervical spine decompression and fusion using an anterior approach. Imaging was performed with a 1.5-tesla scanner integrated with the operative room (BrainSuite). Patients were followed clinically and evaluated using the Japanese Orthopaedic Association (JOA) and Nurick scales and also underwent MR imaging 3 and 6 months after surgery. RESULTS: Preoperative MR imaging showed an alteration (from the normal) of the intramedullary signal in 37 (78.7%) of 47 cases. In 23 cases, signal changes were altered on both T1- and T2-weighted images, and in 14 cases only on T2-weighted images. In 12 (52.2%) of the 23 cases, regression of hyperintensity on T2-weighted imaging was observed postoperatively. In 4 (17.4%) of these 23 cases, regression of hyperintensity was observed during the iMRI at the end of surgery. Residual compression on postoperative iMRI was not detected in any patients. A nonsignificant correlation was observed between postoperative expansion of the transverse diameter of the spinal cord at the level of maximal compression and the postoperative JOA score and Nurick grade. A statistically significant correlation was observed between the surgical result and the length of a patient's clinical history. A significant correlation was also observed according to the preoperative presence of intramedullary signal alteration. The best results were found in patients without spinal cord changes of signal, acceptable results were observed in the presence of changes on T2-weighted imaging only, and the worst results were observed in patients with spinal cord signal changes on both Tl- and T2-weighted imaging. Finally, a statistically significant correlation was observed between patients with postoperative spinal cord signal change regression and better outcomes. CONCLUSIONS: Intramedullary spinal cord changes in signal intensity in patients with CSM can be reversible (hyperintensity on T2-weighted imaging) or nonreversible (hypointensity on T1-weighted imaging). The regression of areas of hyperintensity on T2-weighted imaging is associated with a better prognosis, whereas the T1-weighted hypointensity is an expression of irreversible damage and, therefore, the worst prognosis. The preliminary experience with this patient series appears to exclude a relationship between the time of signal intensity recovery and outcome of CSM.     

Perfusion-weighted magnetic resonance imaging of the spinal cord in cervical spondylotic myelopathy

Principles of echo shifting with a train of observations was used to perform magnetic susceptibility-weighted magnetic resonance imaging with bolus-tracking in 14 patients with spondylotic myelopathy to assess changes in perfusion parameters of the spinal cord before and after decompression surgery for cervical spondylotic myelopathy. The mean transit time (MTT), bolus arrival time (T0), and time to peak (TTP) were obtained from regions of interest (ROIs) and assessed as the ratio between the spinal cord and the pons (MTT index = MTT(ROI)/MTT(pons), T0 index = T0(ROI)/T0(pons), TTP index = TTP(ROI)/TTP(pons)). The patients were divided into two groups according to percentage improvement on the Neurosurgical Cervical Spine Scale. The MTT index in patients with good recovery (> or =50%) was significantly reduced. The T0 index and TTP index showed no significant change in both groups. Reduction of MTT index may indicate improved perfusion of the spinal cord following surgery for cervical spondylotic myelopathy.     

重度脊髓型颈椎病合并后纵韧带钙化的前路手术治疗

[目的]探讨一期前路手术治疗重度脊髓型颈椎病合并后纵韧带钙化的临床疗效。[方法]对33例重度脊髓型颈椎病合并后纵韧带钙化的患者采用一期前路手术治疗,手术依据钙化的后纵韧带和硬脊膜粘连的情况采用彻底切除钙化后纵韧带或使之“漂浮”的方法,减压充分后给予取自体髂骨或骨粒填充的钛网做椎间融合,Windows钢板内固定。[结果]33例病例随访8～45个月（平均22个月）,术前JOA评分6.7分,术后3个月评分10.1分,术后12个月评分10.7分。优良率分别为72.7%和78.8%。未出现脊髓、椎动脉损伤等严重并发症。[结论]一期前路手术治疗重度脊髓型颈椎病合并OPLL,能够获得彻底的椎管减压和良好的临床效果。     

New evaluation method using preoperative magnetic resonance imaging for cervical spondylotic myelopathy

A new method based on the score of preoperative magnetic resonance images (MRI) was devised to evaluate cervical spondylotic myelopathy and predict the results of cervical laminoplasty. On T1- and T2-weighted sagittal MRI, the intervertebral disc spaces at each level from the axis to the first thoracic spine were examined as to whether the anterior or posterior subarachnoid space would be maintained or not, and for the presence or absence of spinal cord deformity. The data were divided into six grades and rated, and the total score for all sites was regarded as the preoperative MRI cumulative score. In conclusion, our method was highly reliable and useful for a preoperative evaluation and prediction of results after cervical laminoplasty for cervical spondylotic myelopathy. Received: 18 December 2000     

前后路手术治疗矢状序列异常的脊髓型颈椎病疗效比较和预后评估

[目的]对比前后路两种手术方式治疗矢状序列异常的脊髓型颈椎病的疗效,探讨影响脊髓型颈椎病预后的相关因素。[方法]对2009~2012年收治的脊髓型颈椎病患者89例进行回顾性研究。53例患者纳入本次研究。其中前路手术31例,后路手术22例,采用改良的日本骨科协会(m JOA)评分法评估脊髓型颈椎病手术疗效,颈椎功能障碍指数(NDI)进行颈椎功能的评价。随访时间12~35个月,平均16.5个月。影像学评估指标包括颈椎(C_(2~7))Cobb角,脊髓横截面积。[结果]前路手术组术后JOA评分较后路手术组高,差异有统计学意义(P=0.048),末次随访差异消除(P=0.31),前路手术组与后路手术组术后NDI评分差异无统计学意义(P=0.32),随访中也是如此(P=0.21)。前路手术组中立位术后Cobb角较后路手术组大,差异有统计学意义(P0.001),在随访中结果也是如此(P=0.021)。前路手术组得分较后路手术组脊髓横截面积更大(P=0.039)。术前Cobb角与术前JOA评分没有相关性(P=0.32),术前Cobb角与术前椎管横截面积没有相关性(P=0.20)。[结论]前路减压植骨融合内固定术、后路单开门椎管成形术治疗矢状面序列异常的脊髓型颈椎病患者疗效满意,随访疗效没有差异,尚没有有效方法能评估脊髓型颈椎病患者预后。     

脊髓型颈椎病患者颈脊髓磁共振扩散张量成像的特点及临床意义

目的 :观察脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者磁共振扩散张量成像(diffusion tensor imaging,DTI)的特点,探讨DTI在评价颈脊髓慢性损伤的价值。方法:纳入2011年2月~2015年2月间收治的20例CSM患者(CSM组),并选择年龄匹配的42例健康志愿者作为对照组,均行颈椎磁共振DTI,测量CSM组病变节段以及对照组C2/3~C6/7节段颈脊髓的表观弥散系数(apparent diffusion coefficient,ADC)、各向异性分数(fractional aniostropy,FA)。比较对照组不同节段颈脊髓的ADC值和FA值,将CSM组和对照组颈脊髓的ADC值和FA值分别进行比较,并对CSM患者颈脊髓ADC、FA评分和颈椎改良JOA(m JOA)评分分别进行相关性分析。结果:对照组颈脊髓的ADC值自C2/3~C6/7节段呈上升趋势,而FA值呈下降趋势,C2/3节段颈脊髓的ADC值较C5/6和C6/7节段明显低,而FA值明显高(ADC:F=3.546,P=0.008;FA:F=13.82,P0.001)。CSM组颈脊髓的FA值与对照组比较显著性减小(P0.001),而ADC值则显著性增加(P0.001)。CSM组颈脊髓的ADC值与m JOA评分无显著相关性(r=-0.287,P=0.220),而颈脊髓的FA值与m JOA评分存在显著性正相关(r=0.359,P=0.005)。结论:CSM患者颈脊髓DTI与正常人群存在差异,其ADC值较正常人群升高,而FA值则明显降低;m JOA评分与FA值呈正相关。     

Comparison between anterior and posterior decompression for cervical spondylotic myelopathy: subjective evaluation and cost analysis

Objective: To compare anterior and posterior approaches for treating cervical spondylotic myelopathy (CSM) involving more than two levels, especially in regard to quality of life and cost effectiveness. Methods: The authors studied 116 CSM patients who underwent decompressive surgery by either an anterior or a posterior approach with instrumentation. In the anterior group, 1–3 levels subtotal vertebrectomy was followed by bone graft and Orion anterior cervical locking plate fixation. In the posterior group, multilevel laminectomy with posterior screw‐rod fixation was performed. Follow‐up, which included radiographic assessment, clinical examination and documentation of length of any hospitalization and cost and incidence of complications, was performed 1 day before discharge, 6 months after leaving hospital, and at final follow‐up. Results: Both groups had improved clinical outcomes. The anterior group showed greater satisfaction but lower visual analog scale scores than the posterior group, whereas SF‐36 emotional role and mental health scores were higher in the anterior group. There was no marked difference between the two groups in length of hospitalization and most of the costs of treating CSM, however treatment and examination fees were significantly higher in the posterior group. Conclusions: Both anterior and posterior decompressions (with instrumentation) are effective procedures for improving the neurological outcomes of patients with CSM. However, although the two approaches have similar health care costs, anterior cervical corpectomy (with instrumentation) seems to be subjectively assessed by patients as better.     

Surgical decompression for cervical spondylotic myelopathy: correlation between operative outcomes and MRI of the spinal cord

Forty-two patients who underwent decompressive surgery for cervical spondylotic myelopathy were studied. The pre- and postoperative magnetic resonance imaging (MRI) findings and the Japanese Orthopedic Association score were analyzed to evaluate whether the different appearances of intramedullary high-signal intensity on T2-weighted MRI are related to the surgical prognosis. Magnetic resonance imaging signal intensities were classified as type 0 if no intramedullary high-signal intensity on T2-weighted images was noted, type 1 if high-signal intensity involved only one segment, and type 2 if high-signal intensity extended over two segments. Statistical analyses of the recovery ratio showed that type 0 and type 1 intramedullary high-signal intensity indicates better prognosis than type 2.     

Cervical spondylotic myelopathy: the relevance of the spinal cord back shift after posterior multilevel decompression. A systematic review

Purpose

Spinal cord back shift has been considered the desired end point of posterior decompression procedures for cervical spondylotic myelopathy (CSM). However, the association with postoperative outcomes has not been definitively demonstrated. The aim of this review is to obtain an overview of the current knowledge on the spinal back shift after posterior decompression to clarify the main controversial aspects and provide recommendations for further studies on the subject.

Methods

A comprehensive quantitative review of the literature was performed. Bibliographic databases were searched using the following keywords: spinal cord drift, spinal cord shift, CSM, ossification of posterior longitudinal ligament, posterior decompression, laminoplasty, laminectomy and fusion.

Results

Twelve eligible studies were included. The authors measured the spinal cord back shift in different ways, using the posterior edge, the center or the anterior margin of the spinal cord as reference points. Six studies analyzed the correlation between the spinal cord back shift and the recovery rate, but their results were discordant. The correlation between the posterior cord migration and cervical alignment was not confirmed in all studies.

Conclusions

There is a need for a consensus on the best way to measure the spinal cord back shift. The action of multiple factors on spinal cord back shift can explain the difference in the results collected from the studies. We recommend further studies to clarify the behavior of the spinal cord after posterior decompression and its clinical meaning.

     

椎管减压联合中药治疗脊髓型颈椎病的临床研究

目的:比较椎管减压联合中药与单纯椎管减压治疗脊髓型颈椎病的临床疗效。方法 :2012年6月至2015年6月,收治脊髓型颈椎病患者73例,其中男42例,女31例,年龄29~73岁,平均50.9岁。根据患者意愿分为手术组和手术联合中药组,手术根据患者病情采用前路间盘摘除或椎体次全切钢板螺钉内固定术或后路单开门减压侧块螺钉内固定术,其中单纯手术组34例,手术联合中药组39例。比较两组患者术前和术后1周、1个月及末次随访的神经功能,通过日本骨科协会(JOA)17分法对所有患者神经功能进行评分,计算神经功能改善率,同时根据颈椎功能障碍指数量表(NDI)及根据JOA评分与《颈椎病临床评价量表》制定的督脉瘀阻证候积分对患者神经功能改善情况进行评定,术后通过X线片、CT、MRI观察内固定及脊髓减压情况。结果:所有患者手术顺利,术中均无硬膜、脊髓、神经根损伤,术后1例患者出现伤口感染,经抗感染治疗后得到控制,1例患者术后出现血肿,并伴有脊髓压迫,出现不全瘫表现,及时行二次手术清除血肿,患者未留下明显后遗症。两组患者术后均获得随访,随访12~24个月,单纯手术组平均(14.6±0.8)个月,手术联合中药组平均(13.5±0.7)个月,随访时间两组差异无统计学意义(P0.05)。单纯手术组术前JOA评分、颈椎功能障碍指数(NDI)及督脉瘀阻证候积分分别为8.31±3.15、29.91±4.52、6.58±1.31,术后1周分别为10.21±2.58、18.67±4.31、8.24±1.18,术后1个月分别为11.38±2.85、16.11±3.18、8.91±2.11,末次随访分别为12.21±3.12、14.61±3.28、9.12±1.56,手术联合中药组术前JOA评分、颈椎功能障碍指数(NDI)及督脉瘀阻证候积分分别为8.29±3.47、30.83±4.14、6.38±1.81,术后1周分别为10.48±2.39、17.59±5.14、8.33±1.57,术后1个月分别为12.14±3.12、13.14±3.21、9.55±2.49,末次随访分别为13.85±3.34、12.11±2.51、10.33±1.95,两组患者术后JOA评分、颈椎功能障碍指数(NDI)及督脉瘀阻证候积分较术前明显提高(P0.05);术后1周两组间差异无统计学意义(P0.05),术后1个月及末次随访时,手术联合中药组较单纯单手术组脊髓功能改善更为明显(P0.05),JOA改善率单纯手术组为(67.59±10.78)%,手术联合中药组为(66.88±12.15)%,两组差异无统计学意义(P0.05)。两组患者术后均行X线、CT、MRI检查,未出现内固定松动断裂。结论:通过椎管减压治疗脊髓型颈椎病,可以扩大椎管,解除神经压迫,以疏通督脉,调节气血,振复阳气,配合中药活血祛瘀,温阳通络、补益肝肾能够达到较单纯手术治疗更佳的治疗效果。     

后路椎板间减压黄韧带切除治疗脊髓型颈椎病

目的：探讨椎板间隙减压黄韧带切除治疗脊髓型颈椎病的效果。方法：对16例以黄韧带退变增生为主的脊髓型颈椎病患者采用后路椎板间开窗黄韧带切除减压术，对其临床效果进行分析。结果：全组病例随访时间6个月～3年，优7例，良6例，优良率为81．4％，未出现脊髓损伤、颈椎不稳及术后鹅颈畸形等并发症。结论：后路椎板间减压黄韧带切除术是治疗以黄韧带退变增生为主要病变的脊髓型颈椎病的一种有效方法，其创伤小、操作简单，术后颈椎稳定性好，并发症少。     

前后路Ⅰ期减压术治疗脊髓型颈椎病

目的:探讨脊髓前后受压所导致脊髓型颈椎病的手术治疗方法.方法:采用前路减压植骨自 锁钢板内固定和后路单开门椎管扩大成形术一次性完成的手术方法对26例脊髓型颈椎病(为脊髓前后均受压的脊髓型颈椎病患者)进行治疗观察,其中男9例,女17例;年龄63～81岁,平均69岁.并对其治疗结果进行分析总结.结果:26例获得1.5～6年的随访,22例症状完全消失,4例尚留有轻度手臂麻木.按JOA评分标准:优16例,良6例,可4例,差0例.结论:采用前后路Ⅰ期手术治疗脊髓前后同时受压的脊髓型颈椎病减压彻底、固定可靠、疗效满意,不但使治疗周期大大缩短、复发率明显减少,而且可使脊髓和神经根受压症状得到彻底缓解.     

脊髓型颈椎病患者行双开门椎管成形术后脊髓肿胀与髓内Gd-DTPA增强MRI的关系

目的 观察脊髓型颈椎病患者行双开门椎管成形术后脊髓肿胀与髓内二乙三胺五乙酸钆络合物(Gd-DTPA)增强MRI的关系.方法 选择2017年1月～2019年12月在本院接受双开门椎管成形术治疗的147例脊髓型颈椎病患者,根据术前有无髓内Gd-DTPA增强分为增强组和非增强组.观察患者术后1个月脊髓肿胀的发病率及术后1年肿胀的变化、脊髓T2WI高信号区的形态、术后1年JOA颈椎病评分及恢复率.结果 增强组术后1个月的脊髓肿胀发生率显著高于非增强组(P<0.05);增强组术后1年的脊髓肿胀恢复率低于非增强组,但差异无统计学意义(P>0.05).术后两组JOA评分均显著高于术前(P<0.05),但增强组脊髓肿胀、无脊髓肿胀患者的术后JOA评分均显著低于非增强组脊髓肿胀、无脊髓肿胀患者(P<0.05);术后增强组、非增强组脊髓肿胀患者的JOA评分和恢复率均显著低于增强组、非增强组的无脊髓肿胀者(P<0.05).脊髓肿胀患者以弥漫为主要表现,非脊髓肿胀患者以蛇眼型为主要表现,两者差异有统计学意义(P<0.05).多元线性回归分析显示,Gd-DTPA增强是影响术后JOA恢复率的风险因素(P<0.05),脊髓肿胀不影响术后JOA恢复率(P>0.05).结论 髓内Gd-DTPA增强与脊髓型颈椎病患者行双开门椎管成形术后脊髓肿胀和预后不良相关.     

影响颈椎后路减压内固定术治疗脊髓型颈椎病预后的影像学因素分析

目的:分析影响颈椎后路减压内固定术治疗脊髓型颈椎病的预后影像学因素。方法 :回顾性分析2014年5月～2018年5月北部战区总医院神经外科接受颈椎后路减压内固定手术治疗脊髓型颈椎病患者的临床及影像学资料(72例),其中男55例,女17例,年龄21～80岁,平均56.9±12.0岁,收集病程、压迫节段、术前/术后1周日本骨科协会(Japanese Orthopaedic Association,JOA)评分、术前Cobb角、压迫节段内致压物最大径、有效颈椎管率、平均压迫率、脊髓横切面积、脊髓椎管占有率以及术后脊髓漂移距离、JOA改善率等相关资料。根据JOA改善率将患者分为:预后优良组(改善率≥50%)58例和预后非优良组(改善率50%)14例。运用单因素、多因素二元Logistic回归分析患者临床资料与影像学参数等预后相关因素,进一步绘制受试者工作特征曲线(receiver operating curve,ROC),选取尤登指数最大的数值作为划界值,明确预后相关因素临界值。结果 :单因素分析显示,预后优良组术前Cobb角12.81°±4.27°,有效颈椎管率(33.71±9.87)%,脊髓漂移距离3.38±0.62mm,致压物最大径3.83±0.83mm,脊髓椎管占有率(64.02±7.74)%,与预后非优良组术前Cobb角9.68°±4.00°,有效颈椎管率(22.86±8.78)%,脊髓漂移距离2.13±0.75mm,致压物最大径5.38±1.01mm,脊髓椎管占有率(69.21±9.28)%相比,差异有统计学意义(P0.05);对上述相关因素进一步多因素分析显示,致压物最大径与脊髓漂移距离是脊髓型颈椎病预后主要影响因素(P0.05);ROC曲线显示,致压物最大径诊断临界值为4.950mm(曲线下面积为0.875);脊髓漂移距离诊断临界值为2.625mm(曲线下面积为0.897)。结论:致压物最大径与脊髓漂移距离是颈椎后路减压内固定治疗脊髓型颈椎病预后的主要影响因素,且当致压物最大径超过4.950mm时,提示颈椎后路减压预后较差,术后脊髓漂移距离低于2.625mm时,提示颈椎后路减压预后不佳。     

颈前路减压融合内固定治疗双节段脊髓型颈椎病术后轴性症状分析

目的:分析颈前路椎体次全切除融合内固定与颈前路双节段椎间盘摘除融合内固定治疗双节段脊髓型颈椎病术后轴性症状(AS)的发生情况。方法:2004年3月～2007年5月113例双节段脊髓型颈椎病患者分别行颈前路椎体次全切除融合内固定(A组,61例)和颈前路双节段椎间盘摘除融合内固定(B组,52例)。观察两组患者术前和末次随访时的JOA评分、融合节段高度和矢状面Cobb角,计算每组的神经功能改善率,统计每组术后颈部AS的发生率。结果:随访24～48个月,平均32.2个月。末次随访时A、B组神经功能改善率分别为(70.1±12.2)%、(63.5±4.7)%,无统计学差异(P0.05);融合节段高度变化值分别为-0.04±0.02cm、0.05±0.02cm,有统计学差异(P0.05);融合节段后凸率分别为34.4%、13.5%,有统计学差异(P0.05);颈部AS发生率分别为45.9%(28/61)、26.9%(14/52),有统计学差异(P0.05)。末次随访时融合节段高度降低者颈部AS发生率较高度增大者高(P0.05),A组中融合节段高度降低者的比例数明显大于B组(P0.05)。末次随访时,A组中融合节段明显后凸者的颈部AS发生率明显高于无后凸或轻度后凸者(P0.05),A组中融合节段明显后凸者的比例数明显大于B组(P0.05)。结论:颈前路减压融合内固定术后融合节段高度降低和明显后凸的患者AS发生率较高。与颈前路椎体次全切除融合内固定术相比,颈前路双节段椎间盘摘除融合内固定术治疗颈椎病在取得良好临床疗效的同时减少了术后颈部AS的发生。     

颈椎病前路手术切除后纵韧带的适应证及意义

目的:探讨脊髓型颈椎病前路手术中后纵韧带切除的适应证及意义. 方法:2000年6月～2010年6月我院行颈椎前路减压植骨融合内固定手术治疗脊髓型颈椎病患者500例,其中213例患者切除后纵韧带,男153例,女60例,年龄30～74岁,平均49.96岁. 回顾分析患者的临床资料和治疗效果.结果:术中切除后纵韧带的213例中,178例术前影像学有相应的后纵切带或椎间盘钙化:30例术中探查后纵韧带弹性差、有韧或硬感;1例术前MRI显示椎间盘突出到硬膜内,周围有脑脊液信号;4例术中发现后纵韧带上有破损,切除后纵韧带后发现椎间盘突出到后纵韧带后方、硬膜囊前方.术后并发脑脊液漏患者3例,经保守治疗后治愈;早期出现硬膜外而肿致神经症状加重2例,均及时发现,手术清除血肿,神经功能在1个月内恢复;术后并发食管损伤者2例,经保守治疗,均在4～6周愈合.随访6～70个月,平均36.7个月,JOA评分由术前4～14分,平均8.71±3.36分,提高到随访时的5～17分,平均13.50±3.50分,差异有显著性(P＜0.05);改善率为7.69％～100％,平均60.0％.结论:根据术前影像学及术中探查时后纵韧带的弹性可以决定颈椎病前路手术是否需要切除后纵韧带,切除后纵韧带时会发生一些并发症,应严格把握适应证,术中谨慎操作.     

脊髓型颈椎病患者脊髓MRI T2WI高信号的危险因素

目的:探讨脊髓型颈椎病(CSM)患者脊髓MRI T2WI高信号的危险因素。方法 :2014年1月~2014年4月因CSM于我院骨科行手术治疗的185例患者被纳入研究。将脊髓MRI T2WI高信号分为3级:0级,无高信号;1级,T2WI有模糊而边界不清的高信号,且高信号范围局限于一个节段;2级,T2WI有明亮而边界清晰的高信号或高信号范围超过一个节段。在MRI T2WI横断位上测量脊髓压迫程度,在过伸、过屈位X线片上测量颈椎节段和整体活动度。对可能影响高信号的因素(性别、年龄、病程、术前mJOA评分、脊髓压迫程度、颈椎活动度、椎间盘退变程度)行单因素分析,挑选出有意义指标(P0.1)行有序Logistic回归分析。结果:脊髓MRI T2WI高信号的发生率为72.4%。按照分级标准,0级51例(27.6%),1级86例(46.5%),2级48例(25.9%)。性别和脊髓压迫程度对高信号的影响有统计学意义(女性相对于男性的OR=0.366,脊髓压迫比值的OR=0.904,P0.05),而年龄、病程、术前mJOA评分、椎间盘退变程度、颈椎活动度与高信号均无明显相关性(P0.05)。结论:男性、脊髓压迫程度重为CSM患者脊髓MRI T2WI高信号的独立危险因素。     

颈椎后路减压术后脊髓后移的临床意义

[目的]探讨颈后路减压术后脊髓后移位对多节段脊髓型颈椎病(cervical spondylotic myelopathy,CMS)的临床意义.[方法]2003年7月～2008年6月,回顾性分析65例多节段脊髓型颈椎病患者,其中,男41例,女24例;年龄40～75岁,平均58.4岁.行颈后路单开门椎管成形减压术后通过MRI比较其术前及术后的脊髓后移位距离.根据患者术后脊髓后移位的距离不同将其分为三组(A≤2 mm;2 mm＜B＜4 mm;C≥4 mm),对三组患者手术前后的JOA评分、颈椎曲度指数的丢失程度(curvature index,CI)及轴性症状(axial symptom,AS)的严重程度进行比较评估.[结果]随访时间24～55个月,平均31个月.JOA评分恢复率,A组患者为63.1哂±16.9%,B组患者为59.5%±22.3%,C组患者为54.3%±9.8%,三组差异无统计学意义.A组患者术后颈椎曲度丢失指数为3.2%±2.4%,B组患者为3.1%±2.7%,C组为4.2%±3.1%,三组患者手术前后颈椎曲度的变化差异无统计学意义.A组术后有明显轴性症状患者的比例为18.2%,B组为36.7%,C组为53.8%,三组比较差异有统计学意义(P＜0.05).[结论]颈后路椎板切除术后脊髓后移位程度与病人术后恢复程度无明显关联.脊髓后移距离与术后曲率指数亦无明显关联.脊髓后移位与术后轴性症状的程度存在相关性.     

颈椎病合并颈椎后纵韧带骨化症的前路手术治疗

目的 探讨颈椎病合并颈椎后纵韧带骨化症(OPLL)前路切除减压的方法及其临床效果.方法采用颈椎前路减压治疗颈椎病合并颈椎OPLL患者61例,其中男42例,女19例,平均57岁(45～74岁).术前明确诊断颈椎病合并OPLL者49例,术中发现合并有OPLL者12例.OPLL椎管狭窄率32%～70%,平均52%.神经功能JOA评分术前4～14分,平均9.6分.手术在常规颈前路经椎间隙或椎体次全切除减压的基础上,切除骨化后纵韧带彻底减压.结果 本组41例患者采用前路椎体次全切除减压,6例经椎间隙扩大减压,14例采用椎体次全切除结合经椎间隙减压的手术方式.所有患者随访6个月～3年,平均16个月.术后JOA评分8～16分,平均12.8分,神经功能恢复率25.0%～87.5%,平均65.2%.5例患者术后并发脑脊液漏,经保守治疗后均获得痊愈,无1例出现脊髓功能损害加重.结论 颈椎病合并颈椎OPLL增加了手术难度和风险,在颈椎前路常规减压的基础上再将骨化的后纵韧带切除,保证了前路减压的彻底性,可提高手术治疗效果.