脊髓型颈椎病术后MRI脊髓高信号改变与疗效的关系

目的 探讨脊髓型颈椎病术后MR T2WI脊髓高信号改变与疗效的关系.方法 功会26例脊髓型颈椎病患者,男15例,女11例;年龄38~73岁,平均49.8岁.收集患者术前和术后3个月以上脊髓MRI矢状位T2WI照片,用Yukawa法对脊髓信号强度进行评分,对照观察手术前后脊髓高信号变化情况.分别测量轴位T2WI压迫最重节段手术前后的脊髓横截面积.应用JOA17分法评价术前及术后脊髓功能,分析脊髓高信号改变与术后神经功能变化的关系.结果 根据手术后脊髓高信号变化将患者分为3组:脊髓高信号减弱组18例,脊髓高信号不变组7例,脊髓高信号增强组1例.脊髓高信号减弱组与不变组术前脊髓信号评分比较,差异无统计学意义.脊髓高信号减弱组与不变组术前脊髓信号评分与术后JOA评分、神经功能改善率均无相关性.两组相比,脊髓高信号减弱组年龄小[(51.94±11.04):(61.12±10.14),P=0.048]、术前脊髓受压最重节段横截面积大[(60.90±14.77):(42.05±18.05),P=0.010]、术后JOA评分高[(14.44±1.82):(11.00±3.89),P=0.042]、神经功能改善率高[(64%±23%):(38%±30%),P=0.027].脊髓高信号增强组因例数少,未列入对比研究.结论 脊髓型颈椎病术后MR T2WI脊髓高信号改变可作为疗效预测指标.

Correlation between postoperative MRI signal changes and operative outcomes in cervical spondylotic myelopathy

Objective To preliminarily discuss the relationship between pre- and postoperative changes of high signal on MR T2W images and operative outcome of cervical spondylotic myelopathy. Methods The participants in this study were 26 patients (including 15 males, 11 females, with the mean age of 49.8 years) who underwent decompressive surgery for cervical spondylotic myelopathy in our hospital. MRI was performed in all patients. Spinal cord signal intensity changes were evaluated by comparing the pre- and postoperative grading scores on sagittal T2WI, according to Yukawa method. The transverse sectional area at the site of maximal compression was also measured in axial position. The Japan Orthopaedic Association (JOA) scoring system was used for evaluation of pre- and postoperative neurological status. The relationship between pre- and postoperative changes of high signal on MR T2WI and operative outcome of cervical spondylotic myelopathy were analyzed. Results According to the postoperative changes of the spinal cord signal intensity, patients were divided into three groups, signal intensity decreasing group (SID) for 18 patients, signal intensity unchanging (SIU) group for 7 patients, signal intensity increasing group (SII) for 1 patient. There was no significant difference in the preoperative signal intensity between SID and SIU groups. No significant relationship was observed between preoperative signal intensity with postoperative JOA score and function improvement in SID and SIU groups. Significant differences were observed in SID vs SIU groups at age[(51.94±11.04) vs (61.12±10.14), P=0.048], the preoperative transverse size[(60.90±14.77) vs (42.05±18.05), P=0.010], postoperative JOA [(14.44±1.82) vs (11.00±3.89), P=0.042], and recovery rate [(64%±23%) vs (38%±30%), P=0.027]. The SII group was excluded from the control study for the lack of number. Conclusion The changes of intramudullary high signal intensity on T2WI are the good predictor of postoperative outcome.