术前MRI T2加权像髓内高信号对颈椎前路椎间盘切除融合术治疗多节段脊髓型颈椎病效果的影响

目的 探讨术前MRI T2加权像髓内高信号对颈椎前路椎间盘切除融合术(ACDF)治疗多节段脊髓型颈椎病(MCSM)效果的影响.方法 回顾性分析2015年1月—2018年5月于本院接受ACDF治疗的83例MCSM患者临床资料.根据术前MRI T2加权像髓内信号强度将患者分为高信号组(41例)和非高信号组(42例).采用日...

Effect of preoperative T2-weighted MRI intramedullary high signal on anterior cervical discectomy and fusion for multilevel cervical spondylotic myelopathy

Objective To investigate the effect of preoperative T2-weighted MRI intramedullary high signal on anterior cervical discectomy and fusion(ACDF) for multilevel cervical spondylotic myelopathy(MCSM). Methods The clinical data of 83 MCSM patients treated with ACDF from January 2015 to May 2018 were retrospectively analyzed. According to the preoperative intramedullary signal intensity on T2-weighted MRI,the patients were divided into high signal group(41 cases) and non-high signal group(42 cases). Japanese Orthopaedic Association(JOA) score,Nurick score,and visual analogue scale(VAS) score were used to evaluate patients'' neurological function and neck-shoulder pain. The risk factors of neurological function recovery in MCSM patients after ACDF were also analyzed. Results Compared to non-high signal group,high signal group exhibited worse preoperative JOA score,JOA sub-item score(motor function of upper limbs) and Nurick score,all with a statistical significance(P<0.05). At the final follow-up,all the patients acquired improvment in JOA score,Nurick score and VAS score. However,high signal group showed worse JOA score,JOA sub-item scores(motor function of upper limbs and lower limbs,sensory function of upper limbs and lower limbs),JOA score improvement rate,and Nurick score than those in non-high signal group,all with a statistical significance(P<0.05). Multivariate logistic regression analysis indicated that intramedullary high signal on T2-weighted MRI(odds ratio=5.61,95% confidence interval 2.014-15.632,P<0.05) and positive Hoffman sign(odds ratio=2.268,95% confidence interval 1.192-4.091,P<0.05) were the independent risk factors for poor prognosis. Conclusions The effect of ACDF on MCSM is satisfactory,but the recovery of neurological function in patients with intramedullary high signal on T2-weighted MRI is worse than that in patients without intramedullary high signal. Intramedullary high signal on T2-weighted MRI and positive Hoffman sign are the independent risk factors for poor prognosis.