Clinical and radiological correlates of severity and surgery-related outcome in cervical spondylosis
Clinical and radiological correlates of severity and surgery-related outcome in cervical spondylosis
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DOI：
10.3171/spi.2001.94.2.0189
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发表时间：
2001-04-01
影响因子：
4.1
通讯作者：
Stevens, J
中科院分区：
文献类型：
--
作者：
Singh, A;Crockard, HA;Stevens, J
Object.本研究的目的是确定影像学特征是否可用于预测脊髓型颈椎病（CSM）患者的预后。作者研究了69例连续转诊至皇后广场国家医院接受减压手术的患者。术前颈椎磁共振（MR）成像研究获得的数据分别由两名不知情的放射科医生在两个不同的场合进行分析。确定的参数是信号变化以及压缩的存在和严重程度。通过术前和术后定时步行，以及脊髓病残疾指数评分、Ranawat分级和Nurick分级来确定临床结局。MR成像信号变化与手术相关结局之间存在显著相关性，如步行参数的改善所反映;然而，信号变化也与术前步行参数相关这一事实混淆了这一点。术前步行功能较差的患者术后步行功能改善更明显。行走相关数据与脊髓压迫的严重程度或范围之间的关系不太明显。颈髓压迫和固有MR成像信号改变与临床严重程度相关，并且，在该人群中，信号改变的存在与更好的手术相关结局相关。然而，混杂因素和缺乏强相关性表明，这些放射学测量不足以作为预测个体患者手术相关受益的可靠工具。
Object. The aim of this study was to determine if radiological features could be used to predict outcome in patients with cervical spondylotic myelopathy (CSM).Methods. The authors studied 69 patients consecutively referred to The National Hospital, Queen Square, for decompressive surgery. Data obtained from preoperative cervical spine magnetic resonance (MR) imaging studies were each analyzed on two separate occasions by two blinded radiologists. The parameters determined were signal change and the presence and severity of compression. Clinical outcome was determined by pre- and postoperative timed walks, as well as by evaluation of myelopathy disability index scores, Ranawat classification, and Nurick grades.There was good inter- and intraobserver reliability for determination of radiological data. A significant relationship was found between MR imaging signal change and surgery-related outcome, as reflected by improvement in walking parameters; however, this was confounded by the fact that signal change also related to preoperative walking parameters. and those patients for whom preoperative walking function was worse experienced greater functional improvement in walking postoperatively. The relationships between ambulatory-related data and severity or extent of spinal cord compression were less marked.Conclusions. Cervical cord compression and intrinsic MR imaging signal change correlate with clinical severity, and, in this population, the presence of signal change was correlated with better surgery-related outcome. However, confounding factors and the lack of strong correlation indicate that these radiological measurements are insufficient to be used as a reliable tool for predicting surgery-related benefits in individual patients.