Is the Cervical Anterior Spinal Artery Compromised in Cervical Spondylotic Myelopathy Patients? Dual-Energy Computed Tomography Analysis of Cervical Anterior Spinal Artery
Is the Cervical Anterior Spinal Artery Compromised in Cervical Spondylotic Myelopathy Patients? Dual-Energy Computed Tomography Analysis of Cervical Anterior Spinal Artery
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脊髓型颈椎病患者的颈椎前动脉是否受损？
DOI：
10.1016/j.wneu.2018.03.217
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发表时间：
2018
影响因子：
2
通讯作者：
Teng Hong Lin
中科院分区：
文献类型：
--
作者：
Wu Shiyang;Ch;oo Suraj;Zhu Minyu;Huang Kelun;Wang Yu;Wang Zhenzhang;Teng Hong Lin
目的脊髓型颈椎病是老年患者脊髓功能障碍的常见获得性原因。据推测，慢性脊髓压迫继发的缺氧或缺血环境在脊髓病的发病机制中起着重要作用。本研究旨在应用双能量计算机断层扫描(DECT)评估脊髓型颈椎病(CSM)患者脊髓血流的改变。据我们所知，本研究首次使用DECT检测颈椎病患者的脊髓前动脉血流。方法对50例单节段脊髓型颈椎病患者和10例非颈椎病患者进行颈椎DECT扫描，分析比较颈椎病患者的ASA。采用日本骨科协会(JOA)评分，分别于术前、术后5天、1个月和6个月对患者的神经功能状态进行评估。所有脊髓型颈椎病患者均行单节段颈椎前路髓核摘除融合术，术后第5天复查DECT。比较脊髓型颈椎病患者手术前后脊髓前动脉的变化。在志愿者组的轴位CT和CSM患者手术前后的轴位CT上测量了特定感兴趣区的血流量(以碘含量表示)。结果C3/C4节段、C4/C5节段和C5/C6节段的碘含量分别为14.2800±1.89527、14.8280±1.83820和15.5000±2.41048。脊髓型颈椎病患者术前测得C3/C4椎间隙压缩的碘含量为10.2621±2.37396，C4/C5椎间压缩为12.1438±1.63447，C5/C6椎间压缩为14.0620±2.44390。术后测得C3/C4、C4/C5和C5/C6椎间的碘含量分别为13.78±2.77、14.16±1.90和15.14±2.62。JOA术前13.650分，术后5天14.010分，术后1个月14.630分，术后6个月15.000分。1个月和6个月的相关系数分别为0.746(P<0.05)和0.760(P<0.05)。结论本研究为颈椎病患者颈前动脉病变的诊断提供了依据。我们认为，DECT是目前可用的最好的放射学工具之一，可以提供客观的筛查工具来检测CSM患者的血流受损。
ObjectiveCervical myelopathy is a common, acquired cause of spinal cord dysfunction in older patients. It is postulated that a hypoxic or ischemic environment secondary to chronic spinal cord compression plays an important role in the pathogenesis of myelopathy. This study aims to use dual-energy computed tomography (DECT) to assess the altered blood flow to the spinal cord in patients with cervical spondylotic myelopathy (CSM). To our knowledge, this study is the first to use DECT in identifying comprised anterior spinal artery blood flow in patients with CSM.MethodsFifty patients with single disc level CSM and 10 volunteers without CSM underwent DECT of the cervical spine to analyze and compare the ASA. The neurologic status of each patient was evaluated preoperatively and postoperatively at 5 days, 1 month, and 6 months using the Japanese Orthopedic Association (JOA) score. All the patients with CSM underwent single-level anterior cervical discectomy and fusion, and at postoperative day 5, each patient underwent repeated DECT. The anterior spinal artery before and after surgery was compared in patients with CSM. The blood flow in terms of iodine content at a specific region of interest was measured in the axial CT of the volunteers group and in the preoperative and postoperative axial CT of patients with CSM. Correlations between change in blood flow and clinical improvement at each follow-up point were analyzed statistically.ResultsIodine content (100 mg/mL) was 14.2800 ± 1.89527 at the C3/C4 disc level, 14.8280 ± 1.83820 at the C4/C5 disc level, and 15.5000 ± 2.41048 at the C5/C6 level. In patients with CSM, the preoperative iodine content (100 mg/mL) measured was 10.2621 ± 2.37396 in C3/C4 disc-level compression, 12.1438 ± 1.63447 in C4/C5 disc-level compression, and 14.0620 ± 2.44390 in C5/C6 disc-level compression. Postoperative iodine content (100 mg/mL) measurement changed to 13.78 ± 2.77 for the C3/C4 disc level, 14.16 ± 1.90 for the C4/C5 disc level, and 15.14 ± 2.62 for the C5/C6 disc level. The JOA score was 13.650 preoperatively, 14.010 at 5 days postoperatively, 14.630 at 1 month postoperatively, and 15.000 at 6 months postoperatively. The 1- and 6-month correlation ratios between the JOA and change in blood flow were statistically significant, with anrvalue of 0.746 (P< 0.05) and 0.760 (P< 0.05), respectively.ConclusionsThis study provided evidence for the benefit of DECT as a radiographic tool for identifying the compromised cervical anterior spinal artery in patients with CSM. We believe that DECT is the one of the best radiographic tools available to provide an objective screening tool to detect compromised blood flow in patients with CSM.