The Impact of Anterior Spondylolisthesis and Kyphotic Alignment on Dynamic Changes in Spinal Cord Compression and Neurological Status in Cervical Spondylotic Myelopathy: A Radiological Analysis Involving Kinematic CT Myelography and Multimodal Spinal Cord
The Impact of Anterior Spondylolisthesis and Kyphotic Alignment on Dynamic Changes in Spinal Cord Compression and Neurological Status in Cervical Spondylotic Myelopathy: A Radiological Analysis Involving Kinematic CT Myelography and Multimodal Spinal Cord
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前路滑脱和后凸对齐对脊髓型颈椎病脊髓受压动态变化和神经状态的影响：涉及运动 CT 脊髓造影和多模式脊髓的放射学分析
DOI：
10.1097/brs.0000000000003735
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Takashi Sakai
中科院分区：
文献类型：
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作者：
Takuya Sakamoto ;Masahiro Funaba;Yasuaki Imajo;Yuji Nagao;Hidenori Suzuki;Norihiro Nishida;Kazuhiro Fujimoto;Takashi Sakai
研究设计。前瞻性收集数据的回顾性研究。目的。本研究旨在检查放射学参数如何影响脊髓型颈椎病（CSM）患者脊髓横截面积（CSA）的动态变化，以及它们如何与脊髓病的严重程度相关，通过评估多模态脊髓诱发电位（SCEP）背景资料摘要适当的动力因素评估应该揭示隐藏的脊髓压迫，并为选择外科手术提供有用的信息。他们进行了检查与运动CT脊髓造影（CTM），并负责其CSM的脊柱水平通过SCEP检查确定。在屈曲和伸展过程中，在正中矢状位上测量C2-7角、C2-7活动范围和滑动百分比，并使用运动CTM在每个颈部位置的轴位上测量CSA。在伸展和屈曲时CSA值最小的患者被分为E组和F组，分别为65.8%（52例）和34.2%（27例）被纳入E组和F组。两组术前乔亚评分无显著差异;然而，F组术前下肢乔亚评分显著低于E组（2.24±0.82 vs. 2.83±1.09，P= 0.016）。在多元逻辑回归分析中，在伸展过程中C2-7角较小（β= 5，比值比：0.69，95%置信区间[CI]：0.54-0.90）和屈曲期间的滑动百分比（β= 5%，比值比：1.42，95% CI：1.09-1.85）被确定为属于F组的显著预测因素。结论：在颈部屈曲时表现出更严重的脊髓压迫与小的C2- 7角型和前滑脱。F组患者的神经功能状态的特点是严重的下肢功能障碍，因为干扰血液供应的前柱。证据等级：4表现出更严重的脊髓压迫在颈部屈曲与小C2-7角和前滑脱。F组患者的神经功能状态的特点是严重的下肢功能障碍，因为干扰血液供应的前柱。
Study Design.A retrospective study of prospectively collected data.Objective.This study aimed to examine how radiological parameters affect dynamic changes in the cross-sectional area of the spinal cord (CSA) in cervical spondylotic myelopathy (CSM) patients and how they correlate with the severity of myelopathy, by evaluating multi-modal spinal cord evoked potentials (SCEPs).Summary of Background Data.Appropriate assessments of dynamic factors should reveal hidden spinal cord compression and provide useful information for choosing surgical procedures.Methods.Seventy-nine CSM patients were enrolled. They were examined with kinematic CT myelography (CTM), and the spinal levels responsible for their CSM were determined via SCEP examinations. The C2–7 angle, C2–7 range of motion, and percentage of slip were measured on the midsagittal view during flexion and extension, and the CSA was measured on the axial view in each neck position using kinematic CTM. The patients who exhibited the smallest CSA values during extension and flexion were classified into Groups E and F, respectively.Results.Fifty-two (65.8%) and 27 (34.2%) cases were included in Groups E and F, respectively. The preoperative JOA score did not differ significantly between the groups; however, the preoperative lower-limb JOA score of Group F was significantly lower than that of Group E (2.24±0.82 vs. 2.83±1.09, P= 0.016). In the multiple logistic regression analysis, a small C2–7 angle during extension (β= 5, odds ratio: 0.69, 95% confidence interval [CI]: 0.54–0.90) and the slip percentage during flexion (β= 5%, odds ratio: 1.42, 95% CI: 1.09–1.85) were identified as significant predictors of belonging to Group F.Conclusion.Exhibiting more severe spinal cord compression during neck flexion was associated with a small C2–7 angle and anterior spondylolisthesis. The neurological status of the patients in Group F was characterized by severe lower limb dysfunction because of a disturbed blood supply to the anterior column.Level of Evidence: 4Exhibiting more severe spinal cord compression during neck flexion was associated with a small C2-7 angle and anterior spondylolisthesis. The neurological status of the patients in Group F was characterized by severe lower limb dysfunction because of a disturbed blood supply to the anterior column.