Postoperative Magnetic Resonance Imaging Can Predict Neurological Recovery After Surgery for Cervical Spondylotic Myelopathy: A Prospective Study With Blinded Assessments
Postoperative Magnetic Resonance Imaging Can Predict Neurological Recovery After Surgery for Cervical Spondylotic Myelopathy: A Prospective Study With Blinded Assessments
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DOI：
10.1227/neu.0b013e31821a418c
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发表时间：
2011-08-01
期刊：
影响因子：
4.8
通讯作者：
Fehlings, Michael G.
中科院分区：
文献类型：
--
作者：
Arvin, Babak;Kalsi-Ryan, Sukhvinder;Fehlings, Michael G.
背景：预测脊髓型颈椎病(CSM)患者术后康复的因素一直是医生、患者及其家属非常关心的问题。磁共振成像(MRI)扫描是一种常见的术后检查方法，因此可以作为预后的预测指标。目的：探讨脊髓型颈椎病患者术后6个月的MRI检查结果是否能预测1年后的恢复情况。方法：对52例患者分别在术前和术后6个月进行MRI检查。测量T1和T2信号变化(面积、高度和节段)和脊髓再扩张。将术后1年评估的结果与手术前的值进行比较。结果：单因素分析显示，改良日本骨科协会评分、Nurick评分(P=.014)和握力试验(P=.006)显示脊髓再扩张失败的患者预后较差。逐步多元回归分析显示，改良的日本骨科协会评分(P=.013)、Berg平衡评分(P=.014)和步行试验(P=.011)显示，脊髓再扩张不能预测术后的预后。术后高T2信号改变预示着Berg平衡量表(P=.014)和步行试验(P=.020)、Nurick评分(P=.001)和Short Form-36评分(P=.020)的预后较差。在T2信号增强的病例中，Nurick评分(P=.013)、握力试验(P=.017)和简明36评分(P=.030)的预后较差。结论：术后6个月的MRI检查结果对判断CSM患者的预后有一定的参考价值。T2信号改变的持续性和类型以及脊髓缺乏再扩张与较差的恢复相关，并可能反映脊髓不可逆的结构变化。
BACKGROUND: Factors that can predict the recovery of cervical spondylotic myelopathy (CSM) patients postoperatively are of significant interest to physicians and patients and their families. Magnetic resonance imaging (MRI) scans are a common method of examination after surgery, and thus of interest as a predictor of outcome.OBJECTIVE: To investigate whether findings on MRI at 6 months postoperatively could predict recovery at 1 year in CSM patients.METHODS: In 52 consecutive prospective patients, MRI was performed preoperatively and 6 months postoperatively. T1 and T2 signal change (area, height, and segmentation) and spinal cord re-expansion were measured. Outcome measures evaluated at 1 year postoperatively were compared with preoperative values. Univariate and stepwise multiple regressions were undertaken.RESULTS: Using univariate analysis, patients whose cord failed to re-expand had poorer outcome according to the modified Japanese Orthopedic Association score and Nurick score (P = .014) and grip test (P = .006) postoperatively. Stepwise multivariate regression showed lack of cord re-expansion to be predictive of prognosis postoperatively in the modified Japanese Orthopedic Association score (P = .013) and Berg Balance Scale (P = .014), and walking test (P = .011). Postoperative hyperintense T2 signal change was predictive of worse outcome on the Berg Balance Scale (P = .014) and walking test (P = .020), Nurick score (P = .001), and Short Form-36 scores (P = .020). In cases in which the T2 signal intensified, there was a poorer outcome on Nurick scores (P = .013), grip test (P = .017), and Short Form-36 scores (P = .030).CONCLUSION: Findings on postoperative MRI at 6 months is of predictive value in determining outcomes in CSM patients. The persistence and type of T2 signal change and lack of re-expansion of the cord correlate with poorer recovery and likely reflect irreversible structural changes in the spinal cord.