Natural Course and Prognostic Factors in Patients With Mild Cervical Spondylotic Myelopathy With Increased Signal Intensity on T2-Weighted Magnetic Resonance Imaging
Natural Course and Prognostic Factors in Patients With Mild Cervical Spondylotic Myelopathy With Increased Signal Intensity on T2-Weighted Magnetic Resonance Imaging
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DOI：
10.1097/brs.0b013e318259a65b
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发表时间：
2012-10-15
期刊：
影响因子：
3
通讯作者：
Tanaka, Sakae
中科院分区：
文献类型：
--
作者：
Oshima, Yasushi;Seichi, Atsushi;Tanaka, Sakae
研究设计.一项回顾性比较研究。探讨轻度脊髓型颈椎病（CSM）患者的自然病程和预后因素，重点关注T2加权磁共振成像上髓内信号强度增加（ISI）。轻度脊髓型颈椎病的长期自然病程，尤其是磁共振成像显示的ISI，仍不确定。对1992年至2004年期间来我院就诊且首次就诊时未接受手术的CSM患者进行回顾性分析。入选标准如下：（1）上肢和下肢的运动功能日本骨科协会评分均为3分或以上;（2）T2加权磁共振成像显示颈髓压迫伴ISI。共有45例患者，平均随访期为78个月（范围，24 208）。我们通过将因神经功能恶化而转为手术的时间作为终点来研究长期自然史。我们进一步比较了中转手术患者和继续非手术随访患者的预后参数。16例患者病情逐渐恶化，接受减压手术，而27例患者没有。此外，2例轻微创伤后急性脊髓损伤患者接受了手术治疗。Kaplan-Meier生存分析显示，分别有82%或56%的患者在初次治疗后5年或10年不需要手术。对于预后因素，考克斯比例风险分析显示颈椎总活动度（风险比：3.25）、最大压缩节段的节段性后凸（风险比：4.51）和局部滑移（风险比：4.67）具有统计学意义。五十六%的临床轻度CSM伴ISI的患者在10年内没有恶化或接受手术。活动度大、节段性脊柱后凸和后外侧椎管不稳定被认为是不良预后因素。
Study Design. A retrospective comparative study.Objective. To investigate natural course and prognostic factors in patients with mild forms of cervical spondylotic myelopathy (CSM), focusing on intramedullary increased signal intensity (ISI) on T2-weighted magnetic resonance imaging.Summary of Background Data. Long-term natural course of mild forms of CSM, especially with ISI on magnetic resonance imaging, remains uncertain.Methods. Patients with CSM who visited our institution between 1992 and 2004 and did not undergo surgery at first visit were retrospectively reviewed. The inclusion criteria were as follows: (1) motor function Japanese Orthopedic Association scores of 3 or more in both upper and lower extremities and (2) cervical spinal cord compression with ISI on T2-weighted magnetic resonance imaging. There were 45 patients, with a mean follow-up period of 78 months (range, 24 208). We investigated long-term natural history by setting the timing of conversion to surgery due to neurological deterioration as an end point. We further compared prognostic parameters between patients who converted to surgery and those who continued to be followed up nonsurgically.Results. Sixteen patients gradually deteriorated and underwent decompression surgery, whereas 27 patients did not. Apart from these, 2 patients with acute spinal cord injury after minor trauma underwent surgery. Kaplan-Meier survival analysis revealed that 82% or 56% of patients did not require surgery 5 or 10 years after the initial treatment, respectively. As for prognostic factors, Cox proportional hazard analysis revealed that total cervical range of motion (hazard ratio: 3.25), segmental kyphosis in the maximum compression segment (hazard ratio: 4.51), and local slip (hazard ratio: 4.67) were statistically significant.Conclusion. Fifty-six percent of patients with clinically mild CSM with ISI had not deteriorated or undergone surgery at 10 years. Large range of motion, segmental kyphosis, and instability at the narrowest canal were considered to be adverse prognostic factors.