| Objective: To investigate the effect of MRI T2 WI intramedullary increased signal intensity on the surgical treatment of patients with cervical spondylosis myelopathy.To explore the clinical and imaging related risk factors of cervical spinal cord MRI T2 WI increased signal intensity formation in patients with cervical spondylotic myelopathy, which can predict the formation of increased signal intensity in patients with cervical spondylosis myelopathy, and improve the postoperative satisfaction rate.Method:The first part: Retrospective analysis of 106 patients with CSM who met the inclusion and exclusion criteria in the Department of spinal surgery, Tianjin People’s Hospital from June 2013 to June 2014.According to whether there is MRI T2 WI intramedullary ISI all cases divided into two groups. Group A of 38 cases of spinal cord without ISI and Group B of 68 cases with ISI.preoperative and postoperative use JOA assess nervous function, calculated the JOA score improvement rate.Compare the two groups of JOA score and JOA score improvement rate.Explore correlation of the degree of spinal cord compression and the spinal cord neurological function.The second part: A retrospective analysis was conducted on 180 cases of patients who met the criteria of selection in Tianjin People’s Hospital from February 2012 to December 2014. According to the MRI T2 WI cervical spinal cord increased signal intensity all cases was divided into 2 groups, group A of 132 cases with MRI T2 WI increased signal intensity, group B of 48 cases without MRI T2 WI increased signal intensity. All patients underwent cervical plain radiograph, CT and MR examination before operation. The risk factors of CSM patients MRI T2 WI spinal cord increased signal intensity include 12 indicators as follow:age, gender, smoking history, diabetes history, duration of the disease, the compressed segment number, the degree of intervertebral disc degeneration, the degree of spinal cord compression, range of motion,cervical curvature, cervical instability, congenital cervical stenosis. In order to make the research results more practical significance,we discrete continuous variables age, duration of disease, range of motion, cervical curvature as classification variables. Gender, smoking history, diabetes history, number of compression segments, the degree of intervertebral disc degeneration, spinal cord compression, cervical instability, congenital cervical stenosis as classification variables.We use χ2 test and rank sum test analyze the above factors. The statistical significant factors as independent variables, whether to appear in the spinal cord MRI T2 WI increased signal intensity as dependent variables. Logistic regression was used to determine the independent risk factors for the formation of increased signal intensity in the spinal cord of CSM patients.Results:The first part: The study group consisted of 106 cases, group A of 38 patients with spinal cord without ISI, including 21 males and 17 females, aged 42 to 80 years old, average(57.23 + 9.13) years old, preoperative course of disease(28.05 + 9.45) months. Group B of 68 cases of spinal cord with ISI, including male 38, female 30 cases, age 32 to 78 years old, average(60.26 + 9.44) years old, preoperative course of disease(31.5 + 9.96) months. There was no significant difference in general data between the two groups.For JOA scores of two groups group A were higher than group B(P<0.05) at 6 months and at the last follow-up. At 6 months after surgery and at the last follow-up, the JOA score improvement rate group A was higher than group B(P<0.05). There was no correlation between preoperative JOA score and JOA score and JOA score improvement rate(P>0.05).The second part:The study group consisted of 180 cases, including 53 cases of anterior surgery and 127 cases of posterior surgery.According to whether to appear in the spinal cord MRI T2 WI increased signal intensity the total cases was divided into 2 groups.Group A of 132 cases MRI T2 WI display cervical spinal cord with increased signal intensity, 102 males,and 30 females,age from 30 to78 years old, average(54.97±9.17) years, duration of symptoms(33.92±12.26) months. In group B, 48 patients without MRI T2 WI increased signal intensity, including 30 males and 18 females, aged from 31-73 years old, average(53.88±10.40) years old. Course of disease(34±10.35) months.Univariate χ2 test or rank sum test results suggested that the duration of symptoms(P = 0.001), cervical curvature(P=0.035), range of motion(P=0.042), cervical instability(P=0.02), congenital cervical stenosis(P=0.004) were related to the formation of MRI T2 WI spinal cord increased signal intensity.while age, gender, history of smoking, history of diabetes, number of compression segments, the degree of intervertebral disc degeneration, the degree of spinal cord compression were not associated with MRI T2 WI spinal cord increased signal intensity. The statistical significant factors as independent variables, whether to appear in the spinal cord MRI T2 WI increased signal intensity as dependent variables. Logistic regression was used to determine the independent risk factors for the formation of increased signal intensity in the spinal cord of CSM patients. The results showed that duration of symptoms(P = 0.012), range of motion(P = 0.019), cervical instability(P = 0.010), congenital cervical stenosis(P = 0.047) are risk factors for the formation of high signal in the spinal cord of patients with CSM, and cervical curvature(P =0.249) was excluded.Conclusion: 1. Expansive open-door laminoplasty is effective treatment of CSM, MRI T2 WI intramedullary ISI has certain influence of CSM patients after surgery. 2.A variety of factors affect the MRI T2 WI intramedullary ISI of CSM patients.Course of disease, cervical curvature, range of motion of cervical spine, cervical spine instability, DCSS associated with the formation of intramedullary ISI.Course of disease, range of motion of cervical spine,cervical spine instability and DCSS was risk factors for the formation of intramedullary ISI. 3. CSM patient’s age, sex, smoking history, history of diabetes, the number of compression segments, the degree of disc degeneration, the degree of spinal cord compression have nothing to do with the MRI T2 WI intramedullary ISI. |
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