Correlation Of Cervical Spinal Cord Lamina Angle With Intramedullary High Signal On MRI-T2WI And Severity Of Patient Dysfunction

Purpose:In recent years,the incidence of cervical spondylotic myelopathy is increasing year by year with the increasing number of people who work at their desk and the increasing trend of population aging,which has caused serious impact on our life and brought heavy burden to the society and family.When imaging examination was carried out on the cervical spondylotic myelopathy,often found that intramedullary high signal on MRI-T2WI,researchers think that intramedullary high signal could be a long term by repeated damage to the spinal cord stimulation caused by edema of spinal cord ischemia,and as the illness progress gradually,spinal cord grey matter and white matter lesions,there is even necrosis of the spinal cord.The Cord Lamina Angle(CLA)of the cervical spine is the angle between the lamina tangent and the anterior spinal cord tangent on MRI-T2WI axial radiograph of the cervical spine,and has been used in the past to predict the incidence of C5 root paralysis symptoms after surgery.This study explored the relationship between bilateral CLA of cervical spine in patients with cervical spondylotic myelopathy accompanied by MRI-T2WI intramedullary high signal grade and severity of patients’ dysfunction,as well as the relationship between the grade of cervical spinal cord MRI-T2WI intramedullary high signal grade and severity of patients’ dysfunction.It provides a possible reference for diagnosis,treatment and prediction of disease progression of cervical spondylotic myelopathy.Methods:In this study,a total of 100 patients with cervical spondylotic myelopathy with intramedullary high signal on MRI-T2WI or non-intramedullary high signal who were admitted to the Spinal Surgery Department of Qilu Hospital of Shandong University from January 2018 to October 2020 were collected according to the inclusion and exclusion criteria.The image data and medical records were complete.Imaging data,age,gender,course of disease,and JOA score of the patients meeting the inclusion and exclusion criteria were collected.Three professional spine surgeons and three professional radiologists divided the patients into three levels of intramedullary high signal on MRI-T2WI level.All patients in the study were divided into three groups according to the intramedullary high signal on MRI-T2WI level,with grade 0 as group A,grade 1 as group B,and grade 2 as group C.Bilateral cervical CLA in the most compressed segment in group A was measured using Image J software,and bilateral cervical CLA in the intramedullary high signal on MRI-T2WI in groups B and C was measured.According to the JOA score,the patients were divided into three groups:mild group as group I,moderate group as group II,and severe group as group III.Statistical analysis was conducted using SPSS 21.0 software to study the relationship between bilateral CLA of patients’ cervical vertebrae and intramedullary high signal on MRI-T2WI classification and severity of patients’ dysfunction,and to study the relationship between intramedullary high signal on MRI-T2WI classification of patients’ cervical spinal cord and severity of patients’ dysfunction.Results:A total of 100 patients were included in this study,including 71 males and 29 females.The mean age was 55.98±10.46 years,and the mean course of disease was 14.20 ±14.28 months.The mean JOA score was 12.75±1.70.There was no statistical difference in bilateral CLA of cervical spine among patients with different spaces.There were statistically significant differences in bilateral CLA of cervical spine among patients with different intramedullary high signal on MRI-T2WI grades in each space.There were statistical differences in bilateral CLA of cervical spine among patients with different severity of dysfunction.The bilateral CLA of the patients’ cervical spine was negatively correlated with the grade of intramedullary high signal on MRI-T2WI,and positively correlated with the severity of the patients’ dysfunction.There were statistically significant differences in JOA scores among the different intramedullary high signal on MRI-T2WI signal groups,and the grade of cervical intramedullary high signal on MRI-T2WI was negatively correlated with the severity of the patient’s dysfunction.Conclusion:In this study,bilateral cervical CLA of patients was negatively correlated with the grade of intramedullary high signal on MRI-T2WI,and positively correlated with the severity of dysfunction,that is,the smaller the bilateral cervical CLA was,the higher the grade of intramedullary high signal on MRI-T2WI,the lower the JOA score and the more severe the dysfunction of patients.The grade of intramedullary high signal on MRI-T2WI in patients was negatively correlated with the severity of dysfunction,that is,the higher the grade of intramedullary high signal on MRI-T2WI in patients,the lower the JOA score of patients and the more severe the dysfunction of patients.Because intramedullary high signal on MRI-T2WI can be determined solely by the imaging data of the patient,and the measurement of bilateral CLA in each space of the patient’s cervical spine is simple and easy,which is easier to achieve in clinical work.Therefore,intramedullary high signal on MRI-T2WI in patients and bilateral cervical CLA in the patient’s lesion segment can be used as an indicator of disease severity in patients with cervical spondylotic myelopathy and a possible predictor of disease progression.