| ObjectiveTo determine the correlation between the signal in the spinal cord and the curative effect of single open door operation of Multilevel Cervical Spondylotic Myelopathy caused by spinal canal stenosis.MethodsA total of 68 patients who underwent single open door laminoplasty in the Department of Orthopaedics and Traumatology,Dade Road General Hospital of Guangdong Hospital of traditional Chinese Medicine from January 1,2017 to December 31,2019 were selected.Among those patients,51 cases were selected to meet the inclusion criteria.All patients had complete cervical MRI examination before and after operation,and were divided into different groups according to signal grade.The Maximum Canal Compromise,Maximum Spinal Cord Compression,Transverse Area and Compression Ratio,of the three groups were measured and recorded respectively.The effect of postoperative recovery was evaluated by modified Macnab scale.The Japan Orthopaedics Association,JOA evaluation index was used to calculate the neurological function and its improvement rate before,after and after the last follow-up.ResultsAccording to the signal grade,51 cases were divided into three groups(A、B、C):group A had no high signal change(n=14),group B had moderate fuzzy signal(n=28),and group C had high grade clear signal(n=9).There was no significant difference in age,sex,follow-up time and other basic data among the three groups(P>0.05).The median course of disease in group A was 183,365 days in group B and 2193 days in group C.The course of disease in group C was significantly longer than that in group A and B(P<0.05).CR:A group M(P25-P75)was 0.31(0.27,0.34),B group M(P25-P75)was 0.33(0.24,0.39),C group M(P25-P75)was 0.28(0.23,0.32).There was no significant difference among the three groups(P>0.05).TA:A group was 80.40±12.69mm2,B group was 68.90±9.65mm2 and C group was 49.01±8.70mm2.There were significant differences among the three groups(P<0.05).The average MSCC was 27.04%±7.97%in group A,36.36%±9.78%in group B and 56.02%±8.79%in group C.There were statistical differences among the three groups(P<0.05).The average MCC was 37.70%±9.54%in group A,49.63%±10.04%in group B,69.82%±10.26%in group C,and there was significant difference among the three groups(P<0.05).The results of JOA score before operation,after operation and the last follow-up:there were significant differences among groups A,B and C before operation,after operation and the last follow-up(all P<0.001).And in group A,group B and group C,preoperative(M)<postoperative(M)<last follow-up(M).Therefore,in the three groups,the JOA score increased after operation,and with the extension of time,the Joa value was higher.The lower the preoperative signal intensity,the higher the Joa value after operation.The stronger the signal intensity before operation,the worse the curative effect after operation.The results of modified Macnab score:in group A,14 cases were good(100.00%)and 0 cases were fair(0.00%).In group B,the score was good in 22 cases(78.57%)and fair in 6 cases(21.43%).In group C,the score was good in 3 cases(33.33%)and fair in 6 cases(66.67%).There were statistical differences among groups A,B and C(P<0.05).Comparison of signal grade distribution before and after operation:before operation,the signal intensity was grade 0 in 14 cases(27.45%),grade 1 in 28 cases(54.90%),and grade 2 in 9 cases(17.65%).After operation,there were 23 cases of signal grade 0(45.10%),21 cases of signal grade 1(41.18%)and 7 cases of signal grade 2(13.73%).There was no significant difference in the distribution of signal intensity before and after operation(Z=-1.653,P=0.104>0.05).The improvement rate of JOA after operation was(32.92±19.06)%in group A,(32.00±19.08)%in group B and(32.11±12.83)%in group C.there was no significant difference in postoperative improvement rate among groups A,B and C.The improvement rate of JOA at the last follow-up was 59.23%in group A,56.96%in group B and 67.22%in group C.there was no significant difference among groups A,B and C.Comparison between the change of signal intensity and the improvement rate of JOA after operation and follow-up.There was no significant difference in the improvement rate of JOA between the patients with decreased signal and those with unchanged signal after operation or in the last follow-up(P>0.05).Logistic multivariate regression analysis showed that the younger the age,the higher the CR,the lower the TA and the higher the MCC,the higher the signal grade.ConclusionThe preoperative MRI intramedullary signal grade is closely related to the neurological function after spine single-door laminoplasty.The more severe the spinal cord compression before operation,the stronger the MRI intramedullary signal intensity,and the worse the postoperative neurological function. |
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