| Objectives:To analyze the correlation between early postoperative MRI T2 WI hypersignal changes and clinical efficacy in patients with multilevel cervical spondylotic myelopathy（MCSM）treated with double door laminoplasty,and to explore its impact on clinical prognosis.Background:With the change of lifestyle and the arrival of population aging,cervical spondylotic myelopathy caused by cervical degeneration is becoming more and more common,causing neurological dysfunction and seriously affecting people’s health and quality of life.Posterior cervical double door laminoplasty is one of the most important methods for the treatment of MCSM.At present,the research on the influencing factors of the clinical efficacy of double door laminoplasty in the treatment of MCSM mostly focuses on the postoperative spinal canal expansion rate,the change of cervical curvature and complications.We found that patients with postoperative spinal cord MRI T2 WI high signal enhancement had poor clinical efficacy.The research on the changes of MRI T2 WI spinal cord signal mostly focuses on the impact of preoperative high signal changes on the prognosis,while ignoring the impact of postoperative high signal changes on the prognosis.Therefore,this study aims to explore the impact of early spinal cord MRI T2 WI high signal changes on the prognosis after double door laminoplasty in the treatment of MCSM.Methods:218 patients with MCSM who underwent double door laminoplasty in our hospital from December 2017 to December 2020 were retrospectively analyzed.165 cases were excluded according to the exclusion criteria.Finally,53 cases with MRI T2 WI high signal in the preoperative spinal cord were included in the study.According to the changes of high signal intensity ratio（SIR）on postoperative spinal cord MRI T2 WI,the patients included in the study were divided into high cord signals（HCS）weakening group,constant group and enhancement group.Clinical and imaging data were collected,including age,gender,duration of symptoms,preoperative and postoperative sir,preoperative and postoperative vertical length of HCS,preoperative canal narrowing ratio（CNR）on MRI,JOA score,neurological recovery rate（RR%）,SF-36 score at 1 week,1 month,3 months,6 months and 12 months follow-up,preoperative and postoperative MRI axial T2 WI high signal morphology,and statistical analysis was carried out to explore the effect of postoperative HCS changes on the curative effect.Results:（1）Postoperative T2 WI Sir decreased in 26 cases（49.1%）,unchanged in 12cases（22.6%）and enhanced in 15 cases（28.3%）.（2）The 12-month follow-up RR% of the weakening group was 67.72 ±17.45%,the unchanged group was 51.53 ± 16.00%,and the enhancement group was13.35 ± 21.35%.There was significant difference in the improvement rate between the enhancement group and the weakening group and the unchanged group（P <0.05）,but there was no statistical significance between the weakening group and the unchanged group（P > 0.05）.（3）The preoperative CNR in the weakening group was（50.86 ± 7.81）%,the unchanged group was（56.03 ± 7.63）%,and the enhancement group was（63.57 ±3.93）%.There was only significant difference between the weakening group and the enhancement group（P < 0.001）.（4）The duration of symptoms in the weakening group was（8.5 ± 9.26）months,the unchanged group was（12.92 ± 6.26）months,and the enhancement group was（29.07 ± 59.48）months.There was significant difference between the weakening group and the enhancement group and the unchanged group（P < 0.05）,but there was no significant difference between the enhancement group and the unchanged group（P > 0.05）.（5）RR%≥50% had a good prognosis and<50% had no poor prognosis.The related factors affecting the prognosis were analyzed by binary logistic regression.There were significant differences in symptom duration,postoperative Sir changes and preoperative CNR（P < 0.05）;Multivariate ordered logistic regression analysis showed that there was significant difference in preoperative CNR（P < 0.05）,and the critical value of CNR was 57.303% by using the Jordan index of ROC curve.（6）MRI axial spinal cord hyperintensity group was mainly diffuse type（15/26,57.7%）,unchanged group was mainly cyclops（6/12,50%）,and enhanced group was mainly snake-eye type.Mainly（9/15,60%）,the patients with poor prognosis were mainly snake-eye type（11/20,55%）,and those with good prognosis were mainly diffuse（16/33,58.5%）.Difference between groups P>0.05.Conclusions:（1）Posterior cervical double-door laminoplasty for the treatment of MCSM with increased T2 WI spinal cord hyperintensity,poor postoperative recovery of neurological function,even worsening of symptoms,and poor prognosis.（2）The increase of spinal cord high signal on MRI T2 WI usually occurs between 2 weeks and 3 months after surgery.（3）Long duration of symptoms,postoperative T2WI spinal cord hyperintensity enhancement,and larger preoperative CNR indicate poor prognosis;preoperative CNR is the same as postoperative T2 WI.（4）An independent risk factor for spinal cord hyperintensity enhancement.When the preoperative CNR is greater than 57.303%,T2WI hyperintensity CSM patients should be highly alert to postoperative T2 WI spinal cord hyperintensity after double-door surgery,and the prognosis may be poor.（5）Axial spinal cord hyperintensities with poor prognosis after double-door surgery were mainly snake-eye type,and those with good prognosis were mainly diffuse. |
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