| Part 1 Correlation of spinal cord compression angle and other imaging factors with increased spinal intensityObjective: To investigate the correlation between spinal cord compression angle,spinal cord compression ratio,spinal canal occupying rate,cervical motion,segmental motion,OPLL classification,cervical curvature and increased spinal intensity(ISI)in patients with ossification of posterior longitudinal ligament(OPLL).Methods: Retrospective analysis was performed on 118 patients with cervical OPLL who underwent surgical treatment in our hospital,and the classification was made according to the occurrence and shape of ISI in MRI-T2 WI phase.The patients with no hypersignal in the spinal cord were classified as grade 0,the patients with punctured hypersignal were classified as grade 1,and the patients with diffuse hypersignal were classified as grade 2.The patients were followed up for at least 1 year after surgery.The neurological function of the patients was evaluated using the Japanese Orthopaedic Association scoring method,and the recovery rate of neurological function was calculated.All patients underwent complete imaging examination.Spearman correlation analysis was used for correlation of spinal compression angle and other imaging factors with ISI,and logistic regression was used for multivariate analysis.Results:1.The preoperative JOA scores in grade 1 ISI group and grade 2 ISI group were lower than those in grade 0 ISI group(P<0.05).The 1 week and 1 year postoperative JOA scores and 1 year postoperative improvement rate in grade 1 ISI group were lower than those in grade 0 ISI group(P<0.05),and the 1 week postoperative JOA,1 year postoperative JOA,1 week postoperative improvement rate and 1 year postoperative improvement rate in grade 2 ISI group were lower than those in grade 0 ISI and grade 1 ISI group(P<0.05).2.The spinal cord compression angle of grade 1 ISI group and grade 2 ISI group was greater than that of grade 0 ISI group(P<0.05),and the spinal cord compression ratio of grade 1 ISI group and grade 2 ISI group was lower than that of grade 0 ISI group(P<0.05).There were no significant differences in OPLL classification and cervical curvature among the three groups(P>0.05).The maximum spinal canal occupying rate in grade 1 ISI group and grade 2 ISI group was greater than that in grade 0 ISI group(P<0.05),and the cervical motion and segmental motion in grade 2 ISI group were greater than that in grade 1 ISI and grade 0 ISI group(P< 0.05).3.There was no significant correlation between gender,age,BMI,OPLL classification,cervical curvature and ISI grade(P>0.05).Preoperative JOA score(r=-0.370,P<0.001)and spinal cord compression ratio(r=-0.379,P<0.001)were negatively correlated with ISI grade.The spinal cord compression angle(r=0.393,P<0.001),maximum spinal canal occupying rate(r=0.317,P<0.001),cervical motion(r=0.189,P=0.041),and segmental motion(r=0.242,P=0.008)were positively correlated with the grade of ISI.4.Preoperative JOA scores(β=-0.284,OR=0.752,95%CI: 0.602-0.940)and spinal cord compression angle(β=-0.043,OR=1.044,95%CI: 1.004-1.085)were independent factors influencing ISI grading(P<0.05).5.The spinal compression angle had a significant positive correlation with the maximum spinal canal occupying rate(r=0.343,P<0.001),and a significant negative correlation with the spinal cord compression rate(r=-0.491,P< 0.001).Conclusion:1.The presence of ISI on MRI-T2 WI of cervical spine is a manifestation of severe symptoms and poor prognosis,and early surgery can achieve good surgical results for those patients who have not yet had ISI in the spinal cord but have risk factors leading to ISI.2.The higher the grade of ISI,the larger the spinal cord compression angle,spinal canal occupying rate,cervical motion,segmental motion,and lower spinal cord compression ratio tended to appear on the imaging of patients.3.Spinal cord compression angle,maximum spinal canal occupying rate,cervical motion and segmental motion were significantly positively correlated with ISI grade.Preoperative JOA score and spinal cord compression ratio were significantly negatively correlated with ISI grade.4.Spinal cord compression angle and preoperative JOA are independent factors influencing ISI grade.5.The spinal cord compression angle is closely related to the spinal canal occupying rate and the degree of spinal cord compression.Part 2 Correlation of spinal cord compression angle and other imaging factors with clinical outcome in patients with ossification of posterior longitudinal ligamentObjective: To investigate the correlation of spinal cord compression angle,spinal cord compression ratio,spinal canal occupying rate,cervical motion and segmental motion with clinical efficacy in patients with ossification of posterior longitudinal ligament(OPLL).At the same time,multivariate analysis was performed to analyze the related factors affecting the therapeutic effect of cervical OPLL patients.Methods: Retrospective analysis was performed on 118 patients with cervical OPLL who underwent surgical treatment in our hospital,and they were divided into two groups according to the surgical approach.There were 66 patients who underwent anterior surgery and 52 patients who underwent posterior surgery.The patients were followed up for at least1 year after surgery.The neurological function of the patients was evaluated using the JOA scoring method,and the recovery rate of neurological function was calculated.All patients underwent cervical spine anterior-lateral and hyperextension and hyperflexion X-ray,CT three-dimensional reconstruction and MRI examination.Imaging indicators were measured and grouped to analyze the correlation between different imaging factors and clinical efficacy.The patients with improvement rate≥50% were regarded as the good effect group,and the patients with recovery rate<50% were regarded as the poor effect group.The general clinical data,laboratory test results and imaging results of patients with different surgical effects were compared to analyze the related factors affecting the surgical effect of patients with cervical OPLL.Results:1.The preoperative JOA score,JOA score at 1 week after surgery,JOA score at 1 year after surgery and rate of neurological function improvement at 1 year after surgery in the spinal cord compression angle≥35°group were all lower than those in the spinal cord compression angle<35° group(P<0.05).In the spinal cord compression angle<35° group,there was no significant difference in the rate of neurological function improvement among different surgical approaches(P>0.05).In the spinal cord compression angle≥35° group,the rate of neurological function improvement at 1 week and 1 year after surgery was lower in the patients undergoing posterior surgery than those undergoing anterior surgery(P<0.05).2.The preoperative JOA score,the JOA score at 1 week after surgery,the JOA score at 1 year after surgery,the rate of neurological function improvement at 1 week after surgery and the rate of neurological function improvement at 1 year after surgery in the spinal cord compression ratio<25° group were all lower than those in the spinal cord compression ratio≥25°group(P<0.05).In the spinal cord compression ratio≥25° group,there was no significant difference in the rate of neurological function improvement among different surgical approaches(P>0.05).In the spinal cord compression ratio<25° group,the rate of neurological function improvement at 1 week and 1 year after surgery were lower in the patients undergoing posterior surgery than those in the anterior surgery(P<0.05).3.JOA score at 1 week after surgery,JOA score at 1 year after surgery,neurological function improvement rate at 1 week after surgery and neurological function improvement rate at 1 year after surgery in the spinal canal occupying rate≥50% group were all lower than those in the spinal canal occupying rate<50% group(P<0.05).In the spinal canal occupying rate<50% group,the JOA score at 1 week after surgery and the rate of neurological function improvement at 1 year after surgery of the posterior surgery patients were lower than those of the anterior surgery patients(P<0.05).In the spinal canal occupying rate≥50% group,the rate of neurological function improvement at 1 week after surgery and 1 year after surgery in posterior approach group was lower than those in anterior approach group(P<0.05).4.There were no significant differences in preoperative and postoperative JOA scores and neurological function improvement rates between patients with cervical motion < 35°and ≥35° groups(P>0.05).There were no significant differences in postoperative neurological improvement rates among patients with different surgical approaches,no matter the cervical motion< 35° or ≥35°(P>0.05).5.Preoperative JOA score,JOA score at 1 week after surgery and JOA score at 1 year after surgery in the segmental motion≥10° group were all lower than those in the segmental motion<10° group(P<0.05),but there was no significant difference in the improvement rate of nerve function between the two groups(P>0.05).There were no significant differences in preoperative JOA score and postoperative neurological function improvement rate among patients with segmental motion<10° in different surgical approaches(P>0.05).In the group with segmental motion ≥10°,the JOA score at 1 year after surgery was lower in the patients undergoing posterior surgery than in the patients undergoing anterior surgery(P< 0.05),and there was no significant difference in the improvement rate of postoperative neurological function(P> 0.05).6.Univariate analysis found that the preoperative JOA scores of the poor efficacy group was lower(P<0.05),and there was no significant difference between the two groups in laboratory results(P>0.05).Imaging examination showed that the poor efficacy group had larger spinal cord compression angle,smaller spinal cord compression ratio,and was more prone to increased spinal intensity(ISI)(P<0.05).Multivariate regression analysis showed that preoperative JOA score(β=-0.297,OR=0.743,95%CI:0.572-0.965),spinal cord compression angle(β=1.088,OR=2.969,95%CI:1.200-7.347)and increased spinal intensity(β= 1.077,OR=2.936,95%CI: 1.106-7.791)were independent prognostic factors(P < 0.05).Conclusion:1.The clinical efficacy is relatively poor in patients with large spinal cord compression angle and spinal canal occupying rate and small spinal cord compression ratio.There was no significant correlation between cervical motion and clinical outcome.Patients with higher segmental motion had more severe clinical symptoms,but no significant difference in postoperative improvement.2.Anterior surgery can completely remove the lesion and relieve the clinical symptoms of patients.The long-term efficacy of anterior surgery is often better than that of posterior surgery for patients with large spinal cord compression angle,small spinal cord compression ratio and large spinal canal occupying rate.Posterior surgery can relieve clinical symptoms through indirect decompression.It is simple,convenient and has a wider indication,but cannot completely end the progression of OPLL.For patients with greater segmental motion,if posterior surgery is performed,it is necessary to evaluate whether internal fixation devices need to be implanted.3.Preoperative JOA score,spinal cord compression angle,and ISI are independent prognostic factors affecting the surgical outcome of patients.The spinal cord compression ratio was also associated with prognosis. |
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