| Purpose:Cervical spondylotic myelopathy(CSM)is a common degenerative disease of the spine.Its main clinical manifestations include numbness and weakness of the limbs,unstable gait,and unfavorable fine movements.The recurrence of numbness and unstable gait has a serious impact on patients’ daily work and life.Magnetic Resonance Imaging(MRI)is an important test for the diagnosis of CSM,and the high intramedullary signal on MRI T2weighted images is considered to be a specific indication of pathological changes within the spinal cord,which has been reported to be an indicator of poor neurological status after surgical decompression in CSM patients.However,there is still some controversy in the current academic community regarding the exact prediction method.Posterior cervical single-opening enlargement kyphoplasty is a common procedure for the treatment of CSM.The aim of this study was to clarify the value of MRI-T2WI combined intramedullary highsignal staging in CSM patients in determining the prognosis of posterior cervical singleopening vertebral canal enlargement by analyzing its correlation with the prognosis of posterior cervical spine surgery in CSM patients.Methods:A total of 334 patients(227 males and 107 females)who were discharged from the Department of Spine Surgery,Qilu Hospital,Shandong University from January 2020 to September 2022 with the first diagnosis of CSM and treated with posterior cervical single-opening vertebroplasty were collected and grouped according to the changes of intramedullary high signal on MRI T2-weighted images.Firstly,the patients were grouped according to the intensity of the intramedullary high signal,which could be classified as:none,low brightness signal with blurred boundary,and high brightness signal with clear boundary.Secondly,the grouping was based on the longitudinal distribution range of the intramedullary high signal,which could be classified as:none,single segment,and multisegment.Combining the above two classification methods,the intensity and longitudinal distribution range of spinal cord high signal on MRI T2-weighted images were classified as:type 1(none/none)normal signal intensity,type 2(single segment/fuzzy)low brightness intramedullary high signal with longitudinal distribution range less than or equal to one disc height and fuzzy boundary,type 3(single segment/clear)longitudinal distribution range less than or equal to one disc height type 3(single segment/clear)with a longitudinal distribution less than or equal to one disc height and well-defined borders of high-intensity intramedullary hyperintensity,type 4(multisegmental/ambiguous)with a longitudinal distribution greater than one disc height and poorly defined borders of low-intensity intramedullary hyperintensity,and type 5(multisegmental/clear)with a longitudinal distribution greater than one disc height and well-defined borders of high-intensity intramedullary hyperintensity.The following parameters were collected and studied:gender,age,personal history,past history,Body Mass Index(BMI),duration of disease(months),presence of fine motor difficulties,presence of sensory planes,presence of dysfunction,presence of gait changes,grip strength,intraoperative anesthesia time(minutes),postoperative length of stay(days),spinal cord compression ratio(Compression Ratio(CR),Maximum Canal Compromise(MCC),Maximum Spinal Cord Compression(MSCC),The ratio of cervical spinal cord to dural sac(RCSCDS),presence of snake eye sign,Nurick score,preoperative Japanese Orthopedic Association(JOA)score,postoperative JOA score,preoperative cervical spine dysfunction index(Neck Disability Index(NDI)score,postoperative NDI score,neurological recovery rate,and preoperative MRI T2-weighted images of intramedullary high signal intensity and longitudinal distribution range.In the analysis of statistical differences between more than two groups,chi-square test and nonparametric test were used according to the type of data.The effect of each variable on the rate of postoperative neurological recovery was investigated using the spearman rank correlation test,and finally a stepwise regression method was used to construct a predictive model regarding the rate of postoperative neurological recovery.Results:Nonparametric tests showed that all three staging methods mentioned above had significant correlation with the postoperative neurological recovery rate of CSM.Moreover,Spearman’s rank correlation test showed that the factors that were significantly associated with the postoperative neurological recovery rate of patients were age(rS=-0.770;P<0.05),disease duration(rS=-0.947;P<0.05),intraoperative anesthesia time(rS=-0.770;P<0.05),postoperative length of stay(rS=-0.532;P<0.05),Nurick score(rS=-0.567;P<0.05),preoperative NDI score(rS=-0.659;P<0.05),preoperative JOA score(rS=0.759;P<0.05),MCC(rS=-0.647;P<0.05),MSCC(rS=-0.595;P<0.05),and CR(rS=0.695;P<0.05)and RCSCDS(rS=0.590;P<0.05).In addition,stepwise regression analysis confirmed the significance of the type of intramedullary high-signal joint classification as a predictor of surgical outcome.The multiple linear regression equation(R2=0.773;P<0.05)was as follows:neurological recovery rate=74.577-3.087(combined intramedullary high-signal classification type)-0.543(age)-0.342(disease duration)+1.768(preoperative JOA score).Conclusion:This study verified the high correlation between clinical symptoms and imaging indices on MRI-T2-weighted images of the cervical spine and the prognosis of posterior cervical spine surg’ery in patients with CSM.It was also found that the combined fractionation of intramedullary high signal on cervical MRI-T2WI correlated more closely with the prognosis of posterior cervical spine surgery in patients with CSM than the change in signal intensity or the change in longitudinal extent of signal alone.Therefore,combined fractionation of cervical MRI-T2WI intramedullary high signal can be a meaningful predictor of the outcome of posterior cervical spine surgery in patients with CSM. |
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