| Purpose:Cervical spondylotic myelopathy(CSM)is a common disease in spinal surgery and a major cause of spinal dysfunction in adults.In the imaging examination of patients with CSM,an increased signal intensity is often found in the spinal cord at the diseased segment on MRI-T2WI.This study aims to explore the relationship between intramedullary hyperintensity and surgical prognosis of patients with CSM on MRI-T2WI,and at the same time investigate independent risk factors of intramedullary hyperintensity,so as to provide theoretical guidance for individualized diagnosis and treatment of patients with CSM and intramedullary hyperintensity.Methods:In this study,206 CSM patients admitted to Qilu Hospital of Shandong University from January 2020 to September 2022 who met the inclusion and exclusion criteria for surgical treatment were divided into 3 groups according to MRI-T2WI hyperintensity grade of spinal cord,including 96 patients in grade 0 hyperintensity group,65 patients in grade 1 hyperintensity group,and 45 patients in grade 2 hyperintensity group.According to clinical cases,imaging data and follow-up results,gender,age,duration of the disease,personal history,past history,degree of intervertebral disc degeneration,cervical curvature,cervical range of motion,spinal cord compression,preoperative and postoperative JOA score of patients were collected and analyzed.The surgical prognosis of patients in different hyperintensity grade groups was compared and verified by propensity score matching(PSM).At the same time,ordered Logistic regression analysis was used to investigate independent risk factors of intramedullary hyperintensity.Results:In the baseline data of the first three high-signal grade groups before PSM treatment,there were statistically significant differences in the duration of disease,cervical range of motion and spinal cord compression(P<0.05),while there were no statistically significant differences in gender,age,personal history,past history,degree of intervertebral disc degeneration,cervical curvature and surgical method(P>0.05).The JOA improvement rates at 6 months after surgery and at the last follow-up were 62.3 00±17.74%and 68.66±16.19%,62.81±17.34%and 68.98±15.41%,53.61±13.90%and 61.73±13.86%in grade 0,Grade 1 and grade 2 hyperintensity groups.The improvement rate of JOA in grade 2 hyperintensity group was significantly lower than that in grade 0 and grade 1 hyperintensity group,and the difference was statistically significant(P<0.05).After PSM treatment,19 cases in each of the hyperintensity groups were matched successfully,and baseline data between groups was balanced without statistical difference(P>0.05).The JOA improvement rates at 6 months after surgery and at the last follow-up were 61.20±15.22%and 64.76±14.48%,62.05±14.40%and 65.91±11.24%,50.62±11.05%and 55.22±11.65%in grade 0,1 and 2 hyperintensity groups.The JOA improvement rate of Grade 2 hyperintensity group was also lower than that of grade 0 and grade 1 hyperintensity group,and the difference was statistically significant(P<0.05).Ordered Logistic regression analysis showed that disease duration(P<0.05),cervical range of motion(P<0.05)and spinal cord compression(P<0.01)were independent risk factors for intramedullary hyperintensity.Conclusion:preoperative hyperintensity grade of spinal cord is significantly correlated with the surgical prognosis of patients with CSM.The surgical prognosis of grade 2 hyperintensity patients is poor,and there is no significant difference between grade 0 hyperintensity patients and grade 1 hyperintensity patients.The longer the duration of the disease,the greater the cervical range of motion,and the greater the degree of spinal cord compression,the greater the likelihood of higher-grade hyperintensity in the spinal cord of patients with CSM. |
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