| ObjectiveCSM (cervical spondylotic myelopathy, CSM) as a common clinical disease is the main reason for spinal cord dysfunction, common for adults. Often due to cervical degeneration, spinal cord compression caused by spinal stenosis, spinal cord blood circulation disorders caused by series of clinical symptoms and signs. Usually presents with different degrees of sensory, motor dysfunction, conservative treatment is often ineffective. Clinically, such as the poor results after conservative treatment or severe clinical symptoms usually require surgery. With the development of Medical Imaging, particularly in the development of MRI, it plays an important role in accurate diagnosis cervical spinal cord, a clear image and clinical symptoms and signs with more to ensure that the CSM and accurate preoperative diagnosis. CSM has been treated widely with surgical treatment, including anterior approach,posterior approach,anterior-posterior united approach.In the actual clinical work, often by the surgeon evaluation of patients with clinical symptoms and imaging findings, based on the existing work experience to determine what surgical approach,lack of standardized,quantifiable indicators, subjective nature, arbitrary. In this study, the indicators of imageological measurement for cervical spondylotic myelopathy, combined with the program of three surgical preoperative and postoperative data for statistical analysis, imageological measurement indicators derived discriminant function to investigate the cervical spondylotic myelopathy imaging measurements in the anterior, posterior, anterior-posterior surgical guidance for the choice. So that, before surgery, the choice of surgical approach of the patients who had suffer from cervical spondylotic myelopathy is more standardized and quantified.MethodsThe cases with cervical spondylotic myelopathy from October 2008 to January 2010 underwent surgery in our hospital, as a cases of retrospective analysis group, selected patients had a complete medical history, with preoperative and postoperative JOA score (Japanese Orthopedic Association), with a complete X-ray, CT, MRI image data, selected a total of 71 cases of which 27 cases of anterior approach and posterior approach surgery in 23 cases, anterior-posterior united approach in 21 cases. Medical records of 71 cases, imaging data compilation, analysis, summary of the imaging features, select seven indexes of cervical spondylotic myelopathy which common and preoperative often considered: 1) cervical vertebra curvature change; 2) cervical vertebra instability; 3) The effective cervical spinal canal ratios; 4) the existence of local ossification; 5) the plumpness of ligamenta flava; 6) the degree of spinal cord compression; 7) spinal cord high signal on T2WI. Each of these seven variables to set the range, and determine and record the variable values. Use the full model method discriminant analysis which is one method of discriminant to analyze, work out the discriminant function and discriminant coincidence rate of anterior approach, posterior approach, anterior-posterior united approach. We also analyzed 71 patients with preoperative and postoperative JOA score and the rate of the improved JOA score(RIS, the rate of the improved JOA score = (post-treatment score -pre-treatment score) / (17-pre-treatment score)×100%); analyzed the JOA score of before and after operation by the paired samples t test (Paried-Sample T Test). Used the discriminant function obtained by retrospective analysis group in February in 2010 to August in 2010 of the proposed surgical treatment of cervical myelopathy patients, a total of 33 cases, as a prospective analysis of group, including anterior approach, 12 cases, posterior approach in 11 cases, anterior-posterior united approach in 10 cases. All of the cases were in the preoperative X ray, CT, MRI examination, and preoperative JOA score statistics, used 7 imaging measurement indexes of prospective group cases in discriminant function generated by retrospective analysis to calculate the anterior approach, posterior approach, and anterior-posterior united approach scores, with the highest score of the surgical operation approach as selected for surgical treatment. In after 2 weeks, 2 months, 6 months for each group of patients with prospective patients were be rechecked and follow-up, while continuing to follow-up retrospective group patients: routine X-ray examination (including cervical spine anteroposterior and lateral film), and some cases underwent CT, MRI check; observed conditions of internal fixation, fusion, recording the clinical symptoms and signs, and recovery of neurological function, and to record postoperative JOA scores. The same application of discriminant analysis method in the prospective analysis group of full model imaging data for statistical analysis, work out anterior approach, posterior approach, anterior-posterior united approach group's discriminant coincidence rate. The preoperative and postoperative JOA score of prospective analysis group also underwent paired sample t test. Finally, statistical analyzed the rate of improved JOA score both the retrospective analysis group and the prospective analysis group by Independent-Samples T Test.ResultsImaging measurement data of the retrospective analysis group by discriminant analysis obtained discriminant function and discriminant coincidence rate of anterior approach, posterior approach, anterior-posterior united approach. The discriminant coincidence rate of retrospective analysis group's anterior approach was 96.3%, in which 82.6% for retrospective analysis group's posterior approach and 76.2% for retrospective analysis group's anterior-posterior united approach. Through discriminant function of retrospective analysis group guided the prospective analysis group to select surgical approach, and calculated the discriminant coincidence rate of anterior, posterior, anterior-posterior united approach all three surgical methods by discriminant analysis: The discriminant coincidence rate of prospective analysis group's anterior approach was 83.3%; in which 81.8% for prospective analysis group's posterior approach and 90% for prospective analysis group's anterior-posterior united approach. Both the retrospective group and prospective group, preoperative and postoperative's JOA scores underwent T-test, the statistical results for the P values were <0.0001, in accordance with the standards of a = 0.05, indicated which have statistical significance. Independent-Samples T Test was used to compare the rate of the improved JOA score Of the retrospective and prospective group, statistical results were P <0.0001, in accordance with the standards of a = 0.05, the rate of the improved JOA score have statistically significant. Complications: in retrospective group's patients, the cerebrospinal fluid leakage occurred in 2 cases, healed well after treatment; prospective group's patients with no complications. The clinical and radiological follow-up data show that in all cases there was no loosening of internal fixation, no movement or breakage, postoperative clinical symptoms and signs were significantly improved.ConclusionAfter measurement data of retrospective group's medical imaging underwent discriminant analysis, we could obtain discriminant functions of anterior approach, posterior approach, and anterior-posterior united approach, which can be used in preoperative to choice surgical approach for patients who suffered from cervical spondylotic myelopathy. Hereby, cervical spondylotic myelopathy as to make preoperative selection of surgical approach is more quantified and standardized. |
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