| Purpose:To investigate the correlation between preoperative MRI intramedullarry signal intensity ? measurement parameters and postoperative effective of Anterior Decompression and Fusion(ADF)in the treatment of Cervical Spondylotic Myelopathy(CSM).Method: From 2012 January to 2017 January,47 patients with cervical spondylotic myelopathy who underwent ADF in spinal surgery of our hospital were included in this study.Among them,35 cases were Anterior Cervical Corpectomy and Fusion(ACCF),12 cases were Anterior Cervical Disectomy and Fusion(ACDF).Of these,25(53.2 %)were male and 22(46.8 %)were female,aged 32 to 68 years,average 52.19±8.37 years,the duration of the disease was 0.2~120 months,with an average 32.06±41.61 months,follow-up period was 3~24 months,with an average of 11.31±4.13 months.All patients were performed preoperative and postoperative MRI imaging,and the patients were grouped by Yukawa method.In group A,there were 21 cases(normal signal),group B were 20 cases(fuzzy signal),group C were 6 cases(high signal),respectively measuring sagittal parameters:Maximum Canal Compromise(MCC)?Maximum Spinal Cord Compression(MSCC);axial parameters:Compression Ratio(CR)?Transverse Area(TA).JOA score system was used to evaluate preoperative and postoperative neurofunction,and the relationship between preoperative intramedullary signal intensity,spinal cord compression and postoperative neurofunction was analyzed.Results: MRI parameters of each group were as follows:MSCC:(21.4±15.0)% in group A,(33.2±15.2)% in group B,and(59.0±15.7)% in group C,There were statistical differences(P value were 0.02?0.003 respectively);MCC: group A was(43.0±11.6)%,group B was(52.7±10.1)%,group C was(70.0±14.5)%.There were statistical differences(P value were 0.007?0.01 respectively);CR: 0.45±0.11 in group A,0.40±0.08 in group B and 0.37±0.21 in group C.There were no statistical differences(P value were 0.21,0.31 respectively).TA: group A was(72.9±13.5)mm2,group B was(61.9±13.0)mm2,group C was(43.1 ± 12.9)mm2 with statistical difference(P value were 0.01 ? 0.007 respectively);Preoperative JOA score: group A was 12.6±3.3,group B was 11.4±3.0,group C was 8.2±3.1,there was a statistical difference between group B and group C(P = 0.034);postoperative JOA score: group A was 15.0±1.7,group B was 14.0±2.6,group C was 10.8±3.0,group B was statistically different from group C(P = 0.024);Postoperative recovery rate: group A was(58.3±21.0)%,group B was(52.3±18.0)%,group C was(33.6±12.1)%,group B and group C had statistical difference(P=0.013);The correlation between parameters and postoperative outcomes was determined by progressive multivariate linear regression analysis: post-m JOA =4.169 + 0.816×preoperative JOA score-0.390×ISI+0.018×MCC-0.005×symptom duration(r2 = 0.958,P<0.001).Conclusion: Preoperative MRI signal intensity of the spinal cord with cervical spondylotic myelopathy postoperative outcome is significantly related to treatment with anterior decompression fusion,intramedullary signal intensity is higher,the postoperative curative effect is poorer,Postoperative efficacy was significantly correlated with preoperative JOA score,intramedullary signal intensity(ISI),maximum canal compromise(MCC)and duration of the disease.We recommend surgical treatment when the patient's intramedullary signal intensity(ISI)is at level 1,the outcome is better. |
PDF Full Text Request