BACKGROUND CONTEXT

High cord signals (HCS) are common in patients undergoing surgery for degenerative cervical myelopathy (DCM). Few studies have investigated the prognostic effects of postoperative HCS changes.

PURPOSE

To investigate whether different changes in the postoperative magnetic resonance imaging (MRI) T2-weighted images (T2WIs) signal intensity ratio (SIR) is related to patient outcomes, predictors of unsatisfactory recovery, and the factors associated with changes in postoperative SIR.

STUDY DESIGN

A retrospective chart review at a single institution.

PATIENT SAMPLE

The study population included all consecutive patients who showed HCS in preoperative MRI T2WIs and underwent double-door laminoplasty for DCM from December 2017 to December 2020.

OUTCOME MEASURES

Patient self-reported measures included the Japanese Orthopedic Association (JOA) score, 36-Item Short Form Survey (SF-36) physical component score, and SF-36 mental component score. Imaging measures included SIR, length of HCS, and canal narrowing ratio (CNR).

METHODS

We reviewed patient records and analyzed the statistical associations of MRI T2WI measures with the JOA score, SF-36 physical, and mental component scores.

RESULTS

Fifty-three patients were categorized into three groups based on the postoperative HCS changes, identified from MRI T2WI before and after surgery: reduced (Group A, N=26); unchanged (Group B, N=12); and increased (Group C, N=15). The neurological recovery rates 12 months after surgery were 67.72%±17.45% in Group A, 51.53%±16.00% in Group B, and 13.35%±21.35% in Group C (p<.001). Significant differences across the three groups were found in symptom duration, postoperative SIR and length of HCS, pre- and postoperative CNR, recovery rate, JOA, SF-36 scores, with patients in Group C having the worst outcomes. Longer DCM symptom duration, greater preoperative CNR, and increased postoperative HCS were prognostic factors for a recovery rate<50%. Preoperative CNR, with an optimal threshold of 57.303%, was an independent risk factor for increased postoperative HCS.

CONCLUSIONS

Less than one-third of DCM patients with preoperative HCS exhibited an increase in HCS after double-door laminoplasty and reported worse outcomes at the 12-month follow-up when compared to patients with decreased or unchanged postoperative HCS.

中文翻译：

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术后 MRI T2WI 高信号强度增加对退行性脊髓型颈椎病预后的影响

背景语境

高脊髓信号 (HCS) 在接受退行性脊髓型颈椎病 (DCM) 手术的患者中很常见。很少有研究调查术后 HCS 变化的预后影响。

目的

调查术后磁共振成像 (MRI) T2 加权图像 (T2WIs) 信号强度比 (SIR) 的不同变化是否与患者预后、恢复不理想的预测因素以及与术后 SIR 变化相关的因素有关。

学习规划

单个机构的回顾性图表审查。

患者样本

研究人群包括 2017 年 12 月至 2020 年 12 月期间术前 MRI T2WI 显示 HCS 并接受双门椎板成形术治疗 DCM 的所有连续患者。

结果测量

患者自我报告的指标包括日本骨科协会 (JOA) 评分、36 项简短调查 (SF-36) 身体成分评分和 SF-36 心理成分评分。成像指标包括 SIR、HCS 长度和根管狭窄率 (CNR)。

方法

我们回顾了患者记录并分析了 MRI T2WI 测量值与 JOA 评分、SF-36 身体和心理成分评分的统计关联。

结果

根据手术前后 MRI T2WI 确定的术后 HCS 变化，将 53 名患者分为三组：减少（A 组，N=26）；不变（B组，N=12）；并增加（C 组，N=15）。术后 12 个月神经功能恢复率 A 组为 67.72%±17.45%，B 组为 51.53%±16.00%，C 组为 13.35%±21.35% (p<.001)。三组患者在症状持续时间、术后 SIR 和 HCS 长度、术前和术后 CNR、恢复率、JOA、SF-36 评分方面存在显着差异，C 组患者的预后最差。较长的 DCM 症状持续时间、较高的术前 CNR 和术后 HCS 增加是恢复率 <50% 的预后因素。术前 CNR，最佳阈值为 57.303%，

结论

与术后 HCS 减少或不变的患者相比，术前 HCS 不足三分之一的 DCM 患者在双门椎板成形术后表现出 HCS 增加，并且在 12 个月的随访中报告的结果更差。