颈髓MRI T2高信号改变类型与颈椎病再手术预后的关系

Relationship of changes in MR T2 image signal intensity with prognosis of patients underwent reoperation for cervical spondylotic myelopathy

目的探讨颈髓MRI T2高信号强度改变类型与颈椎病再手术患者预后的关系。方法颈椎前路融合术后症状复发或加重的患者17例行单开门椎管扩大椎板成形术。根据术后颈髓信号变化分为三组:A组3例,颈髓信号正常;B组9例,颈髓局部高信号;C组5例,颈髓长节段高信号。应用日本骨科学会(JOA)评分和Nurick分级评价患者再手术后神经功能和行走功能。分析颈髓MRI信号强度的变化与再手术后神经功能和行走功能的关系。结果术后随访13-52个月。三组术后JOA评分和Nurick分级均较术前改善(P<0.05)。A组术后Nurick评级平均改善1.6级,多于B组的1.3级和C组的0.5级(P<0.05)。A组术后神经功能改善率大于B、C组(71%vs.53%、39%)(P<0.05)。结论颈髓MRI T2高信号强度改变类型与再手术后疗效有关,多节段高信号改变者的预后不良。

Objective To evaluate the relationship between the changes in MRI T2 image signal intensity and the prognosis of patients underwent reoperation for cervical spondylotic myelopathy. Methods An open-door laminaplasty was performed in 17 patients, who had relapsed cerical spondylotic myelopathy after anterior decompression surgery before. On the basis of MRI image signal changes, the patients were divided into three groups of A（without change of image signal intensity, 3 cases）,B（with partional high image signal intensty, 9 cases） and C（with high image signal intensity in multiple levels, 5 cases）. The ability of walk and nerve function were evaluated by JOA scoring and Nurick grading. The relationship between the changes in MRI T2 image signal intensity and the ability of walk and nerve function after reoperation was analyzed. Results The patients were followed up for 15 to 36 months and JOA scores and walk ability were all improved in three groups. The Nurick grade in group A was improved by 1.6 in average, which was more than 1.3 in group B and 0. 5 in group C （P^0. 05）. The improvement rate in nerve function was higher in group A than that in groups of B and C（71% vs. 53% and 39%）（P^0. 05）. Conclusion The paterns of the changes in MRI T2 image signal intensity are closely associated with postoperative outcomes in the patients underwent reoperation for cervical spondylotic myelopathy and the patients with high image signal intensity in multiple levels have poor prognosis.