术前常规MRI+颈椎矢状面参数预测神经根型颈椎病术后病情转归价值及对手术治疗指导意义分析

Preoperative Conventional MRI+Cervical Sagittal Plane Parameters in Predicting the Prognosis of Cervical Radiculopathy after Surgery and Analysis of Its Guiding Significance for Surgical Treatment

目的分析术前常规MRI+颈椎矢状面参数预测神经根型颈椎病术后病情转归价值及对手术治疗指导意义,以期为临床早期针对性制定干预方案提供参考。方法选取2020年1月~2022年6月我院收治的249例神经根型颈椎病患者,根据术后6个月日本骨科学会(JOA)评分改善率将患者分为病情转归良好组(n=211,JOA改善率>50%)、不良组(n=38,JOA改善率≤50%)。比较两组术前常规MRI+颈椎矢状面参数[受累节段数量、脊髓水肿/变性、C2~7 Cobb角、C1~7矢状面轴向距离(SVA)、C2~7 SVA、T1倾斜角(T1S)、椎间孔宽度、T1倾斜角与颈椎前凸角的差值(T1S-CL)、节段前凸(SL)],Pearson分析C2~7 Cobb角、T1S、椎间孔宽度、T1S-CL与术后6个月JOA评分关系,偏相关性分析术后6个月JOA评分相关因素,受试者工作特征曲线(ROC)分析术前常规MRI+颈椎矢状面参数预测术后病情转归价值。结果不良组脊髓水肿/变性患者占比、T1S、T1S-CL高于良好组,C2~7 Cobb角、椎间孔宽度低于良好组(P<0.05);T1S、T1S-CL与术后6个月JOA评分呈负相关,C2~7 Cobb角、椎间孔宽度与术后6个月JOA评分呈正相关(P<0.05);偏相关性分析显示,脊髓水肿/变性、C2~7 Cobb角、T1S、椎间孔宽度、T1SCL均与术后6个月JOA评分相关(P<0.05);脊髓水肿/变性、C2~7 Cobb角、T1S、椎间孔宽度、T1S-CL预测病情转归AUC分别为0.647、0.797、0.802、0.767、0.750,各参数联合预测AUC为0.913,敏感度为94.74%,特异度为78.67%。结论术前常规MRI+颈椎矢状面参数可用于神经根型颈椎病术后病情转归预测评估中,临床可通过其制定术前手术方案,以改善术后病情转归。

Objective To analyze the value of preoperative routine MRI+cervical sagittal plane parameters in predicting postoperative outcome of cervical radiculopathy and its guiding significance for surgical treatment,so as to provide reference for making targeted intervention programs in early clinical stage.Methods 249 patients with radicular cervical spondylosis admitted to our hospital from January 2020 to June 2022 were selected and divided into good group(n=211,JOA improvement rate>50%)and bad group(n=38,JOA improvement rate≤50%)according to the improvement rate of Japanese Orthopaedic Association(JOA)6 months after surgery.Preoperative conventional MRI+cervical sagittal plane parameters(number of involved segments,spinal edema/degeneration,C2-7 Cobb Angle,C1-7 sagittal plane axial distance(SVA),C2-7 SVA,T1) were compared between the two groups Inclination Angle(T1S),width of foraminal,difference between inclination Angle of T1 and lordosis Angle of cervical spine(T1sCl),segmental lordosis(SL),Pearson analyzed the relationship between C2-7 Cobb Angle,T1S,width of foraminal,T1s-Cl and JOA score 6 months after surgery,and partial correlation analysis of factors related to JOA score 6 months after surgery.Receiver operating characteristic curve(ROC)was used to analyze the predictive value of preoperative conventional MRI+cervical sagittal plane parameters for postoperative outcomes.Results The proportion of patients with spinal edema/degeneration,T1S and T1s-Cl in poor group were higher than those in good group,and the C2-7 Cobb Angle and the width of foramina in poor group were lower than those in good group(P<0.05).T1S and T1s-Cl were negatively correlated with JOA score 6 months after surgery,and C2-7 Cobb Angle and foraminal width were positively correlated with JOA score 6 months after surgery(P<0.05).Partial correlation analysis showed that spinal cord edema/degeneration,C2-7 Cobb Angle,T1S,foraminal width,t1s-Cl were correlated with JOA score 6 months after surgery(P<0.05).Spinal cord edema/degeneration,C2-7 Cobb Angle,T1S,foraminal width,and T1s-Cl predicted the outcome AUC of the disease to be 0.647,0.797,0.802,0.767,and 0.750,respectively.The combined prediction AUC was 0.913,sensitivity 94.74%,and specificity 78.67%.Conclusion Preoperative conventional MRI+cervical sagittal plane parameters can be used to predict and evaluate the postoperative prognosis of cervical radiculopathy,which can be used in the clinical development of preoperative surgical plan to improve the postoperative prognosis.