颈前路椎间盘切除减压植骨融合术后患者颈长肌和颈伸肌的影像观察

Imaging observation of cervical longus and cervical extensor muscles in patients after anterior cervical discectomy,decompression,and bone graft fusion surgery

目的观察脊髓型颈椎病患者接受颈前路椎间盘切除减压植骨融合术(anterior cervical discectomy and fusion,ACDF)术后的颈长肌和颈伸肌变化情况,并分析颈长肌和颈伸肌的术后变化与ACDF手术疗效的相关性。方法以该科2016年6月~2021年6月开展单节段ACDF手术的62例脊髓型颈椎病患者作为研究对象,分别于术前、术后3个月、术后1年和末次随访时,进行VAS评分、mJOA评分和NDI指数等疗效指标评价;同时,采用颈椎MRI T2加权像检查并测量其颈长肌和颈伸肌的横截面积(cross section area,CSA),颈长肌的最长径/最短径比值(ratio of long and short lines,RLS)以及颈长肌和颈伸肌的容积。采用Pearson相关性系数对颈长肌和颈伸肌容积与上述疗效指标进行相关性分析。结果62例患者均成功完成单节段ACDF手术且获访24~30个月、平均25.9个月。与术前相比,患者术后3个月、1年和末次随访时的颈肩痛VAS评分、mJOA评分和NDI指数均显著改善(P<0.05)。末次随访时采用Odom标准评价,优38例,良22例,可2例。与术前相比,所有患者术后3个月、1年和末次随访时的颈长肌CSA和颈长肌容积均显著减少(P<0.05),术后3个月、1年和末次随访时的颈长肌RLS均显著增加(P<0.05);颈伸肌CSA和颈伸肌容积在手术前和术后各时间的变化无显著性差异(P>0.05)。经Pearson相关性分析显示,术后3个月、术后1年和末次随访的颈长肌容积与同时期的VAS评分和NDI指数均呈负相关性(P<0.05),与mJOA评分无明确相关性(P>0.05);而颈伸肌容积与同时期的VAS评分、NDI指数和mJOA评分均无明确的相关性(P>0.05)。结论脊髓型颈椎病患者行ACDF手术后,颈长肌可出现一定程度退变,颈伸肌的退变并不显著。颈长肌的退变可对手术预后产生不利影响。

Objective To observe the changes of cervical longus and cervical extensor muscles after anterior cervical discectomy and fusion(ACDF)in patients with spinal cord-type cervical spondylosis,and to analyze the correlation between the postoperative changes of cervical longus and cervical extensor muscles and the efficacy of ACDF surgery.Methods Sixty-two patients with spinal cord-type cervical spondylosis who underwent single-segment ACDF surgery in our department from June 2016 to June 2021 were studied,and the efficacy indexes such as VAS score,mJOA score and NDI index were evaluated before surgery,3 months,1 year and at the final follow-up,respectively;meanwhile,cervical MRI T2-weighted images were used to examine and measure the cervical longus and cervical extensor muscles.The cross section area(CSA),the ratio of long and short lines(RLS)and the volume of the long and extended cervical muscles were measured using T2-weighted MRI.Pearson’s correlation coefficient was used to correlate the volume of cervical longissimus and cervical extensor with the above efficacy indexes.Results All 62 patients successfully completed single-segment ACDF surgery and were followed up for 24-30 months with a mean of 25.9 months.The VAS score,mJOA score and NDI index of neck and shoulder pain were significantly improved 3 months,1 year and at the last follow-up compared with those before surgery(P<0.05).At the final follow-up,38 patients were evaluated using the Odom criteria,38 were excellent,22 were good,and 2 were acceptable.Compared with the preoperative period,the cervical longissimus muscle CSA and cervical longissimus volume were significantly reduced(P<0.05),and the cervical longissimus RLS significantly increased(P<0.05)in all patients 3 months,1 year and at the final follow-up after surgery;there was no significant difference in the changes of cervical extensor CSA and cervical extensor volume at the preoperative and postoperative time points(P>0.05).Pearson correlation analysis showed that cervical longissimus muscle volume 3 months,1 year postoperatively and at the final follow-up was negatively correlated with VAS score and NDI index at the same time(P<0.05)and not clearly correlated with mJOA score(P>0.05);while cervical extensor muscle volume was not clearly correlated with VAS score,NDI index and mJOA score at the same time(P>0.05).Conclusion After ACDF surgery in patients with spinal cord cervical spondylosis,degeneration of the long cervical muscles may occur to some extent,while degeneration of the cervical extensor muscles is not significant;degeneration of the long cervical muscles may adversely affect the prognosis of the surgery.