Changes in Intramedullary Increased Signal Intensity on Axial T2-weighted MRI After Laminoplasty for Cervical Spondylotic Myelopathy: A 10-year Follow-up Study.

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Spine Surgery Pub Date : 2025-03-01 Epub Date: 2024-07-25 DOI:10.1097/BSD.0000000000001654

Tenghui Ge, Linzhen Xie, Jianing Li, Jile Jiang, Yuqing Sun

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Abstract

Study design: A retrospective study.

Objective: To investigate whether the preoperative classification and changes in the intramedullary increased signal intensity (ISI) on axial T2-weighted magnetic resonance imaging (MRI) reflect the postoperative functional outcome in patients after laminoplasty for cervical spondylotic myelopathy (CSM).

Summary of background data: Although patients with CSM exhibit ISI on axial MRI, the association between ISI (preoperative classification and changes) and surgical outcomes has not been investigated.

Patients and methods: We retrospectively included patients with CSM who underwent MRI preoperatively and at least 10 years postoperatively after laminoplasty between January 2009 and December 2010. According to axial images for the cervical compressive myelopathy (Ax-CCM) system, the ISI on axial images was classified as follows: type 0, normal; type 1, diffuse; type 2, fuzzy focal; and type 3, discrete focal. Functional outcomes, as measured by the Japanese Orthopaedic Association (JOA) score and JOA recovery rate, were evaluated based on the Ax-CCM classification.

Results: Forty-three patients were enrolled. The mean follow-up time was 11.0±1.0 years. At the final follow-up, postoperative changes in the type of ISI were observed in 62.8% of patients. The type of ISI improved in 5 patients (11.6%), remained unchanged in 16 patients (37.2%), and worsened in 22 patients (51.2%). Patients with preoperative type 2 ISI had worse postoperative JOA scores and JOA recovery rates than those with other types. A worse ISI type was related to a lower postoperative JOA score and a lower recovery rate at the final follow-up.

Conclusions: Type 2 ISI was associated with poor postoperative symptoms and low postoperative function improvement. ISI changed after laminoplasty in 27 patients (62.8%), and worsened ISI was related to poor surgical outcomes.

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颈椎脊髓病椎板成形术后轴向 T2 加权 MRI 上髓内信号强度增高的变化：10年随访研究

研究设计回顾性研究：调查轴向 T2 加权磁共振成像（MRI）上髓内信号强度增高（ISI）的术前分类和变化是否反映了颈椎病（CSM）椎板成形术后患者的术后功能预后：尽管CSM患者在轴向MRI上表现出ISI，但ISI（术前分类和变化）与手术结果之间的关联尚未得到研究：我们回顾性地纳入了 2009 年 1 月至 2010 年 12 月间接受 MRI 术前检查和术后至少 10 年接受板层成形术的 CSM 患者。根据颈椎压迫性脊髓病（Ax-CCM）系统的轴向图像，将轴向图像上的ISI分为以下几种类型：0型，正常；1型，弥漫型；2型，模糊病灶型；3型，离散病灶型。根据 Ax-CCM 的分类，以日本骨科协会（JOA）评分和 JOA 恢复率来衡量功能结果：共有 43 名患者入选。平均随访时间为（11.0±1.0）年。在最终随访中，62.8% 的患者术后 ISI 类型发生了变化。其中，5 名患者（11.6%）的 ISI 类型有所改善，16 名患者（37.2%）的 ISI 类型保持不变，22 名患者（51.2%）的 ISI 类型有所恶化。与其他类型的患者相比，术前患有 2 型 ISI 的患者术后 JOA 评分和 JOA 恢复率更差。ISI类型越差，术后JOA评分越低，最终随访的恢复率也越低：结论：2 型 ISI 与术后症状不佳和术后功能改善率低有关。27名患者（62.8%）在板层成形术后ISI发生了变化，ISI恶化与手术效果不佳有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.