The Effect Of DTI-based Responsible Segmental Localized On Nonsurgical Spinal Decompression In Cervical Spondylotic Myelopathy

Objective:To study the accuracy of magnetic resonance diffusion tensor imaging in determining the location of responsible segments in multilevel CSM,and to explore its clinical value in guiding nonsurgical spinal decompression therapy.Methods:This study included 30 patients with cervical spondylotic myelopathy with multilevel disc herniation who were hospitalized in the Department of Rehabilitation Medicine of the First Affiliated Hospital of XX from September 2020 to September 2021.The inclusion criteria were based on the minutes of the third National Symposium on Cervical Spondylotic Disease in 2008.These patients underwent cervical magnetic resonance imaging and diffusion tensor imaging to obtain anisotropy maps,and recorded the fractional anisotropy（FA）value and apparent diffusion coefficient（ADC）value at each spinal plane.The responsible segment of CSM was determined by comparing the FA value and ADC value of each spinal segment,and the FA value and ADC value of the responsible segment and non-responsible segment as well as the FA value and ADC value of the affected spinal cord and the healthy spinal cord of the responsible segment were compared and analyzed respectively.Meanwhile,the corresponding responsible segments were treated with nonsurgical spinal decompression once a day,5 times a week for 3 weeks.The cervical m JOA score and NDI score were evaluated before,2 weeks after and 3 weeks after treatment,and the differences of m JOA score and NDI score were compared before and after treatment.Results:1.Among the 30 subjects,34 responsibility segments were identified by DTI,including 9 at C3/4,8 at C4/5,12 at C5/6 and 5 at C6/7;2.MRI images showed that the FA value of spinal cord compression segment was significantly lower than that of other segments,while the ADC value was higher than that of other segments,and the difference was statistically significant（P < 0.05）;3.The FA value of the responsible segment identified by DTI was significantly lower than that of the non-responsible segment at the same level（P < 0.05）;The ADC value of the responsible segment was significantly higher than that of the non-responsible segment at the same level（P <0.05）,both were statistically significant;4.The FA value of the affected spinal cord in the responsible segment was significantly lower than that of the healthy spinal cord,and the ADC value of the affected spinal cord was significantly higher than that of the healthy spinal cord,with statistical significance（P < 0.05）;5.m JOA score and NDI score were significantly improved 2 and 3 weeks after treatment compared with before treatment,and m JOA score and NDI score were also significantly improved 3 weeks after treatment compared with 2 weeks after treatment,with statistically significant differences（P < 0.001）.Conclusion:Diffusion tensor imaging can quantify the degree of spinal cord compression in patients with CSM,contribute to the diagnosis of early CSM,and assist in determining the responsible segments of patients with multilevel CSM.Its related parameters（FA value is superior to ADC value）can help detect myelopathy before abnormal changes in conventional T2 signal,which can help improve the success rate of clinical non-surgical decompression therapy.