Outcomes Of Alternative Procedures In Management Of Cervical Spondylotic Myelopathy And Reorganization Of Brain Strucure In Patients With CSM By MRI Study

[Background]There are various surgery methods for Cervical Spondylotic Myelopathy(CSM).Most of the patients have good surgical result,but there are a small number of patients who do not have obvious improvement.Is the surgery method affecting the clinical effect?Is a problem with the implant frame?In addition to damage to the spinal cord,are there any changes to other tissue and organs that affect the patient’s recovery?[Objective](1)to prove that different surgery methods do not have obvious impact on patients’ recovery;(2)through brain MRI prove that CSM patients incur shrink over brain sensation of the pallium;(3)to prove that CSM patients’ recovery is related to the atrophy over brain sensation of the pallium and the change of the corticospinal tracts demyelination;(4)to discuss if brain MRI can be a factor to evaluate an patient’s damage level and recovery status of spinal cord after the surgery.[Methods]Retrospective analysis the surgery results of patients who received surgeries for CSM in Spine Surgery Department of PL A Army General Hospital from January 2012 to March 2015.Analyze surgery effect of anterior cervical discectomy and fusion(ACDF)and anterior cervical discectomy plus anterior cervical corpectomy and fusion(ACDF+ACCF)and posterior open door laminoplasty and fixation(ODLF).Evaluate the surgery effect from general index,nerve function and imaging finding.Reorganization of brain structure and function in some patients with CSM who underwent surgery were analyzed fMRI scans on a 3-T MR system before surgery in our department from Dec.2013 to Mar.2015.Analyzing if there is a relation between this function reconstruction and patient’s recovery after surgery.Relationship between brain mantle atrophy and motor function rehabilitation were observed from fMRI.Diffusion tensor imaging(DTI)were used to study the abnormality of fibrous bands of brain white matter impact on patient’s motor function rehabilitation after chronic spinal cord damage.[Results]122 cases with CSM who received surgical treatment in our department during January 2012 and March 2015 meet the requirements and are surveyed for this report.Among the 122 cases,73 are male and 49 are female.The age range is 39～84,the average age is 62.5y.The course of desease is 6～98 months,on average 26.6 months.We categorize them by three groups:A is ACDF,B is ACDF+ACCF and C group is ODLF.No statistics difference when we comparing the course of disease before the surgery,the percentage of patients who have diabetes and who smoke cigarettes,VAS and JO A etc(p>0.05).More blood loss in posterior approach.No statistics difference in neck pain VAS and JOA evaluation were observed after surgery among three groups(p>0.05).There is statistics difference of VAS and JOA before and after surgery in every group(p<0.05),which shows that good results were gained from surgery.No relation to the surgery method and the condition of JOA improvement.The improvement rate for JOA is 60.4%for patients with high signal after surgery,and 78.3 in patients no spinal high signal in cervical spinal cord.There is statistics deference between these two types,improvement rate is higher in patients who have no MRI spinal high signal.Complication rate is 9.38%in Group A,8.33%in Group B and 16.67%in Group C,respectively.Complication rate is higher in posterior approach and it has statistics difference from Group A and B.From brain function MRI and neck MRI,cross-sectional spinal cord area at the C2/C3 level is 85.3±5.8 mm2 in control group,76.5±5.5 mm2 in CSM.Compared to control group,smaller average area in CSM group is observed(P<0.01).Using VBM method,we found decrease volume of grey matter and white matter atrophy.CSM patients were split into two sub-groups according to JOA:good group(recovery rate>50%)and average group(recovery rate<50%).ROI based methods also was used to investigate the volume changes of gray matter in both groups of the primary motor cortex(M1),primary sensory cortex(S1),supplementary motor cortex(SMA),premotor cortex(PMC),medial prefrontal cortex and thalamus.The gray matter volume in M1,S1,SMA and thalamus is smaller in average group,compared to good group(P<0.05).That means the more brain structure atrophy,the worse of patients function recovery.[Conclusion]Outcomes of alternative procedures got good results.No statistics difference found between surgical approach.Poor surgical results maybe relative to brain structure atrophy.Both spinal cord decompression and brain structure damage prospection are should consideration.