| Objectives: Cervical myelopathy is a commonly acquired cause of spinal cord dysfunction in the elderly.It is postulated that hypoxic/ischemic environment secondary to chronic spinal cord compression plays an important role in the pathogenesis of myelopathy.This study aims to analyze the change between pre-operative and post-operative ASA blood flow in cervical spondylotic myelopathy patients and to assess the correlation with the post-operative neurological function recovery.Methods: Between June 2015 and February 2017,50 patients who underwent single-disc level anterior cervical discectomy and fusion at our department were included.The patients underwent DECT prior to surgery and at post-operative day 5 to analyze the change in ASA blood flow.The neurological status of each CSM patient was evaluated pre-operatively,the fifth post-operative day,one month,six months and one year after surgery using the Japanese Orthopedic Association(JOA).The rate of change in JOA score at each follow-up point was calculated.According to the presence or absence of spinal cord degenerescence,the 50 patients were divided into two groups and change in pre-operative and post-operative ASA blood flow and JOA score was compared.Thirty asymptomatic volunteers without any obvious clinical and radiological findings were included as the control group.All the data obtained,were statistically analyzed.Results: The iodine content in the control group were 14.28 ± 1.90 at C3/C4 disc level,14.82 ±1.83 at C4/C5 disc level and 15.50 ±2.41 at C5/C6 level.In the CSM patients,the pre-operative Iodine content measured was 10.26 ± 2.37 in C3/C4 disc level compression,12.14 ±1.63 in C4/C5 disc level compression and 14.06 ± 2.44 in C5/C6 disc level compression;and post-operatively,the iodine content in the three disc level was 13.78±2.77,14.16±1.90,15.14±2.62 respectively.The change was statistically significant(P<0.05)with a rate of change of 21.0±15.3%.The JOA at 1-day prior to surgery was 13.65 and at post-operative follow-up,the change in JOA was statistically significant with a rate of change of 11.3±9.4%,27.2±17.5%,38.8±17.9%,44.3±18.2%.The 1-month,6-month and 1-year correlation ratio between the change in JOA and change in blood flow was statistically significant(P<0.05).The post-operative change in ASA blood flow in the degenerescence and non-degenerescence group was significant(P<0.05)with a rate of 20.3±13.1% and 23.1±17.4% respectively.The pre-operative,post-operative and the rate of change in ASA blood flow in the degenerescence group was significantly lower than the nondegenerescence group(P<0.05).Post-operatively,there was a significant change in JOA score in both groups(P<0.05).The pre-operative JOA and JOA at each follow-up point in the degenerescence group was significantly lower than the nondegenerescence group(P<0.05).In the degenerescence group,the linear correlation at day-5 between change in ASA blood flow and change in JOA was not significant(P>0.05),however,at 1-month,6-months and 1-year follow up,the ratio was statistically significant(P<0.05).Conclusions: This study confirmed the benefit of DECT as a radiographic tool for identifying the compromised cervical anterior spinal artery in patients with CSM.DECT can quantitatively analyze the ASA blood flow in term of iodine content.There is a positive correlation between change in post-operative ASA blood and early neurological function recovery.The DECT is one of the best radiographic tools currently available to provide an objective screening tool to detect the positive correlation between the blood flow in the cervical anterior spinal artery and the recovery of JOA.Objectives : The aim of this study was to discuss the role of DECT in the measurement of Anterior Spinal Artery(ASA)blood flow in patients with cervical spinal cord injury and its correlation with post-operative neurological recoveryMethods: Between January 2014 and June 2016,thirty patients who underwent cervical open door laminoplasty for Spinal Cord Injury were included in the study.Each patient had a DECT preoperatively and five days after surgery to measure and compare the iodine content from which the blood flow rate could be calculated.All the patients were followed up at post-operative five days,one month,6 months and 12 months.The neurological status was evaluated at each point of follow up using the Japanese Orthopedic Association(JOA)score and ASIA neurological function score.Thirty asymptomatic volunteers without any obvious clinical and radiological findings were included in the control group.All the data obtained,were statistically analyzed.Results: The average iodine content in vertebral artery and anterior spinal artery was 161.84±5.66 and 14.82±1.83 respectively in the control group.The pre-operative average iodine content in vertebral artery for the surgical group was 161.8±12.0.The statistical difference between the vertebral artery iodine content in the control group and the surgical,group pre-operatively was not significant(P>0.05).The post-operative vertebral artery iodine content in the operative group was 161.8±11.5.The statistical difference between the pre-operative and post-operative(161.8±11.5)iodine content in vertebral artery was not significant(P>0.05).The pre-operative ASA iodine content was 12.01±3.14 which was significantly lesser than the control group(P<0.05).The post-operative ASA iodine content was 14.32±3.09,showing a distinct change as compared with pre-operative(P<0.05).The rate of post-operative ASA iodine content change was 21.1±12.5%.The pre-operative JOA was 7.73±0.92 and the JOA of post-operative day 5,1 month,6 months and 12 months was 7.98±0.90,9.93±1.04,12.47±1.78 and 12.75±1.95 respectively.The rate of change in JOA was 71±3.04%,23.34±3.10%,50.01±21.08% and 53.02±23.11% at post-operative day 5,1 month,6 months and 12 months respectively.The linear correlation between change in blood flow with improvement in 1-month,6-month and 12-month JOA was also significant.Conclusions: Dual energy computed tomography is a useful radiographic tool in detection of Anterior Spinal Artery in Cervical spinal cord injury patients.It can be used for quantitative determination of change in Anterior Spinal Artery blood flow.The early post-operative change in ASA blood flow can be used to determine the neurological function recovery. |
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