| Background:Ossification of the posterior longitudinal ligament(OPLL)is a common degenerative disease of the cervical spine,which often presents as sensory and motor dysfunction of the extremities.Japanese Orthopedic Association(JOA)score is commonly used to evaluate the functional state of spinal cord in clinic currently.However,JOA score can only reflect the functional status of the spinal cord,and cannot effectively reflect the compression of the spinal cord.There is no simple and effective method to evaluate the compression of the spinal cord in OPLL of the cervical spine in clinic.Objective:1?To establish a new scoring system to asses spinal cord compression of ossification of posterior longitudinal ligament(OPLL)of cervical spine-CSFM score.2?To verify the consistency and reliability of the CSFM score by testing its reproducibility between different observers.3?To explore the correlation between the improvement rate of CSFM score and the improvement rate of JOA score in the three groups of patients with posterior longitudinal ligament ossification.Methods:1?Through literature review and expert advice to determine variables of CSFM score.CSFM score including four variables(C: Curvature of the spinal cord,S: increased Signal intensity of spinal cord,F: Cerebrospinal Fluid imaging,M: Cross section Morphology of spinal cord).2?The clinical and imaging data of 387 patients with cervical OPLL admitted to our hospital from June 2015 to June 2018 were retrospectively analyzed.The variables(C,S,F,M)were measured and recorded.Different scores were assigned according to the analysis of the relationship between the variables and JOA score.Then two spine surgeons scored the patients according to the CSFM score,and analyzed the internal consistency and reliability of the CSFM score.3?86 cases of OPLL who underwent ACAF,65 cases of ACCF,and 74 cases of posterior decompression surgery(PDS)were selected.The preoperative and postoperative CSFM scores and JOA scores were statistically analyzed,and the improvement rates of postoperative CSFM scores and postoperative JOA scores were calculated.The correlation between postoperative improvement rate of CSFM score and JOA score was analyzed.Results:1?The CSFM scoring system consists of four variables,each of which is divided into four grades.C(Curvature of the spinal cord): The curvatures are parallel between spinal cord and cervical spine and the curvatures are normal;The curvatures are parallel between spinal cord and cervical spine and the curvatures are straight;The curvatures are parallel between spinal cord and cervical spine and the curvatures are kyphosis;The curvatures are not parallel between spinal cord and cervical spine.S(increased Signal intensity of spinal cord): normal signal;Discrete focus;Fuzzy focus;Intramedullary diffuse.F(CSF imaging): There are cerebrospinal fluid imaging on both anterior and posterior of spinal cord;There was no cerebrospinal fluid imaging on one side of the spinal cord,and no compression;There were no cerebrospinal fluid imaging on both sides of the spinal cord,and no compression;There were no cerebrospinal fluid imaging on both sides of the spinal cord,obvious compression of spinal cord.M(Cross section Morphology of spinal cord): cylinder shape;triangle or crescent shape;boomerang shape;Arc shape.Each variable was assigned a score of 0-3 according to different grades.The total score of the CSFM score was 12,and the minimum score was 0.A higher score indicates more severe spinal cord compression.2?The intergroup correlation coefficients(ICC)of CSFM scores and scores of C,S,F and M were 0.961,0.974,0.971,0.964 and 0.939,respectively,in 387 patients with cervical OPLL.The Kappa values of CSFM score and variables C,S,F and M were 0.757,0.927,0.917,0.937 and 0.902,respectively,in 387 patients with cervical OPLL by two spinal surgeons.The results showed that CSFM score and each variable score had good consistency and reliability.3?The preoperative and postoperative CSFM scores of the ACAF group were 7.31±1.97 and 3.10±1.94,respectively,and the improvement rate of the postoperative CSFM scores was 60.03±20.83%.The preoperative and postoperative CSFM scores of ACCF group were 7.23±2.01 and 3.62±1.72,respectively.The improvement rate of CSFM score was 49.15±21.02%.The preoperative and postoperative CSFM scores of the PDS group were 7.28±1.86 and 4.29±1.69,respectively,and the improvement rate of the postoperative CSFM scores was 41.13 ±17.37%.There was no significant difference in preoperative CSFM scores between the three groups(P>0.05).The postoperative CSFM score of each group was significantly lower than that of the preoperative group(P<0.05).The pairwise difference in the improvement rate of postoperative CSFM score between the three groups was statistically significant(P<0.05).4?In the ACAF group,the preoperative and postoperative scores of C(curvature of the spinal cord)score were 1.44±0.87 and 0.63±0.74,respectively,and the improvement rate of C-score was 49.22±43.79%.The preoperative and postoperative scores of ACCF group were 1.42 ±1.09 and 0.74±0.86,respectively,and the improvement rate of postoperative C-score was 30.73±42.41%.The preoperative and postoperative scores of PDS group were 1.27±1.04 and 1.18±0.91,respectively,and the improvement rate of postoperative C-score was 5.18±26.83%.There was no statistically significant difference in preoperative pairwise scoring between the three groups(P>0.05).The pairwise difference in the improvement rate of postoperative C-score between the three groups was statistically significant(P<0.05).The preoperative and postoperative scores of S(increased Signal intensity of spinal cord)score in the ACAF group were 1.19±0.72 and 1.14±0.73,respectively.The preoperative and postoperative scores of ACCF group were 1.17±0.74 and 1.09±0.67,respectively.The preoperative and postoperative scores of PDS group were 1.09±0.72 and 1.04±0.72,respectively.There was no significant difference in preoperative pairwise score between the three groups(P>0.05).There was no significant difference in postoperative score between the two groups(P>0.05).The preoperative and postoperative scores of F(CSF imaging)score in the ACAF group were 2.66±0.49 and 0.74±0.61,respectively,and the improvement rate of F-score was 73.64±22.37%.The preoperative and postoperative scores of ACCF group were 2.63±0.51 and 0.80±0.68,respectively,and the improvement rate of F-score was 70.26±25.27%.The preoperative and postoperative scores of PDS group were 2.77±0.42 and 1.03±0.72,respectively,and the improvement rate of postoperative F-score was 63.06±25.30%.There was no statistically significant difference in preoperative pairwise scoring between the three groups(P>0.05).The postoperative F-score of each group was significantly lower than that of the preoperative group,and the difference was statistically significant(P<0.05).The preoperative and postoperative scores of M(cross section morphology of spinal cord)score in the ACAF group were 2.01±0.72 and 0.58±0.67,respectively,and the improvement rate of M-score was 72.87±33.91%.The preoperative and postoperative scores of the ACCF group were 2.02±0.71 and 1.02±0.75,respectively.The preoperative and postoperative scores of PDS group were 2.15±0.67 and 1.08±0.91,respectively,and the improvement rate of the postoperative M-score was 49.55±42.09%.There was no statistically significant difference in preoperative pairwise scoring between the three groups(P>0.05).The pairwise difference in the improvement rate of postoperative CSFM score between the three groups was statistically significant(P<0.05).5?In the ACAF group,the improvement rate of postoperative JOA score was 58.78±22.71%.The improvement rate of CSFM score was 60.03±20.83%.Pearson correlation analysis was performed for the two,and the correlation coefficient was 0.632,P<0.05,showing a significant positive correlation.In ACCF group,the improvement rate of postoperative JOA score was 50.33±23.56%.The improvement rate of CSFM score was 49.15±21.02%.Pearson correlation analysis was performed for the two,and the correlation coefficient was 0.789,P<0.05,showing a significant positive correlation.In the PDS group,the improvement rate of postoperative JOA score was 40.43±19.88%.The improvement rate of CSFM score was 41.13±17.37%.Pearson correlation analysis was performed for the two,and the correlation coefficient was 0.783,P<0.05,showing a significant positive correlation.Conclusions:1?We established the CSFM score based on MRI to evaluate spinal cord compression in patients with cervical OPLL.The CSFM score included four variables: C:(Curvature of the spinal cord),S(increased Signal intensity of spinal cord),F:(Cerebrospinal Fluid imaging),M:(Cross section Morphology of spinal cord).2?CSFM score and each variable score have good consistency and reliability.3?The postoperative CSFM scores of ACAF group,ACCF group and PDS group were significantly lower than preoperative,and the improvement rate of CSFM scores in the ACAF group was the highest.4?The postoperative CSFM score was negatively correlated with the JOA score.The improvement rate of postoperative CSFM score was positively correlated with the improvement rate of JOA score.5?As a method to evaluate spinal cord compression,CSFM score is simple and easy to operate.It can be used in the selection of surgical strategies and the evaluation of postoperative spinal cord decompression.6?The limitations of the study including the small cohort of patients and retrospective analysis.Futher prospective randomized controlled studies is required to evaluate the accuracy and reliability of the CSFM score in assessing spinal cord compression. |
PDF Full Text Request