| OBJECTIVE:To explore the effect of abnormal T2-weighted sagittal signal morpholo-gical characteristics of spinal cord magnetic resonance before CSM on functional rehabilitation after spinal cord decompression.Exploring the best surgical period for cervical spondylotic myelopathy and provide a theoretical basis for early clinical intervention.METHODS:A total of 59 patients with CSM,including 35 males and 24 females,were enrolled in our hospital from January 2017 to February 2018.All patients underwent cervical MRI scan before surgery.According to the signal morphology in the compression site of the spinal cord on MRI T2 weighted sagittal plane,the patients can be divided into normal signal group(the patient has the symptoms and signs of spinal cord compression,and the spinal cord compression can be seen on magnetic resonance imaging).However,no high signal pattern could be seen,excluding other diseases).Punctuate signal group(high signal intensity of spinal cord in compressed segment could be seen,and its maximum sagittal diameter was less than 1/3 of the lost diameter of spinal cord in that segment).In the flaky signal group(high signal intensity of the spinal cord was visible,and the maximum sagittal diameter was larger than 1/3 of the lost diameter of the spinal cord in the compressed segment).There were 19 cases of normal signal group,20 cases of point signal group and 20 cases of flake signal group.All patients underwent spinal cord decompression.The neurological function of CSM patients was evaluated by JOA score before operation,3 months,6 months,12 months after operation and the last follow-up.Nurick score was used to evaluate the motor function of lower extremities.JOA improvement rate was used to evaluate the improvement rate of neurological function in CSM patients,and the improvement rate of neurological function among the three groups was compared.At 6 months after surgery,cervical spine MRI was performed to assess the decompression of the spinal cord.RESULTS:There were no differences in gender,age and course of disease of the three groups(P>0.05).Average follow-up(16.20?3.59)months.The median and interquartile range of the preoperative JOA scores of the three groups were 12(10,13),10(8,11),and9.5(8,10.75),respectively.The normal group was different from the punctate group(P=0.043)and the flaky group(P=0.032).The median and interquartile range of the preoperative Nurick scores of the three groups were:2(1,3),3(2,3.75),and 3(3,3);there was a significant difference between the normal signal group and the flaky signal group(P=0.01).The JOA scores of the normal signal group before surgery,3 months after surgery,6 months after surgery,1 year after surgery,and the last follow-up were 12(10,13),14(13,15),16(15,16),16(16,17),and 16(16,17).There was a difference in JOA scores between preoperative and postoperative time points(?~2=71.348,P<0.001).The Nurick grades at the time points before and after surgery in the normal signal group were 2(1,3),2(1,2),1(1,1),1(1,1),and 1(1,1),respectively.There were differences in Nurick scores between preoperative and postoperative time points(?~2=45.919,P<0.001).The JOA scores of punctuate signal group were 10(8,11),13(12,15),15(14,15.75),15.5(15,16),16(15,16).There was a statistically significant difference in JOA scores between preoperative and postoperative time points(?~2=69.807,P<0.001).The Nurick scores of the high-signal high-frequency group before and after surgery were 3(2,3.75),2(1,2),1(1,2),1(1,1),and 1(1,1),respectively.The Nurick scores were obtained before and after surgery.Statistical difference(?~2=61.259,P<0.001).The JOA scores of the flaky signal group were 9.5(8,10.75),12(11,13),13(12,15),14(13,15),and 15(14,15)at each time point before and after surgery.The JOA scores of the flaky group were different before and after surgery.(?~2=73.446,P<0.001);Nurick grades were 3(3,3),2(2,3),2(1,2.75),2(1,2),2(1,2)at each time point before and after surgery in the flaky group;There were differences in the Nurick scores before and after surgery(?~2=58.667,P<0.001).In the last follow-up,there were significant differences in JOA score between the flaky signal group and the punctuate signal group(P=0.027),the flaky signal group and the normal signal group(P<0.001).In the last follow-up,there were significant differences in Nurick score between the flaky signal group and the normal signal group(P=0.001),the flaky signal group and the punctuate signal group(P=0.002).The improvement rate of three groups of JOA was(82.56?16.46)%,(77.15?18.57)%,(62.80?14.37)%,There were differences between flaky signal group and punctuate signal group(P=0.008);,flaky signal group and normal signal group(P<0.001);but there was no difference between normal signal group and punctuate signal group(P=0.312).The regression equation was obtained by multiple linear regression:the last JOA score=16.715-0.723×gender-0.051×age-1.407×flaky signal-0.814×punctuate signal+0.222×preoperative JOA score(R~2=0.509,corrected R~2=0.463).Conclusion:The signal morphology of T2 weighted sagittal spinal cord compression in CSM patients was closely related to the results of postoperative neurological rehabilitation.There was no difference in postoperative efficacy between normal signal group and punctuate signal group.Both groups were superior in effect and better than flaky signal group.The flasky signal group was effective after surgery.It is recommended that CSM patients with magnetic resonance T2 weighting as normal signal or punctuate signal should be treated with surgical decompression,and satisfactory surgical results can be obtained after operation. |
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