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Abstract：
BACKGROUND: T2-weighted increased signal intensity (ISI) is commonly recognized as a sign of more severe spinal cord lesions, usually accompanied by worse neurological deficits and possibly worse postoperative neurological recovery. The combined approach could achieve better decompression and better neurological recovery for multilevel degenerative cervical myelopathy (MDCM). The choice of surgical approach for MDCM with intramedullary T2-weighted ISI remains disputed. This study aimed to compare the neurological outcomes of posterior and one-stage combined posteroanterior approaches for MDCM with T2-weighted ISI.
METHODS: A total of 83 consecutive MDCM patients with confirmed ISI with at least three intervertebral segments operated between 2012 and 2014 were retrospectively enrolled. Preoperative demographic, radiological and clinical condition variables were collected, and neurological conditions were evaluated by the Japanese Orthopedic Assessment score (JOA) and Neck Disability Index (NDI). Propensity score matching analysis was conducted to produce pairs of patients with comparable preoperative conditions from the posterior-alone and combined groups. Both short-term and mid-term surgical outcomes were evaluated, including the JOA recovery rate (JOARR), NDI improvements, complications, and reoperations.
RESULTS: A total of 83 patients were enrolled, of which 38 and 45 patients underwent posterior surgery alone and one-stage posteroanterior surgery, respectively. After propensity score matching, 38 pairs of comparable patients from the posterior and combined groups were matched. The matched groups presented similar preoperative clinical and radiological features and the mean follow-up duration were 111.6 ± 8.9 months. The preoperative JOA scores of the posterior and combined groups were 11.5 ± 2.2 and 11.1 ± 2.3, respectively (p = 0.613). The combined group presented with prolonged surgery duration(108.8 ± 28.0 and 186.1 ± 47.3 min, p = 0.028) and greater blood loss(276.3 ± 139.1 and 382.1 ± 283.1 ml, p<0.001). At short-term follow-up, the combined group presented a higher JOARR than the posterior group (posterior group: 50.7%±46.6%, combined group: 70.4%±20.3%, p = 0.024), while no significant difference in JOARR was observed between the groups at long-term follow-up (posterior group: 49.2%±48.5%, combined group: 59.6%±47.6%, p = 0.136). No significant difference was found in the overall complication and reoperation rates.
CONCLUSIONS: For MDCM patients with ISI, both posterior and one-stage posteroanterior approaches could achieve considerable neurological alleviations in short-term and long-term follow-up. With greater surgical trauma, the combined group presented better short-term JOARR but did not show higher efficacy in long-term neurological function preservation in patients with comparable preoperative conditions.
METHODS: A total of 83 consecutive MDCM patients with confirmed ISI with at least three intervertebral segments operated between 2012 and 2014 were retrospectively enrolled. Preoperative demographic, radiological and clinical condition variables were collected, and neurological conditions were evaluated by the Japanese Orthopedic Assessment score (JOA) and Neck Disability Index (NDI). Propensity score matching analysis was conducted to produce pairs of patients with comparable preoperative conditions from the posterior-alone and combined groups. Both short-term and mid-term surgical outcomes were evaluated, including the JOA recovery rate (JOARR), NDI improvements, complications, and reoperations.
RESULTS: A total of 83 patients were enrolled, of which 38 and 45 patients underwent posterior surgery alone and one-stage posteroanterior surgery, respectively. After propensity score matching, 38 pairs of comparable patients from the posterior and combined groups were matched. The matched groups presented similar preoperative clinical and radiological features and the mean follow-up duration were 111.6 ± 8.9 months. The preoperative JOA scores of the posterior and combined groups were 11.5 ± 2.2 and 11.1 ± 2.3, respectively (p = 0.613). The combined group presented with prolonged surgery duration(108.8 ± 28.0 and 186.1 ± 47.3 min, p = 0.028) and greater blood loss(276.3 ± 139.1 and 382.1 ± 283.1 ml, p<0.001). At short-term follow-up, the combined group presented a higher JOARR than the posterior group (posterior group: 50.7%±46.6%, combined group: 70.4%±20.3%, p = 0.024), while no significant difference in JOARR was observed between the groups at long-term follow-up (posterior group: 49.2%±48.5%, combined group: 59.6%±47.6%, p = 0.136). No significant difference was found in the overall complication and reoperation rates.
CONCLUSIONS: For MDCM patients with ISI, both posterior and one-stage posteroanterior approaches could achieve considerable neurological alleviations in short-term and long-term follow-up. With greater surgical trauma, the combined group presented better short-term JOARR but did not show higher efficacy in long-term neurological function preservation in patients with comparable preoperative conditions.
摘要：
背景：T2加权信号强度（ISI）增加通常被认为是更严重的脊髓病变的标志，通常伴有更严重的神经功能缺损和可能更差的术后神经功能恢复。联合入路治疗多节段退变性脊髓型颈椎病(MDCM)可获得更好的减压效果和更好的神经功能恢复。髓内T2加权ISI的MDCM手术方法的选择仍存在争议。这项研究旨在比较后路和一期联合后路入路对MDCM和T2加权ISI的神经系统预后。
方法：回顾性纳入了2012年至2014年间手术的83例确诊为ISI且至少有三个椎间节段的MDCM患者。术前人口统计，收集放射学和临床条件变量，通过日本骨科评估评分（JOA）和颈部残疾指数（NDI）评估神经系统状况。进行倾向评分匹配分析，以从后路单独组和联合组中产生具有可比术前条件的患者对。评估短期和中期手术结果，包括JOA回收率(JOARR)，NDI改进，并发症,和再操作。
结果：共纳入83例患者，其中38例和45例患者接受了单纯后路手术和一期后路手术，分别。在倾向得分匹配后，匹配来自后路组和联合组的38对可比患者。匹配组的术前临床和放射学特征相似，平均随访时间为111.6±8.9个月。后路组和联合组术前JOA评分分别为11.5±2.2和11.1±2.3(p=0.613)。联合组手术时间延长（108.8±28.0和186.1±47.3分钟，p=0.028）和更大的失血量（276.3±139.1和382.1±283.1ml，p<0.001)。在短期随访中，合并组的JOARR高于后路组（后路组：50.7％±46.6％，合并组：70.4%±20.3%，p=0.024),而在长期随访中，两组之间的JOARR没有显着差异（后组：49.2％±48.5％，合并组：59.6%±47.6%，p=0.136）。总体并发症和再手术率无明显差异。
结论：对于患有ISI的MDCM患者，在短期和长期随访中,后路和一期后路均可实现相当大的神经系统缓解.手术创伤更大，联合组患者的短期JOARR效果较好,但在术前条件相当的患者中,长期神经功能保留方面未表现出更高的疗效.
方法：回顾性纳入了2012年至2014年间手术的83例确诊为ISI且至少有三个椎间节段的MDCM患者。术前人口统计，收集放射学和临床条件变量，通过日本骨科评估评分（JOA）和颈部残疾指数（NDI）评估神经系统状况。进行倾向评分匹配分析，以从后路单独组和联合组中产生具有可比术前条件的患者对。评估短期和中期手术结果，包括JOA回收率(JOARR)，NDI改进，并发症,和再操作。
结果：共纳入83例患者，其中38例和45例患者接受了单纯后路手术和一期后路手术，分别。在倾向得分匹配后，匹配来自后路组和联合组的38对可比患者。匹配组的术前临床和放射学特征相似，平均随访时间为111.6±8.9个月。后路组和联合组术前JOA评分分别为11.5±2.2和11.1±2.3(p=0.613)。联合组手术时间延长（108.8±28.0和186.1±47.3分钟，p=0.028）和更大的失血量（276.3±139.1和382.1±283.1ml，p<0.001)。在短期随访中，合并组的JOARR高于后路组（后路组：50.7％±46.6％，合并组：70.4%±20.3%，p=0.024),而在长期随访中，两组之间的JOARR没有显着差异（后组：49.2％±48.5％，合并组：59.6%±47.6%，p=0.136）。总体并发症和再手术率无明显差异。
结论：对于患有ISI的MDCM患者，在短期和长期随访中,后路和一期后路均可实现相当大的神经系统缓解.手术创伤更大，联合组患者的短期JOARR效果较好,但在术前条件相当的患者中,长期神经功能保留方面未表现出更高的疗效.
