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Abstract：
BACKGROUND: Poor neurological recovery in patients after anterior cervical discectomy and fusion has been frequently reported; however, no study has analyzed the preoperative imaging characteristics of patients to investigate the factors affecting surgical prognosis. The purpose of this study was to investigate the factors that affect the preoperative imaging characteristics of patients and their influence on poor neurologic recovery after anterior cervical discectomy and fusion.
METHODS: We retrospectively analyzed the clinical data of 89 patients who met the criteria for anterior cervical discectomy and fusion for the treatment of single-level cervical spondylotic myelopathy and evaluated the patients\' neurological recovery based on the recovery rate of the Japanese Orthopaedic Association (JOA) scores at the time of the final follow-up visit. Patients were categorized into the \"good\" and \"poor\" groups based on the JOA recovery rates of ≥ 50% and < 50%, respectively. Clinical information (age, gender, body mass index, duration of symptoms, preoperative JOA score, and JOA score at the final follow-up) and imaging characteristics (cervical kyphosis, cervical instability, ossification of the posterior longitudinal ligament (OPLL), calcification of herniated intervertebral discs, increased signal intensity (ISI) of the spinal cord on T2-weighted imaging (T2WI), and degree of degeneration of the discs adjacent to the fused levels (cranial and caudal) were collected from the patients. Univariate and binary logistic regression analyses were performed to identify risk factors for poor neurologic recovery.
RESULTS: The mean age of the patients was 52.56 ± 11.18 years, and the mean follow-up was 26.89 ± 11.14 months. Twenty patients (22.5%) had poor neurological recovery. Univariate analysis showed that significant predictors of poor neurological recovery were age (p = 0.019), concomitant OPLL (p = 0.019), concomitant calcification of herniated intervertebral discs (p = 0.019), ISI of the spinal cord on T2WI (p <0.05), a high grade of degeneration of the discs of the cranial neighboring levels (p <0.05), and a high grade of discs of the caudal neighboring levels (p <0.05). Binary logistic regression analysis showed that ISI of the spinal cord on T2WI (p = 0.001 OR = 24.947) and high degree of degeneration of adjacent discs on the cranial side (p = 0.040 OR = 6.260) were independent risk factors for poor neurological prognosis.
CONCLUSIONS: ISI of the spinal cord on T2WI and high degree of cranial adjacent disc degeneration are independent risk factors for poor neurological recovery after anterior cervical discectomy and fusion. A comprehensive analysis of the patients\' preoperative imaging characteristics can help in the development of surgical protocols and the management of patients\' surgical expectations.
METHODS: We retrospectively analyzed the clinical data of 89 patients who met the criteria for anterior cervical discectomy and fusion for the treatment of single-level cervical spondylotic myelopathy and evaluated the patients\' neurological recovery based on the recovery rate of the Japanese Orthopaedic Association (JOA) scores at the time of the final follow-up visit. Patients were categorized into the \"good\" and \"poor\" groups based on the JOA recovery rates of ≥ 50% and < 50%, respectively. Clinical information (age, gender, body mass index, duration of symptoms, preoperative JOA score, and JOA score at the final follow-up) and imaging characteristics (cervical kyphosis, cervical instability, ossification of the posterior longitudinal ligament (OPLL), calcification of herniated intervertebral discs, increased signal intensity (ISI) of the spinal cord on T2-weighted imaging (T2WI), and degree of degeneration of the discs adjacent to the fused levels (cranial and caudal) were collected from the patients. Univariate and binary logistic regression analyses were performed to identify risk factors for poor neurologic recovery.
RESULTS: The mean age of the patients was 52.56 ± 11.18 years, and the mean follow-up was 26.89 ± 11.14 months. Twenty patients (22.5%) had poor neurological recovery. Univariate analysis showed that significant predictors of poor neurological recovery were age (p = 0.019), concomitant OPLL (p = 0.019), concomitant calcification of herniated intervertebral discs (p = 0.019), ISI of the spinal cord on T2WI (p <0.05), a high grade of degeneration of the discs of the cranial neighboring levels (p <0.05), and a high grade of discs of the caudal neighboring levels (p <0.05). Binary logistic regression analysis showed that ISI of the spinal cord on T2WI (p = 0.001 OR = 24.947) and high degree of degeneration of adjacent discs on the cranial side (p = 0.040 OR = 6.260) were independent risk factors for poor neurological prognosis.
CONCLUSIONS: ISI of the spinal cord on T2WI and high degree of cranial adjacent disc degeneration are independent risk factors for poor neurological recovery after anterior cervical discectomy and fusion. A comprehensive analysis of the patients\' preoperative imaging characteristics can help in the development of surgical protocols and the management of patients\' surgical expectations.
摘要：
背景：经常报道颈椎前路椎间盘切除术和融合术后患者的神经功能恢复不良；然而，尚无研究分析患者术前影像学特征以探讨影响手术预后的因素。目的探讨影响患者术前影像学特点的因素及其对颈前路髓核摘除融合术后神经功能恢复不良的影响。
方法：我们回顾性分析89例符合颈前路髓核摘除融合术治疗单节段脊髓型颈椎病的患者的临床资料，并根据最终随访时日本骨科协会（JOA）评分的恢复率对患者的神经功能恢复情况进行评价。根据JOA恢复率≥50％和<50％，将患者分为“好”和“差”组。分别。临床信息（年龄，性别,身体质量指数,症状持续时间，术前JOA评分,和最终随访时的JOA评分）和影像学特征（颈椎后凸畸形，颈椎不稳,后纵韧带骨化（OPLL），椎间盘突出钙化,T2加权成像（T2WI）上脊髓信号强度（ISI）增加，从患者中收集与融合水平（颅骨和尾骨）相邻的椎间盘的退变程度。进行了单变量和二元逻辑回归分析，以确定神经系统恢复不良的危险因素。
结果：患者的平均年龄为52.56±11.18岁，平均随访26.89±11.14个月。20例（22.5％）患者的神经系统恢复不良。单因素分析显示神经功能恢复不良的显著预测因素是年龄(p=0.019),伴随OPLL（p=0.019），伴随钙化的椎间盘突出（p=0.019），脊髓在T2WI上的ISI（p<0.05），颅骨邻近水平的椎间盘退化程度很高（p<0.05），和尾部相邻水平的高等级椎间盘(p<0.05)。二分类logistic回归分析显示,T2WI上脊髓ISI(p=0.001OR=24.947)和颅侧邻近椎间盘高度退变(p=0.040OR=6.260)是神经系统预后不良的独立危险因素。
结论：T2WI脊髓ISI及颅旁椎间盘高度退变是颈前路椎间盘切除融合术后神经功能恢复不良的独立危险因素。对患者术前影像学特征的综合分析可以帮助制定手术方案和管理患者的手术期望。
方法：我们回顾性分析89例符合颈前路髓核摘除融合术治疗单节段脊髓型颈椎病的患者的临床资料，并根据最终随访时日本骨科协会（JOA）评分的恢复率对患者的神经功能恢复情况进行评价。根据JOA恢复率≥50％和<50％，将患者分为“好”和“差”组。分别。临床信息（年龄，性别,身体质量指数,症状持续时间，术前JOA评分,和最终随访时的JOA评分）和影像学特征（颈椎后凸畸形，颈椎不稳,后纵韧带骨化（OPLL），椎间盘突出钙化,T2加权成像（T2WI）上脊髓信号强度（ISI）增加，从患者中收集与融合水平（颅骨和尾骨）相邻的椎间盘的退变程度。进行了单变量和二元逻辑回归分析，以确定神经系统恢复不良的危险因素。
结果：患者的平均年龄为52.56±11.18岁，平均随访26.89±11.14个月。20例（22.5％）患者的神经系统恢复不良。单因素分析显示神经功能恢复不良的显著预测因素是年龄(p=0.019),伴随OPLL（p=0.019），伴随钙化的椎间盘突出（p=0.019），脊髓在T2WI上的ISI（p<0.05），颅骨邻近水平的椎间盘退化程度很高（p<0.05），和尾部相邻水平的高等级椎间盘(p<0.05)。二分类logistic回归分析显示,T2WI上脊髓ISI(p=0.001OR=24.947)和颅侧邻近椎间盘高度退变(p=0.040OR=6.260)是神经系统预后不良的独立危险因素。
结论：T2WI脊髓ISI及颅旁椎间盘高度退变是颈前路椎间盘切除融合术后神经功能恢复不良的独立危险因素。对患者术前影像学特征的综合分析可以帮助制定手术方案和管理患者的手术期望。
