PDF(Pubmed)
Abstract：
UNASSIGNED: New diagnostic techniques are a substantial research focus in degenerative cervical myelopathy (DCM). This cross-sectional study determined the significance of cardiac-related spinal cord motion and the extent of spinal stenosis as indicators of mechanical strain on the cord.
UNASSIGNED: Eighty-four DCM patients underwent MRI/clinical assessments and were classified as MRI+ [T2-weighted (T2w) hyperintense lesion in MRI] or MRI- (no T2w-hyperintense lesion). Cord motion (displacement assessed by phase-contrast MRI) and spinal stenosis [adapted spinal canal occupation ratio (aSCOR)] were related to neurological (sensory/motor) and neurophysiological readouts [contact heat evoked potentials (CHEPs)] by receiver operating characteristic (ROC) analysis.
UNASSIGNED: MRI+ patients (N = 31; 36.9%) were more impaired compared to MRI- patients (N = 53; 63.1%) based on the modified Japanese Orthopedic Association (mJOA) subscores for upper {MRI+ [median (Interquartile range)]: 4 (4-5); MRI-: 5 (5-5); p < 0.01} and lower extremity [MRI+: 6 (6-7); MRI-: 7 (6-7); p = 0.03] motor dysfunction and the monofilament score [MRI+: 21 (18-23); MRI-: 24 (22-24); p < 0.01]. Both patient groups showed similar extent of cord motion and stenosis. Only in the MRI- group displacement identified patients with pathologic assessments [trunk/lower extremity pin prick score (T/LEPP): AUC = 0.67, p = 0.03; CHEPs: AUC = 0.73, p = 0.01]. Cord motion thresholds: T/LEPP: 1.67 mm (sensitivity 84.6%, specificity 52.5%); CHEPs: 1.96 mm (sensitivity 83.3%, specificity 65.6%). The aSCOR failed to show any relation to the clinical assessments.
UNASSIGNED: These findings affirm cord motion measurements as a promising additional biomarker to improve the clinical workup and to enable timely surgical treatment particularly in MRI- DCM patients.
UNASSIGNED: www.clinicaltrials.gov, NCT02170155.
UNASSIGNED: Eighty-four DCM patients underwent MRI/clinical assessments and were classified as MRI+ [T2-weighted (T2w) hyperintense lesion in MRI] or MRI- (no T2w-hyperintense lesion). Cord motion (displacement assessed by phase-contrast MRI) and spinal stenosis [adapted spinal canal occupation ratio (aSCOR)] were related to neurological (sensory/motor) and neurophysiological readouts [contact heat evoked potentials (CHEPs)] by receiver operating characteristic (ROC) analysis.
UNASSIGNED: MRI+ patients (N = 31; 36.9%) were more impaired compared to MRI- patients (N = 53; 63.1%) based on the modified Japanese Orthopedic Association (mJOA) subscores for upper {MRI+ [median (Interquartile range)]: 4 (4-5); MRI-: 5 (5-5); p < 0.01} and lower extremity [MRI+: 6 (6-7); MRI-: 7 (6-7); p = 0.03] motor dysfunction and the monofilament score [MRI+: 21 (18-23); MRI-: 24 (22-24); p < 0.01]. Both patient groups showed similar extent of cord motion and stenosis. Only in the MRI- group displacement identified patients with pathologic assessments [trunk/lower extremity pin prick score (T/LEPP): AUC = 0.67, p = 0.03; CHEPs: AUC = 0.73, p = 0.01]. Cord motion thresholds: T/LEPP: 1.67 mm (sensitivity 84.6%, specificity 52.5%); CHEPs: 1.96 mm (sensitivity 83.3%, specificity 65.6%). The aSCOR failed to show any relation to the clinical assessments.
UNASSIGNED: These findings affirm cord motion measurements as a promising additional biomarker to improve the clinical workup and to enable timely surgical treatment particularly in MRI- DCM patients.
UNASSIGNED: www.clinicaltrials.gov, NCT02170155.
摘要：
■新的诊断技术是退行性颈椎病（DCM）的重要研究重点。这项横断面研究确定了与心脏相关的脊髓运动和脊髓狭窄程度作为脊髓机械应变指标的重要性。
■84例DCM患者接受了MRI/临床评估，并分为MRI+[MRI中T2加权（T2w）高强度病变]或MRI-（无T2w高强度病变）。通过受试者工作特性（ROC）分析，脊髓运动（通过相位对比MRI评估的位移）和椎管狭窄[适应的椎管占用比（aSCOR）]与神经（感觉/运动）和神经生理读数[接触热诱发电位（CHEP）]有关。
■MRI患者（N=31；36.9％）与MRI患者（N=53；63.1％）相比，受损更严重。上部{MRI[中位数（四分位距）]：4（4-5）；MRI-：5（5-5）；MRI-：5（5-5）；p<21-24（MRI-24）（P-24）：24）两组患者的脊髓运动和狭窄程度相似。仅在MRI组中移位确定了具有病理评估的患者[躯干/下肢针刺评分(T/LEPP):AUC=0.67,p=0.03;CHEP:AUC=0.73,p=0.01]。帘线运动阈值:T/LEPP:1.67mm(灵敏度84.6%,特异性52.5%)；CHEP：1.96mm(灵敏度83.3%，特异性65.6%）。aSCOR未能显示与临床评估的任何关系。
■这些发现证实了脐带运动测量是一种有希望的额外生物标志物，可以改善临床检查并及时进行手术治疗，特别是在MRI-DCM患者中。
■www.clinicaltrials.gov,NCT02170155。
■84例DCM患者接受了MRI/临床评估，并分为MRI+[MRI中T2加权（T2w）高强度病变]或MRI-（无T2w高强度病变）。通过受试者工作特性（ROC）分析，脊髓运动（通过相位对比MRI评估的位移）和椎管狭窄[适应的椎管占用比（aSCOR）]与神经（感觉/运动）和神经生理读数[接触热诱发电位（CHEP）]有关。
■MRI患者（N=31；36.9％）与MRI患者（N=53；63.1％）相比，受损更严重。上部{MRI[中位数（四分位距）]：4（4-5）；MRI-：5（5-5）；MRI-：5（5-5）；p<21-24（MRI-24）（P-24）：24）两组患者的脊髓运动和狭窄程度相似。仅在MRI组中移位确定了具有病理评估的患者[躯干/下肢针刺评分(T/LEPP):AUC=0.67,p=0.03;CHEP:AUC=0.73,p=0.01]。帘线运动阈值:T/LEPP:1.67mm(灵敏度84.6%,特异性52.5%)；CHEP：1.96mm(灵敏度83.3%，特异性65.6%）。aSCOR未能显示与临床评估的任何关系。
■这些发现证实了脐带运动测量是一种有希望的额外生物标志物，可以改善临床检查并及时进行手术治疗，特别是在MRI-DCM患者中。
■www.clinicaltrials.gov,NCT02170155。
