Analysis on the choice of surgical approaches and clinical effect on multilevel cervical spondylotic myelopathy with MRI T2WI intramedullary high signal

English Keywords:Cervical spondylotic myelopathy  Intramedullary high signal  Surgical approaches  Clinical effect  Multilevel

English Abstract:

  【Abstract】 Objectives: To analyze the clinical effect of different surgical approaches on multilevel cervical spondylotic myelopathy with MRI T2WI intramedullary high signal, and to provide guidance for clinical surgical strategy. Methods: The clinical data from 45 patients who had multilevel cervical spondylotic myelopathy with MRI T2WI intramedullary high signal from January 2011 to December 2014 were retrospectively selected. The patients were divided into two groups based on the surgical approaches: group A comprised 17 men and 5 women(average age, 54.36±6.18 years) who underwent anterior approach surgery, and group B comprised 19 men and 4 women(average age, 58.09±8.83 years) who underwent posterior approach surgery. The intramedullary high signal intensity ratio was defined as the ratio of the signal intensity of 0.1cm2 zone in high signal zone and normal signal zone in cervical MRI T2WI. The JOA score, improvement rate of neurological function, change of intramedullary high signal intensity ratio and the incidence rate of complications were assessed in both groups. Results: All patients were followed up regularly, and the average follow-up period was 16.84±9.95 months. There were no significant differences with regard to gender, age, duration of disease, number of lesion segments, preoperative JOA score, preoperative intramedullary high signal intensity ratio and the follow-up time between two groups(P＞0.05). The average of final postoperative follow-up JOA score in group A was 14.64±1.09 and that in group B was 13.09±1.56, and the average of final postoperative follow-up JOA score in group A was significantly higher than that in group B(P＜0.05). The improvement rate of neurological function of two groups was (64.14±12.76)% and (35.08±20.52)%, respectively, which showed significant difference(P＜0.05). The average of intramedullary high signal intensity ratio was 1.36±0.14 in group A and 1.53±0.15 in group B. The average of high signal intensity ratio in group A was significantly lower than that in group B(P＜0.05). The incidence rate of complications was 13.64% in group A and 13.05% in group B, which showed no difference between two groups(P＞0.05). Conclusions: When confronting patients of multilevel cervical spondylotic myelopathy with MRI T2WI intramedullary high signal, both anterior and posterior surgical approaches can improve the neurological function and intramedullary high signal intensity. But the anterior approach can better improve the neurological function and decrease intramedullary high signal intensity ratio.