RESUMO

BACKGROUND: Cervical spondylotic myelopathy (CSM) is the most common chronic spinal cord injury with poor surgical and neurologic recovery in the advanced stages of the disease. DTI parameters can serve as important biomarkers for CSM prognosis. The study aimed to investigate the predictive value of dynamic diffusion tensor imaging (DTI) for the postoperative outcomes of CSM. METHODS: One hundred and five patients with CSM who underwent surgery were included in this study. Patients were assessed using the Modified Japanese Orthopedic Association Score (mJOA) before and one year after surgery and then divided into groups with good (≥ 50%) and poor (< 50%) prognoses according to the rate of recovery. All patients underwent preoperative dynamic magnetic resonance imaging of the cervical spine, including T2WI and DTI in natural(N), extension (E), and flexion (F) positions. ROM, Cross-sectional area, fractional anisotropy (FA), and apparent diffusion coefficient (ADC) were measured at the narrowest level in three neck positions. Univariate and multivariate logistic regression were used to identify risk factors for poor postoperative recovery based on clinical characteristics, dynamic T2WI, and DTI parameters. Predictive models were developed for three different neck positions. RESULTS: Forty-four (41.9%) patients had a good postoperative prognosis, and 61 (58.1%) had a poor prognosis. Univariate analysis showed statistically significant differences in diabetes, number of compression segments, preoperative mJOA score, cross-sectional area ((Area-N), (Area-E), (Area-F)), ADC((ADC-N), (ADC-E), (ADC-F)) and FA (((FA-N), (FA-E), (FA-F)) (p < 0.05). Multivariable logistic regression showed that natural neck position: Area-N ([OR] 0.226; [CI] 0.069-0.732, p = 0.013),FA-N([OR]3.028;[CI]1.12-8.19,p = 0.029); extension ne-ck position: Area-E([OR]0.248;[CI]0.076-0.814,p = 0.021), FA-E([OR]4.793;[CI]1.737-13.228,p = 0.002);And flextion neck postion: Area-F([OR] 0.288; [CI] 0.095-0.87, p = 0.027),FA-F ([OR] 2.964; [CI] 1.126-7.801, p = 0.028) were independent risk factors for poor prognosis.The area under the curve (AUC) of the prediction models in the natural neck position, extension neck position, and flexion neck positions models were 0.708[(95% CI:0.608∼0.808), P < 0.001]; 0.738 [(95% CI:0.641∼0.835), P < 0.001]; 0.703 [(95% CI:0.602∼0.803), P < 0.001], respectively. CONCLUSION: Dynamic DTI can predict postoperative outcomes in CSM. Reduced FA in the extension position is a valid predictor of poor postoperative neurological recovery in patients with CSM.

Assuntos

Vértebras Cervicais , Imagem de Tensor de Difusão , Espondilose , Humanos , Imagem de Tensor de Difusão/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Espondilose/diagnóstico por imagem , Espondilose/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Idoso , Prognóstico , Valor Preditivo dos Testes , Resultado do Tratamento , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Adulto

RESUMO

PURPOSE: To investigate the clinical application of zonally magnified oblique multislice (ZOOM) imaging technology in patients with degenerative cervical myelopathy (DCM) and compare it with T2WI imaging. METHODS: A total of 111 patients diagnosed with DCM were recruited. According to mJOA, patients with DCM were divided into ND + group with neurological dysfunction and ND- group without neurological dysfunction. Routine MRI and ZOOM-DWI were performed on 3.0 T MRI to obtain sagittal T2WI and apparent diffusion coefficient (ADC) diagram. ADC values of the narrow segment and its adjacent upper and lower segments were measured, and compared between the ND + and ND- groups. The correlation between ADC value of cervical spinal cord and mJOA score was analyzed. Additionally, ROC curves were plotted to calculate the AUC values. RESULTS: The comparison between ND + and ND- groups shows that there are significant differences in mJOA score, T2WI, anteroposterior diameter of spinal canal, ADC values of narrow, upper and lower segment (P < 0.05). In ND + group, there is a significant difference between ADC values of the narrow and its upper and lower segments (P < 0.001), while with no significant difference in ADC values of the upper and lower segments (P > 0.05). Results of correlation analysis indicate that in the ND + group, neurological dysfunction evaluated by mJOA scores is correlated with increased ADC values of the narrow segment (r = -0.52, P < 0.001), but not significantly correlated with ADC values of the upper and lower segments. Furthermore, T2WI, anteroposterior diameter of the spinal canal, and cervical cord ADC values all has diagnostic efficacy in evaluating neurological dysfunction in DCM (AUC > 0.5, P < 0.05), with the ADC value of the narrow segment being optimal. CONCLUSION: The ADC value of spinal cord obtained by small-field ZOOM-DWI can be used to evaluate neurological dysfunction in DCM, and is superior to traditional T2WI.

RESUMO

OBJECTIVE: The purpose of this study was to explore the impact of central obesity on spinal sagittal balance in adults aged 18 and older by examining correlations between waist circumference (WC) and abdominal circumference (AC) and spinopelvic alignment parameters. METHODS: This prospective cohort study included 350 adults aged 18 and older. Participants underwent whole-body biplanar radiography using the EOS imaging system. Spinal and pelvic parameters were measured and correlated with body mass index, WC, and AC. Statistical analyses included one-way analysis of variance, Wilcoxon rank-sum tests for data with nonhomogeneous variances, and chi-squared tests for categorical data. Intra-rater and inter-rater reliability were assessed using intraclass correlation coefficients, with subsequent analyses to explore correlations between body measurements and spinal parameters. RESULTS: The study found significant correlations between increased WC and AC and changes in spinopelvic parameters. However, obesity did not uniformly influence all sagittal alignment parameters. Significant variations in spinal measurements indicate that central obesity plays a role in altering spinal stability and alignment. CONCLUSIONS: The findings highlight the impact of central obesity on spinal alignment and emphasize the importance of considering central obesity in clinical assessments of spinal pathologies. Further research is essential to better understand the relationship between obesity, spinal sagittal balance, and related health conditions.

Assuntos

Índice de Massa Corporal , Obesidade Abdominal , Circunferência da Cintura , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , China/epidemiologia , Estudos de Coortes , População do Leste Asiático , Obesidade Abdominal/diagnóstico por imagem , Pelve/diagnóstico por imagem , Pelve/anatomia & histologia , Estudos Prospectivos , Coluna Vertebral/diagnóstico por imagem

RESUMO

PURPOSE: To investigate the clinical application value of the non-shared incentive diffusion imaging technique (ZOOM-DWI) diagnoses of cervical spondylotic myelopathy (CSM). METHODS: 49 CSM patients who presented from January 2022 to December 2022 were selected as the patient group, and 50 healthy volunteers are recruited as the control group. All subjects underwent conventional MRI and ZOOM-DWI of the cervical spine and neurologic mJOA scores in patients with CSM. The spinal ADC values of segments C2-3, C4-5, C5-6, and C6-7 are measured and analyzed in all subjects, with C5-6 being the most severe level of spinal canal compression in the patient group. In addition, the study also analyzes and compares the relationship between the C5-6 ADC value and mJOA score in the patient group. RESULTS: The mean ADC shows no significantly different levels in the control group. Among the ADC values at each measurement level in the patient group, except for C4-5 and C6-7 segments are not statistically significant, the remaining pair-wise comparisons all show statistically significant differences (F = 24.368, p < 0.001). And these individuals have the highest ADC value at C5-6. The C5-6 ADC value in the patient group is significantly higher compared with the ADC value in the control group (t = 9.414, p < 0.001), with statistical significance. The ADC value at the patient stenosis shows a significant negative correlation with the mJOA score (r = -0.493, p < 0.001). CONCLUSION: Cervical ZOOM-DWI can be applied to diagnose CSM, and spinal ADC value can use as reliable imaging data for diagnosing cervical myelopathy.

Assuntos

Doenças da Medula Espinal , Espondilose , Humanos , Imagem de Tensor de Difusão/métodos , Espondilose/diagnóstico por imagem , Doenças da Medula Espinal/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem

RESUMO

BACKGROUND: Magnetic resonance imaging (MRI) is the preferred examination approach for patients with suspected cervical spondylotic myelopathy (CSM). OBJECTIVE: To investigate the predictive value of MRI spinal cord swelling on the prognosis of decompression surgery in patients with CSM. METHODS: A retrospective analysis of 115 patients with CSM who underwent decompression surgery was performed. According to whether cervical MRI showed spinal cord swelling, they were divided into a spinal cord swelling group and non-swelling group. The Modified Japanese Orthopaedic Association (MJOA) score, MJOA improvement rate and abnormal spinal cord enhancement rate in the two groups were compared before and after surgery. Multiple linear regression was used to analyse the influencing factors of the MJOA improvement rate. RESULTS: The time from symptom onset to operation (t= 2.400, p= 0.018) and preoperative MJOA score in the spinal cord swelling group were lower than those in the non-swelling group (t= 3.253, p= 0.002). The body mass index (t= 2.895, p= 0.005), anteroposterior diameter of the spinal canal (t= 4.421, p< 0.001), cross-sectional area (t= 3.136, p= 0.002), postoperative improvement rate (t= 4.277, p< 0.001) and proportion of abnormal enhancement of the spinal cord in the swelling group were higher than those in the non-swelling group (χ2= 3.136, p= 0.002). The preoperative MJOA score in the swelling group was lower than that in the non-swelling group (t= 2.583, p= 0.013). A multivariate linear regression model revealed that age and spinal cord swelling were independent predictors of MJOA score improvement, explaining 33.2% of the total variation. CONCLUSION: Patients with CSM with spinal cord swelling have less time from symptoms to surgery, and the degree of preoperative neurological deterioration is more obvious. Spinal cord swelling is an independent predictor of surgical prognosis in patients with CSM.

Assuntos

Doenças da Medula Espinal , Espondilose , Humanos , Resultado do Tratamento , Estudos Retrospectivos , Espondilose/diagnóstico por imagem , Espondilose/cirurgia , Espondilose/patologia , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Doenças da Medula Espinal/patologia , Prognóstico , Imageamento por Ressonância Magnética/métodos , Medula Espinal/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Edema/patologia

RESUMO

In recent years, people's living conditions have significantly improved, and their lifestyles have been diversified. However, the incidence of various diseases has also increased with it, including cervical spondylotic myelopathy (CSM). Spinal cord cervical spondylosis is one of the spinal cord compression disorders that can be severely disabling and accounts for 10% to 15% of all cervical spondylosis. In this paper, DKI image processing technology is used to study the symptoms of cervical spondylosis, which is helpful to help them explore the symptoms and causes. The onset of cervical spondylosis has a longer period of time, and the period of conservative treatment will inevitably require a longer period of time. The clinical symptoms of cervical spinal cord compression are mainly pain, and after the cervical spinal cord nerve is compressed, ischemia and hypoxia will occur, the nerve sensitivity will increase, and the patient will have reflex neck muscle pain symptoms. This causes degeneration of the patient's intervertebral disc tissue, degeneration of facet joints, ossification of the posterior longitudinal ligament, and formation of spurs on the posterior edge of the vertebral body. The condition will become more complicated, so it is very important to identify the characteristics of the clinical symptoms of cervical spondylotic myelopathy to help patients with cervical spondylosis recover. This paper identifies the clinical symptoms of cervical spondylosis based on the parameter ratio method of Diffusional Kurtosis Imaging (DKI). The current state of diffusion kurtosis imaging and the treatment of cervical spondylosis and the treatment operation are introduced, and the image enhancement technology in medical imaging is used to analyze the disc herniation of each segment in the overflexion, neutral and hyperextension positions. After comparing the FA, MK, and MD values in the spinal cord between the normal group and the patient group, the results showed that the FA, MD and MK values in the patient group were lower than those in the normal group, and the findings showed that the MD and MK values were positively correlated with the JOA score, reflecting that as the clinical symptoms of spinal cervical spondylosis worsened. The size and number of cervical intervertebral disc bulge on the hyperextension image is obvious and the number increases (especially the C4/5, C5/6, and C6/7 intervertebral discs with greater mobility), and the highest is 0.82 and 27%, respectively.

Assuntos

Compressão da Medula Espinal , Doenças da Medula Espinal , Espondilose , Humanos , Compressão da Medula Espinal/complicações , Compressão da Medula Espinal/cirurgia , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Espondilose/diagnóstico por imagem , Espondilose/complicações , Espondilose/cirurgia

RESUMO

OBJECTIVE: To investigate the correlations between preoperative diffusion tensor imaging (DTI), a Magnetic Resonance Imaging (MRI)-based technique and surgical outcome in patients with cervical spondylotic myelopathy (CSM). METHODS: A retrospective study of 95 patients with CSM who received diagnosis and surgical treatment in our hospital was carried out. According to the recovery rate of the Japanese Orthopaedic Association (JOA) scale at the 1-year postoperative follow-up, the patients were divided into a good recovery group (JOA recovery rate ≥60%, n = 47) and a poor recovery group (JOA recovery rate <60%, n = 48). Patients in both groups underwent diffusion tensor imaging examination before surgery. The preoperative fractional anisotropy (FA) value, apparent diffusion coefficient (ADC) value, longitudinal dispersion (AD) rate, and lateral dispersion (VD) rate were compared between the two groups. Pearson correlation coefficient was used to analyze the correlation between the preoperative DTI quantization parameters (FA, ADC, AD, VD) and the postoperative JOA recovery rate. In addition, we compared the preoperative spinal cord compression ratio (CR), spinal cord cross-sectional area (TA), maximum spinal cord compression (MSCC), and maximum canal compromise (MCC) between the above two groups. The correlations between the four measurements and the postoperative JOA recovery rate were analyzed using Pearson correlation coefficient. RESULTS: The preoperative FA value in the good recovery group was significantly higher than that in the poor recovery group, while the ADC value was significantly lower (both P<0.001). The good recovery group had lower preoperative AD and VD, but there was no statistical significance (both P>0.05). Pearson correlation analysis showed that the preoperative FA value was positively correlated with the JOA recovery rate (P<0.05), while the VD value had significantly negative correlation with the JOA recovery rate (P<0.05). The preoperative ADC and AD values were negatively correlated with JOA recovery rate, whereas there was no statistical significance (both P>0.05). The CR, TA, MSCC and MCC values measured before surgery in the good recovery group were significantly lower than those in the poor recovery group (all P<0.001); were negatively correlated with the JOA recovery rate (all P<0.05), while the correlation with TA was not statistically significant (P>0.05). CONCLUSION: DTI can evaluate the severity of the patient's condition before surgery by analyzing the subtle structural changes in patients with CSM. At the same time, the preoperative FA, VD, CR, MSCC, and MCC values are all associated with the surgery efficacy, which paves the way for the next step of clinical treatment.