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Comparison of Three Different Surgical Approach for Multilevel Cervical Spondylotic Myelopathy by Classification of Quantifying MRI T2 Signal Intensity Ratio

Author: WangLinFeng
Tutor: ShenYong
School: Hebei Medical University
Course: Surgery
Keywords: Multi- segmental cervical spondylosis NMR Surgical decompression Surgical approach Surgical treatment
CLC: R445.2
Type: Master's thesis
Year: 2009
Downloads: 66
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Abstract


Objective: multi-segmental cervical spondylosis (multilevel cervical spondylotic myelopathy) refers to lesions involving three or more than three cervical segments, which is characterized by a wide range of spinal cord compression, and severe nerve damage. Hybrid prevalent mainly clinical myelopathy or spinal cord, mainly for the pyramidal tract damage symptoms seriously affect the patient's daily life and work. With the rapid development of imaging, in particular, the advent of MRI (magnetic resonance imaging, MRI), play an important role in the diagnosis and treatment of multi-segmental cervical spondylotic myelopathy (MCSM). MRI is a valuable means of checking the cervical spinal cord disorders widely recognized as one of the subtle changes to show the degree of spinal cord compression and its nerve within. Surgical treatment of multilevel cervical disease has been more popular, including anterior, posterior, anterior combined surgery, but there are still differences of the choice of specific surgical procedures. Direct impact on the efficacy of the surgical method of choice, no quantifiable spinal MRI T2 signal intensity on the choice of surgical approach of multi-segmental cervical spondylosis clinical research at home and abroad. This study focuses on the multilevel cervical disease quantify the MRI T2 signal intensity level, different surgical methods selected clinical applications. Methods: December 2000 to November 2007, a total of 116 patients were treated with different surgical treatment of multi-segmental cervical spondylosis 86 males and 30 females, aged 31 to 78 years, an average of 58.73 ± 8.29 years. All patients underwent preoperative high-resolution 1.5T MR imaging and quantify the ratio of signal intensity of the spinal cord. Cervical spinal cord sagittal imaging T1-weighted images using a spin-echo sequence, T2-weighted images using fast spin-echo sequence. Scan using the surface coil. Thickness 4mm, acquisition matrix of 512 × 256. Sequence parameters: T1-weighted images, repetition time (TR) 612ms, echo time (TE) 13ms; T2-weighted images TR 2400ms, TE 114ms. Like spinal cord compression, signal enhancement in the sagittal plane T2-weighted the most significant parts take the region of interest (the area of ??0.05cm2) measured signal strength values, and then taken C7/T1 vertebral spinal segment region of interest (the area 0.3cm2) and the measurement signal intensity value, to calculate the ratio of the two. T2-weighted images cord signal no significant change in the most serious part of spinal cord compression take interest area (area 0.05cm2) measuring the signal strength values. Patients by the ratio of the size of the data were divided into three groups, focusing on analysis of signal level group of patients and all patients in the former Road, posterior, anterior and combined decompression JOA score improvement rate of three surgical treatment methods. Results: All patients obtained at least 12 months follow-up, the longest follow-up time of 5 years, an average of 13.8 months, preoperative JOA score was 8.68 ± 2.26 after 3 months to 12.89 ± 2.94 after 1 year 12.16 ± 3.07 to improve the rate of 55.13% ± 15.27%. Rank sum test, low signal intensity ratio of the group, the rate of improvement was no significant difference among the three groups; signal intensity ratio of the group, the rate of improvement was statistically significant difference among the three groups. Further pairwise comparisons showed that anterior surgery group (71%) and posterior surgery group (47%), posterior surgery and anterior group (64%) improvement rate difference was statistically significant; in the high signal intensity ratio of the group to improve the rate of significant differences among the three groups. Further pairwise comparison, The anterior surgical group (20%) and posterior surgery group (36%), anterior surgery anterior group (28%) improvement rate difference was statistically significant. All patients grouped under the conditions of the three surgical methods improvement rate was no significant difference among the three groups. CONCLUSIONS: Surgery is an effective method for the treatment of multi-segmental cervical spondylosis in different signal strength grade group, three surgical showing different surgical treatment. Quantify the cervical spinal cord MRI T2 signal intensity level selected surgical approach for multi-segmental cervical spondylosis clinical significance.

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CLC: > Medicine, health > Clinical > Diagnostics > Diagnostic Imaging > Magnetic resonance imaging
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