Effects of MRI in the diagnosis and prognosis of cervical spinal cord injury without fracture or dislocation

doi:10.3969/j.issn.2095-4344.2017.31.020

Abstract

Abstract:

BACKGROUND: In the elderly, the cervical vertebrae will appear with different degrees of spinal stenosis caused by various factors. Notably, the incidence of cervical spinal cord injury without fracture or dislocation is high, accounting for 3%-16% of cervical spinal cord injury.

OBJECTIVE: To explore the efficacy of MRI in the diagnosis and prognosis of cervical spinal cord injury without fracture or dislocation, and to analyze the influencing factors for surgical effectiveness.

METHODS: Fifty-one patients with cervical spinal cord injury without fracture or dislocation in Zibo Central Hospital from August 2014 to June 2016 were analyzed retrospectively. All the patients underwent anterior, posteror, or anterior-posterior fusion, respectively, and then the intraoperative ligament injury and MRI images were compared. The age, injury type, spinal cord injury type revealed on MRI, time from injury to hospital, signal length of spinal cord injury, American Spinal injury Association grade, degree of cervical stenosis, whether hormone used or not within 8 hours after injury, time from injury to surgery, and surgical approaches were analyzed based on univariate analysis and multivariate analysis by Logistic regression analysis.

RESULTS AND CONCLUSION: (1) MRI showed more comprehensive damage of the spinal cord and intervertebral disc ligament complex than the intraoperative findings (χ²=5.966，P < 0.05), and the cervical spinal cord injury was related to the injury of the corresponding intervertebral disc ligament complex (χ²=1.53, P > 0.05). (2) Univariate analysis results showed that the spinal cord injury type revealed on MRI, signal length of spinal cord injury, American Spinal injury Association grade, degrees of cervical stenosis, whether hormone used or not within 8 hours after injury, and time from injury to surgery were related to the functional recovery of spinal cord (P < 0.01). (3) Multivariate analysis results indicated that the type revealed on MRI, signal length of spinal cord injury and degrees of cervical stenosis were significantly related to the functional recovery of spinal cord (P < 0.05). (4) These results suggest that MRI has a high tissue resolution, so it plays an important role in the diagnosis of cervical spinal cord injury without fracture or dislocation. Moreover, the degrees of spinal cord injury and spinal stenosis, as well as operation time are main factors for curative efficacy.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Fractures, Bone, Spinal Cord Injuries, Regression Analysis, Factor Analysis, Statistical, Tissue Engineering

CLC Number:

R318

Liu Xin-ge, Li Tao, Chen Fang-min, Han Dun-fu, Shi Ming. Effects of MRI in the diagnosis and prognosis of cervical spinal cord injury without fracture or dislocation [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(31): 5036-5041.

Figures/Tables 3

2.2 MRI表现与术中所见比较对本组51例患者的MRI显示均有颈脊髓信号异常，其中44例(86%)1个部位损伤，7例(14%)2个部位损伤，椎间盘韧带复合体损伤39例(77%)56部位，其中单部位25例(64%)，2部位11例(28%)，3部位3例(8%)；术中所见椎间盘韧带复合体损伤38例(75%)53部位，单部位27例(71%)，两部位7例(18%)，三部位4例(11%)，见表1。将MRI图像显示与术中发现椎间盘韧带复合体损伤进行配对设计卡方检验，χ2=5.966，P < 0.05；将颈脊髓损伤部位与对应椎间隙平面椎间盘韧带复合体损伤随机设计两样本率比较的卡方检验，χ2=1.514，P < 0.05。 2.3 疗效判断及统计学处理所有患者顺利完成手术，术后肺部感染1例，积极对症处理后治愈，无其他并发症。本组51例患者无失访，随访时间6-77个月。术前JOA评分(9.87±1.15)分，末次随访时为(15.87±2.37)分，手术前后JOA评分平均改善率可达(72.67±10.09)%，即说明3种术式均能有效改善无骨折脱位型颈脊髓损伤患者脊髓功能。以手术治疗后颈脊髓功能恢复是否优良为因变量，以患者的年龄、外伤类别脊髓损伤MRI类型、受伤到就诊时间、脊髓损伤信号范围、脊髓损伤ASIA评分、颈椎管狭窄程度、伤后8 h内是否使用激素治疗、受伤至手术的时间、手术方式等因素为自变量行单因素筛选：脊髓损伤MRI类型、脊髓损伤信号范围、脊髓损伤ASIA评分、椎管狭窄程度、伤后8 h内是否使用激素治疗、受伤至手术的时间等因素与脊髓神经功能恢复有相关性(P < 0.1)。见表2，3。然后以颈脊髓损伤MRI类型、脊髓损伤信号范围、脊髓损伤ASIA分级、颈椎管狭窄程度、伤后8 h内是否使用激素治疗、受伤至手术的时间等因素为自变量，术后颈脊髓功能恢复是否优良为因变量，行多因素Logistic回归分析。结果显示，影响术后颈脊髓功能恢复作用最强的因素为脊髓损伤MRI类型、脊髓损伤信号长度，其次为颈椎管狭窄程度、脊髓损伤AISA分级和受伤到手术时间(P < 0.05)，伤后8 h是否使用激素暂不作为独立因素起作用(P > 0.05)，见表4。 "

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