Dergiler / Journal of Neurological Sciences (Turkish) / 2015 / Cilt: 32 - Sayı: 1
Selection of Operative Approaches for Cervical Spinal Cord Injury without Radiologic Evidence of Trauma by Imaging Scoring System
- Sayfa
- 134–145
- DOI
- —
Özet
Giriş ve amaç: Bu çalışmanın amacı travmanın radyolojik bulgusu olmaksızın oluşan spinalkord yaralanmasında (SCIWORET) optimal cerrahi yaklaşımı gerektiren olguları saptamak vestandardize etmek üzere bir görüntüleme skor sistemi oluşturmaktır.Yöntemler: Azami olası ayırım kullanılarak tatminkar klinik sonuç alınan (>%60 şifa oranı)farklı cerrahi yaklaşım uygulanmış 150 servikal myelopati hastası retrospektif olarak analizedilerek görüntüleme skor sistemi tasarlandı. Segmental instabilite, kongenital spinal kanalstenozu, spinal kord kompresyon derecesi, ligamantum flavum kalınlaşmasıve süregelenposterior longitudinal ligaman ossifikasyonu olarak saptanan altı görüntüleme endeksi cerrahiyaklaşım için ilişkili bulunarak seçildiler. SCIWORET hastalarının klinik sonuçlarıgörüntüleme skor sistemi ile tutarlı (Grup A) ve tutarsız (Grup B) olarak değerlendirilerekgörüntüleme skor sistemi irdelendi.Sonuçlar: Post-operatif JOA skoru (t=9,626; p
Abstract
Objective: The purpose of this study is to present an imaging scoring system for the patientswith spinal cord injury without radiologic evidence of trauma (SCIWORET), by which theselection of the optimal surgical approaches for this injury needing surgical intervention canbe quantified and standardized.Methods: The imaging scoring system was designed and established from the retrospectiveanalysis of the 150 patients with cervical myelopathy who underwent different surgicalapproaches with satisfactory clinical results (>60% recovery rates) using the maximumlikelihood discriminance. Six imaging indices closely related to the surgical approach wereselected for each patient, including segmental instability, congenital spinal canal stenosis, thedegree of spinal cord compression, hypertrophy of the ligamentum flava, and the localized orcontinuous ossification of the posterior longitudinal ligament. Then the clinical outcomes ofpatients with SCIWORET were evaluated between the patients consistent with the imagingscoring system(Group A) and those not consistent with the imaging scoring system (Group B)to explore the clinical significance of the scoring system.Results: Of the two groups of patients with SCIWORET, there was a significant difference inpost-operative JOA score (t=-9.626; p＜0.0001) and recovery rate (t=-2.387; P=0.023),showing statistically significant more improvement at the clinical symptoms and JOA scoresin Group A than that in Group B.Conclusions: For the patients with SCIWORET needing surgical intervention, the imagingscoring system can provide guidelines for surgeons in choosing the appropriate surgicalapproach to optimize clinical outcomes and minimize complications.