caa a22 4500 44583188X CHVBK 20180317145317.0 cr unu---uuuuu 170323e20110901xx s 000 0 eng 10.1007/s00586-011-1813-7 doi (NATIONALLICENCE)springer-10.1007/s00586-011-1813-7 Do intramedullary spinal cord changes in signal intensity on MRI affect surgical opportunity and approach for cervical myelopathy due to ossification of the posterior longitudinal ligament? [Elektronische Daten] [Qizhi Sun, Hongwei Hu, Ying Zhang, Yang Li, Linwei Chen, Huajiang Chen, Wen Yuan] Some controversy still exists over the optimal treatment time and the surgical approach for cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL). The aim of the current study was first to analyze the effect of intramedullary spinal cord changes in signal intensity (hyperintensity on T2-weighted imaging and hypointensity on T1-weighted imaging) on magnetic resonance imaging (MRI) on surgical opportunity and approach for cervical myelopathy due to OPLL. This was a prospective randomized controlled study. Fifty-six patients with cervical myelopathy due to OPLL were enrolled and assigned to either group A (receiving anterior decompression and fusion, n=27) or group P (receiving posterior laminectomy, n=29). All the patients were followed up for an average 20.3months (12-34months). The clinical outcomes were assessed by the average operative time, blood loss, Japanese Orthopedic Association (JOA) score, improvement rate (IR) and complication. To determine the relevant statistics, we made two factorial designs and regrouped the data of all patients to group H (with hyperintensity on MRI, n=31), group L (with hypointensity on MRI, n=19) and group N (no signal on MRI, n=25), and then to further six subgroups as well: AH (with hyperintensity on MRI from group A, n=15), PH (with hyperintensity on MRI from group P, n=16), AL (with hypointensity on MRI from group A, n=10), PL (with hypointensity on MRI from group P, n=9), AN (no signal intensity on MRI from group A, n=12) and PN (no signal intensity on MRI from group P, n=13). Both hyperintensity on T2-weighted imaging and hypointensity on T1-weighted imaging had a close relationship with the JOA score and IR. The pre- and postoperative JOA score and postoperative IR of either group H or group L was significantly lower than that of group N (P<0.05), regardless of whether the patients had received anterior or posterior surgery. On the other hand, both the JOA score and IR of subgroup AH were higher than those of subgroup PH at 1week, 6 and 12months postoperatively (P<0.05), as well as between subgroup AL and PL; but in group N, there was no difference between the subgroup AN and PN (P>0.05). In conclusion, regardless of hyperintensity on T2-weighted imaging or hypointensity on T1-weighted imaging in patients with OPLL, severe damage to the spinal cord is indicated. Surgical treatment should be provided before the advent of intramedullary spinal cord changes in signal intensity on MRI. The anterior approach is more effective than posterior approach for treating cervical myelopathy due to OPLL characterized by intramedullary spinal cord changes in signal intensity on MRI. Springer-Verlag, 2011 Anterior decompression and fusion nationallicence Laminectomy nationallicence Ossification of the posterior longitudinal ligament nationallicence Signal intensity on MRI nationallicence Sun Qizhi Department of Orthopedics, Changzheng Hospital, Secondary Millitary Medical University of China, 415 Fengyang Road, 200003, Shanghai, People's Republic of China aut Hu Hongwei Department of Orthopedics, No. 88 Hospital of Chinese People's Liberation Army, Taian, People's Republic of China aut Zhang Ying Department of Orthopedics, Changzheng Hospital, Secondary Millitary Medical University of China, 415 Fengyang Road, 200003, Shanghai, People's Republic of China aut Li Yang Department of Orthopedics, Changzheng Hospital, Secondary Millitary Medical University of China, 415 Fengyang Road, 200003, Shanghai, People's Republic of China aut Chen Linwei Department of Orthopedics, Changzheng Hospital, Secondary Millitary Medical University of China, 415 Fengyang Road, 200003, Shanghai, People's Republic of China aut Chen Huajiang Department of Orthopedics, Changzheng Hospital, Secondary Millitary Medical University of China, 415 Fengyang Road, 200003, Shanghai, People's Republic of China aut Yuan Wen Department of Orthopedics, Changzheng Hospital, Secondary Millitary Medical University of China, 415 Fengyang Road, 200003, Shanghai, People's Republic of China aut European Spine Journal Springer-Verlag 20/9(2011-09-01), 1466-1473 0940-6719 20:9<1466 2011 20 586 https://doi.org/10.1007/s00586-011-1813-7 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00586-011-1813-7 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Sun Qizhi Department of Orthopedics, Changzheng Hospital, Secondary Millitary Medical University of China, 415 Fengyang Road, 200003, Shanghai, People's Republic of China aut NATIONALLICENCE 700 1- Hu Hongwei Department of Orthopedics, No. 88 Hospital of Chinese People's Liberation Army, Taian, People's Republic of China aut NATIONALLICENCE 700 1- Zhang Ying Department of Orthopedics, Changzheng Hospital, Secondary Millitary Medical University of China, 415 Fengyang Road, 200003, Shanghai, People's Republic of China aut NATIONALLICENCE 700 1- Li Yang Department of Orthopedics, Changzheng Hospital, Secondary Millitary Medical University of China, 415 Fengyang Road, 200003, Shanghai, People's Republic of China aut NATIONALLICENCE 700 1- Chen Linwei Department of Orthopedics, Changzheng Hospital, Secondary Millitary Medical University of China, 415 Fengyang Road, 200003, Shanghai, People's Republic of China aut NATIONALLICENCE 700 1- Chen Huajiang Department of Orthopedics, Changzheng Hospital, Secondary Millitary Medical University of China, 415 Fengyang Road, 200003, Shanghai, People's Republic of China aut NATIONALLICENCE 700 1- Yuan Wen Department of Orthopedics, Changzheng Hospital, Secondary Millitary Medical University of China, 415 Fengyang Road, 200003, Shanghai, People's Republic of China aut NATIONALLICENCE 773 0- European Spine Journal Springer-Verlag 20/9(2011-09-01), 1466-1473 0940-6719 20:9<1466 2011 20 586 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer