Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.

Objective To establish a rat liver transplantation model under direct vision of single operator and to explore the effect of different perfusion methods on the quality of the donor liver. Methods On the basis of the "two-cuff method" established by Kamada, the operation details were improved to established the rat liver transplantation model. The recipient rats were divided into two groups according to different perfusion methods, group A (perfusion via abdominal aorta) and group B (perfusion via portal vein). The perfusion effect, operation time, operation success rate, postoperative liver function, liver graft pathological manifestations and survival were compared between the two groups. Results There were more residual red blood cells in sinus hepaticus in group B than in group A after perfusion. Both the donor liver perfusion time and donor operation time were longer in group A than those in group B, and the differences were statistically significant (both P < 0.01). The success rate of operation in group A and group B was 77% and 71%, respectively. At 3 d after liver transplantation in rats, the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TB) of the rats in the two groups were significantly higher than normal. At 7, 30 d after operation, compared with group A, the levels of ALT, AST and TB in group B were significantly increased, and the differences were statistically significant (all P < 0.01-0.05). The liver pathological examination showed that the degree of inflammatory reaction in the liver and degree of destruction of liver tissue in group B were more severe than those in group A, but there was no significant difference in long-term survival rate between the two groups. Conclusions Although the perfusion time and donor operation time of rat liver transplantation model were slightly prolonged by means of abdominal aorta perfusion, the perfusion effect was better, which can reduce liver tissue damage after operation and restore liver function to normal levels more quickly.

Objective To investigate the expression of Situin 1 ( SIRT1) in 5 strains of human lung adenocarcinoma cell lines, inclu-ding HCC827, H1650, H1975, A549 and H1299, and its relation to the susceptibility of nedaplatin ( NDP ) . Methods The SIRT1 mRNA and protein levels in 5 strains of human lung adenocarcinoma cells were detected by real-time quantitative PCR and Western blot, respectively. The viability of cells treated with NDP was detected by the CCK-8 method and the half growth inhibition concentra-tion ( IC50 ) was calculated. After the expressions of SIRT1 in A549, H1299, H1650 and H1975 cells were down-regulated by the siR-NA interference, the effects of NDP on the viability and apoptosis of these cells were determined by the CCK-8 method and flow cytom-etry, respectively.Results The expression levels of SIRT1 mRNA (4.53 ± 0.74, 3.11 ± 0.64, 15.76 ± 2.28 and 18.09 ± 1.17) and protein (0.23 ± 0.03, 0.21 ± 0.02, 0.52 ± 0.11 and 0.56 ± 0.08) in H1650, H1975, A549 and H1299 cells were significantly higher than that in HCC827 cells (1.00 for SIRT1 mRNA and 0.11 ± 0.02 for SIRT1 protein, F=122.10 and 26.50, respectively, P<0.01). The susceptibility of A549 and H1299 cells to NDP [IC50=(7.38 ± 1.59) and (8.14 ± 1.43) μmol/L, respectively] was significantly higher than that of HCC827, H1650 and H1975 cells [IC50=(26.16±4.35),(22.29±3.26) and (24.41 ± 2.58), respectively, F=30.86, P<0.01].The survivals of A549 and H1299 cells transfected by siSIRT1 and treated with NDP were significantly higher than that in the NC group ( F=235.10 and 39.20, respectively,P<0.01) , and the apoptotic rates were the reverse ( t=7.29 and 6.68, re-spectively, P<0.05) . However, the survivals of H1650 and H1975 cells transfected by siSIRT1 and treated with NDP were significantly lower than that in the NC group ( F=185.40 and 60.09, respectively,P<0.01) , and the apoptotic rates were the reverse ( t=6.15 and 31.36, respectively,P<0.01).Conclusion The expression of SIRT1 in A549 and H1299 cells with high expression of SIRT1 increases their susceptibility to NDP , while that in H1650 and H1975 cells with moderate expression of SIRT1 decreases their susceptibility to NDP, indicating that SIRT1 may play dual roles in the resistance of human lung adenocarcinoma cells to platinum.

Objective To investigate the expression of sperm-associated antigen 6 (Spag6) in liver cancer tissue and its association with the clinicopathological features and prognosis of liver cancer patients,as well as the effect of Spag6 on the proliferation and migration of HCCLM3 hepatoma cells.Methods Clinical samples were collected from 102 liver cancer patients who were treated in Xiangya Hospital of Central South University from August 2006 to November 2009,and Western blot was used to measure the expression of Spag6 in hepatoma cells,normal liver tissue,tumor tissue,and corresponding adjacent tissue.Immunohistochemistry was used to measure the expression of Spag6 in 102 liver cancer tissue samples,and according to the immunohistochemical scoring criteria,the patients were divided into high Spag6 expression group and low Spag6 expression group.Lentivirus-mediated RNA interference technique was used to silence Spag6 expression in HCCLM3 cells;Western blot was used to analyze silencing effect,wound-healing assay was used to investigate the effect of Spag6 gene silencing on the migration of HCCLM3 cells,and colony formation assay was performed to observe the effect of Spag6 gene silencing on the proliferation of HCCLM3 cells.The chi-square test was used to investigate the association between Spag6 expression and clinicopathological features of liver cancer patients,and the Kaplan-Meier survival analysis and log-rank test were used to analyze the association between Spag6 expression and the prognosis of liver cancer patients.Results Hepatoma cells and liver cancer tissue had significantly higher expression of Spag6 than the normal L02 cells and normal liver tissue.Immunohistochemistry showed that the expression rate of Spag6 was 58.8％ (60/102) in liver cancer tissue samples and 12.7％ (13/102) in adjacent tissue samples (x2 =47.123,P ＜0.001).According to the results of the chi-square test,Spag6 expression was associated with the number of tumor nodules,presence or absence of capsule,vascular invasion,and Edmondson-Steiner classification (x2 =8.360,6.761,4.344,and 7.172,P =0.004,0.009,0.037,and 0.007).Further analysis showed that the high Spag6 expression group had significantly lower 1-,3-,and 5-year survival rates than the low Spag6 expression group (71.5％ vs 90.5％,43.7％ vs 68.8％,19.7％ vs 48.7％,x2 =11.228,P =0.001).Cell assays showed significant reductions in the proliferation and migration of HCCLM3 cells after Spag6 gene silencing (both P ＜ 0.01).Conclusion Spag6 is highly expressed in hepatoma cells and liver cancer tissue,and its high expression is associated with poor clinicopathological features and postoperative survival of liver cancer.Spag6 can promote the proliferation and migration of hepatoma cells,suggesting that Spag6 may be involved in the development and progression of liver cancer.Therefore,it can be used as a reference index for predicting the prognosis of liver cancer patients and a potential target for liver cancer treatment.

OBJECTIVE:To investigate the effects of Jintiange capsules combined with zoledronic acid on bone mineral densi-ty(BMD),VAS scores and lab indexes of patients with postmenopausal diabetic osteoporosis. METHODS:140 patients with post-menopausal diabetic osteoporosis were divided into control group and treatment group according to randomized blocks,with 70 cas-es in each group. Both group received 0.9% Sodium chloride injection 100 ml intravenously before and after treatment,and were given vitamin D and calcium. Control group was given Zoledronic acid injection 5 mg intravenously for more than 15 min,once ev-ery 4 weeks. Treatment group was additionally given Jintiange capsules 1.2 g,po,tid,on the basis of control group. Both groups received 6 months of treatment. BMD,VAS score,lab indexes before and after treatment and the occurrence of ADR were com-pared between 2 groups. RESULTS:After treatment,BMD of 2 groups were increased significantly compared to before treatment, and the treatment group was significantly higher than the control group,with statistical significance (P<0.05). VAS score of 2 groups after treatment were significantly lower than before treatment,and VAS score of treatment group was significantly lower than that of control group after treatment,with statistical significance(P<0.05). The levels of blood calcium and serium inorganic phosphorus had no change in 2 groups;but the level of osteocalcin was significantly higher than before treatment,while the level of bone-specific alkaline phosphatase was significantly lower than before treatment,and the levels of osteocalcin and bone-specific alkaline phosphatase in treatment groups were significantly better than in control group,with statistical significance (P<0.05). There was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Jintiange capsules combined with Zoledronic acid injection in the treatment of postmenopausal osteoporosis patients with diabetes can significantly in-crease BMD,relieve pain and improve lab index levels. Moreover,it doesn’t increase the risk of ADR.

OBJECTIVETo evaluate the clinical results and the value of the posterior approach 360° vertebral canal decompression and transfacet discectomy combined with interbody fusion and pedicle screw internal fixation for the treatment of ossifying thoracic disc herniation.

METHODSThirty nine cases of ossifying thoracic disc herniation who accepted the posterior approach 360° vertebral canal decompression and transfacet discectomy combined with interbody fusion and pedicle screw internal fixation were included in this study. There were 21 male and 18 female patients. The age ranged from 33 to 69 years, with an average of 53 years. The course of disease ranged from 1 month to 18 months, with an average of 6.5 months. The lesion locations were T7-8 for 1 case, T8-9 for 4 cases, T9-10 for 9 cases, T10-11 for 7 cases, T11-12 for 10 cases, T12-L1 for 6 cases, and both T11-12 and T12-L1 for 2 cases. The clinical results were evaluated by Otani scored system.

RESULTSThe operative time was from 2.5 to 5.0 hours, with average of 3.3 hours. The blood loss was from 400 to 2 000 ml, with average of 850 ml. All patients were successfully operated without neurological symptoms aggravation and accidents. The followed-up period was 24 to 60 months, mean 40.5 months. According to Otani scored system, there were excellent results in 16 cases and good results in 18 cases. The clinical satisfaction rate was 87.2%. All obtained bony fusion without instrument failure.

CONCLUSIONPosterior approach 360° vertebral canal decompression and transfacet discectomy combined with interbody fusion and pedicle screw internal fixation is a safe and effective surgical procedure for the treatment of ossifying thoracic disc herniation.

Adult ; Aged ; Decompression, Surgical ; methods ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; surgery ; Male ; Middle Aged ; Spinal Fusion ; methods ; Thoracic Vertebrae ; Treatment Outcome

Objective To observe the therapeutic effects of posterior laminectomy and lateral bone fusion on multi-segments thoracic disk herniation. Methods 18 patients with multi-segments thoracic disk herniation accepted the posterior laminectomy and lateral bone fusion. They were followed up with JOA score and Frankel system. Results The mean of operative time was 190.6 min with a mean of blood loss of 806.3 ml. Cerebrospinal fluid leakage happened in 3 patients, and recovered after treatment. Wound infection occurred in 1 case and recovered after applied sensitive antibiotics. The Cobb's angle decreased after surgery (P<0.05). Compared with the preoperative, the JOA score improved 3 months later and at the last follow-up (P<0.05). During the follow-up, there was no fixation loosen, displacement and spinal instability happened. Conclusion Patients with multi-segments thoracic disk herniation may benefit full spinal decompression and a stable spinal sagittal alignment from posterior laminectomy and lateral bone fusion.

Objective To investigate prevention and treatment of cerebrospinal fluid leakage (CSFL)in anterior cervical spine surgery for severe ossification of posterior longitudinal ligament (OPLL).Methods A retrospective analysis of 47 patients with severe cervical OPLL (thickness of the ossified mass ＞ 5 mm,spinal stenosis ＞50％),who had undergone anterior cervical surgery between January 2008 and May 2011,was conducted.Fifteen cases of dural defect were found intraoperatively,including 11 males and 4 females,aged from 40 to 68 years (average,55.6 years).Preoperative CT scans were earefully analyzed.During the operation,the ossified mass was excised or floated and the arachnoid was reserved in order to reduce dural damage.Dural defects were repaired by suturing or covering with muscle.After surgery,patients were confined to bed rest to allow for drainage or puncture.Results All 15 patients were followed up for 12 to 18months (average,14.8 months).After operation,10 patients recovered fully without CSFL.Five patients developed CSFL,including 4 cases of spinal dural mater injury that healed within 4-6 days with bed rest and pressure dressing,and 1 case of cerebrospinal fluid pseudocyst that disappeared within 3 weeks with repeat puncture and aspiration treatment.No cases required secondary operations or shunt placement.All cases exhibited good neurological improvement.Conclusion During anterior surgical treatment for severe cervical OPLL,CSFL can be effectively prevented through eareful analysis of preoperative CT images,meticulous operative technique,reasonable handling of the ossified mass and positive repair of dural damage.Moreover,postoperative bed rest and drainage are effective to treat CSFL.

Objective To evaluate the clinical outcomes of modified eggshell technique through posterior approach for the treatment of hard thoracic disc herniation. Methods From January 2006 to June 2009, 22 patients admitted for hard thoracic disc herniation were reviewed, including 13 males and 9 females, with an average age of 49.5 years (range, 33-69). The courses of disease were 11 months on the average (range, 3-18 ). The lesions located in T8-9 for 4 cases, T9-10 for 9, T10-11 for 7, T11-12 for 2. Each of the patients underwent X-ray, CT scanning and MRI examination before surgery. There were 16 cases of central type, and 6 cases of paracentral type. All patients were treated surgically by modified eggshell technique via posterior approach. Results The mean operative time was 210 min (range, 180-300 min), with a mean blood loss of 860 ml (range, 600-1200 ml). All surgeries were performed successfully without neurological symptoms aggravation. Surgical complications included dural laceration in 2 cases, both dural lacerations were repaired intraoperatively, epidural hematoma in 1 case with lower extremity neurological symptoms, full neurologic recovery was observed after surgical removal of the hematoma. All patients were followed up for average 27.5 months (range, 12-54). The mean JOA score increased from 3.36±1.79 before operation to 7.45±2.99 after the operation at 12 months follow up, and the mean improvement rate of neurological status was 58.3%±30.7%. There was significant difference in JOA score before and after surgery(t=10. 12,P＜0.01 ).The results of 14 cases were ranked as good, 6 as fair, 2 as unchanged, and none as worsened. All cases obtained bony fusion without instrument failure. Conclusion Modified eggshell technique enable ventral and dorsal spinal decompression from the posterior approach in cases of hard thoracic disc herniation, with reduction of the rate of postoperative paralysis.

Objective To investigate whether increased signal intensity (ISI) can help assess the prognosis in patients with cervical spondylotic myelopathy (CSM) by means of measuring the ratio of signal intensity. Methods A retrospective study with two or more years follow-up of 57 patients with CSM underwent posterior cervical decompression were carried out from February 2000 to February 2006. 1.5T MRI was performed in all patients before surgery. T2-weighted images (T2WI) of sagittal ISI on the cervical spinal cord were obtained, For those with ISI, the values of signal intensity of the spinal cord on T2-weighted image (T2Wl) and TI-weighted image (TIWI) of sagittal view were measured at the location where there was ISI on T2WI, and the ratio of signal intensity of T2WI / T1WI (T2/T1 ratio) at the same level of the spinal cord and with similar area was calculated on the computer. Patients with ISI were subdivided into 2 groups according to T2/T1 ratio. Results ISI was not observed in 20 patients (group 1). The range of T2/T1 ratio of other 37 patients was from 1.28 to 2.80 and the median was 1.65. Nineteen patients were divided into group 2 (ratio range, 1.28-1.63), and 18 into group 3 (ratio range, 1.67-2.80). Significant differences were noted in age at surgery, duration of disease, recovery rate, pre and preoperative JOA score among three different groups.Spearman's rank correlation showed that T2/T1 ratio was positively correlated with age at surgery and duration of disease, negatively with pre- and postoperative JOA score and recovery rate. Conclusion Patients with ISI and higher T2/T1 ratio tend to have relatively severe preoperative state of illness and poor prognosis after surgical intervention. Spinal cord signal intensity change on T2-weighted MRI might be a predictor of a poor outcome in terms of functional recovery rate in patients underwent operations for multi-level CSM.