青少年特发性脊柱侧凸大弯度患者脊髓圆锥位置的MRI研究

目的探讨青少年特发性脊柱侧凸(AIS)患者的脊髓圆锥位置及其与患者年龄、性别、侧凸严重程度和侧凸模式之间的关系。方法对202名 Cobb 角40°以上的 AIS 患者和52名对照组青少年进行腰椎 MRI 扫描,在矢状面自旋回波 T1WI 序列图像上,观测脊髓圆锥末端的位置,并根据圆锥末端与相邻的椎体的上、中、下1/3和椎间盘的对应关系进行定位。结果 AIS 组和对照组青少年的圆锥位置范围分别为 T_(12)中1/3～L_(2/3)椎间盘和 T_(12)下1/3～L_2下1/3,平均位置则均为 L_1下1/3水平。两组间圆锥位置分布无统计学差异。这两组青少年的圆锥位置不受年龄和性别的影响。在AIS 组内,圆锥位置与侧凸的严重程度和侧凸模式无显著相关性。结论 AIS 患者的圆锥位置分布与对照组相当,圆锥位置不受年龄、性别、侧凸严重程度和侧凸模式等影响。这提示,圆锥位置的改变不能用于对 AIS 的发病及进展的研究。

Variation of the position of the conus medullaris in adolescent idiopathic scoliosis patients with a Cobb angle greater than 40 degrees: Analysis of MRI

OBJECTIVE: To investigate the position of the conus medullaris in adolescent idioppathic scoliosis (AIS) with a greater curve and the relationship of that with age, sex, curve severity and curve pattern. METHODS: In this study, 202 AIS patients with a Cobb angle greater than 40 degrees on coronal plane were included. And 52 age-matched healthy adolescents were recruited to serve as controls. Both of them displayed neurologically normal upon physical examinations. The T1-weighted, sagittal, spino-echo magnetic resonance imaging (MRI) of lumbar spine was performed on both of AIS patients and healthy controls. According to a standard method described previously, the position of the conus medullaris relative to lumbar vertebrae and intervertebral disc space was measured. RESULTS: There was no significant difference in the distributions of the positions of the conus medullaris in AIS patients and healthy controls. In both groups, the mean position of the conus medullaris located at the same level, the lower 1/3 of L(1) (range: the middle 1/3 of T(12) to L(2 - 3) disc space). No significant correlations were found between the position of the conus medullaris and age or sex in AIS and control subjects. It was shown that the positions of the conus medullaris were not significantly different among AIS patients with different curve severity and curve patterns. CONCLUSIONS: The distribution of the conus location in AIS patients is shown to be ranged from the middle 1/3 of T(12) to L(2 - 3) disc space, with no significant difference when compared to controls. No significant associations are found between the conus position with curve severity and curve patterns, indicating the conus location might be of no significant relevance of research on AIS pathogenesis and curve progression.