动态MRI检测颈椎健康者、颈肩部不适者脊髓型颈椎病未确诊及确诊者的价值

背景：目前MRI对于颈椎病的检查多是常规的中立仰卧位静态平扫,是在非运动和非承重的条件下完成的,容易忽略脊髓在人体中承重和动态下脊髓的器质性改变。 目的：分析颈椎动态MRI结合临床表现早期诊断脊髓型颈椎病的临床意义。 方法：对随机抽取的正常人群10名(正常组)、有颈肩部不适的亚健康人群20名(亚健康组)、有脊髓型颈椎病症状体征但常规MRI不支持的患者20名(MRI正常脊髓型颈椎病组)、符合现行脊髓型颈椎病诊断标准的患者20名(脊髓型颈椎病组)进行JOA评分,颈椎正侧位片、颈椎中立位MRI及颈椎动态MRI检查,并随访18个月以上,观察4组研究对象各项观察指标的变化情况及4组人群的转归情况。 结果与结论：脊髓型颈椎病组20例患者均在入组半年内手术治疗;MRI正常脊髓型颈椎病组20例中有16例在入组16个月内行手术治疗,其中4例入组1年内在中立位MRI检查尚无明显改变时即行手术治疗,12例在入组1年后颈椎中立位MRI也已有脊髓型颈椎病的典型改变时行手术治疗,前者治疗效果明显优于后者(P < 0.05);亚健康组有4例出现了脊髓型颈椎病的症状体征,发现此4例患者动态颈椎MRI检查均有椎管变窄脊髓受压征象,但中立位MRI仅发现1例由此改变,且此例动态MRI在入组12个月时已经发现脊髓受压。在正常组随访中动态MRI与中立位MRI检查均发现1例有椎管变窄脊髓受压征象,但患者没有任何不适症状,考虑为假阳性;二者假阳性率相同。结果表明,颈椎动态MRI检查较中立位MRI能够更早期、更真实客观地发现脊髓受压征象;在临床症状、体征检查的基础上将常规的中立位MRI检查与动态MRI检查相结合将会更早期发现脊髓型颈椎病。     

前屈-后伸位MRI对判断颅脊交界区畸形内固定指征的临床价值

目的分析前屈-后伸位MRI对诊断Arnold-Chiari畸形可能合并寰枢椎脱位的作用,以及指导治疗的临床意义。方法回顾分析40例Arnold-Chiari畸形患者的前屈-后伸位MRI影像学资料,测量寰齿间距,通过前屈位和后伸位颈椎椎管狭窄程度分级,判断颅脊交界区稳定性。单纯Arnold-Chiari畸形患者采用枕大孔减压和枕大池扩大成形术,存在寰枢椎脱位者兼行枕颈内固定融合术。结果经前屈-后伸位MRI检查,证实有12例患者存在颅颈失稳,于枕大孔减压的同时行枕颈内固定融合术。手术后第3天颈椎影像学检查,40例中10例脊髓空洞病灶明显缩小;12例兼行枕颈内固定融合术者颅颈复位满意,脊髓压迫解除;手术后3个月随访,脊髓空洞病灶明显缩小(17例),颅脊交界区骨痂形成、骨融合效果良好、颅颈复位无丢失(12例),日本矫形外科评分13.08±1.40,与手术前评分(11.08±1.61)比较,差异有统计学意义(t=5.928,P=0.000)。结论前屈-后伸位MRI对判断颅脊交界区稳定性、选择适宜的手术方式具有重要意义。     

前屈-后伸位MRI对判断颅脊交界区畸形内固定指征的临床价值

目的分析前屈-后伸位MRI对诊断Arnold—Chiari畸形可能合并寰枢椎脱位的作用,以及指导治疗的临床意义。方法回顾分析40例Arnold—Chiari畸形患者的前屈-后伸位MRI影像学资料,测量寰齿间距,通过前屈位和后伸位颈椎椎管狭窄程度分级,判断颅脊交界区稳定性。单纯Arnold．Chiari畸形患者采用枕大孔减压和枕大池扩大成形术,存在寰枢椎脱位者兼行枕颈内固定融合术。结果经前屈．后伸位MRI检查,证实有12例患者存在颅颈失稳,于枕大孔减压的同时行枕颈内固定融合术。手术后第3天颈椎影像学检查,40例中10例脊髓空洞病灶明显缩小;12例兼行枕颈内固定融合术者颅颈复位满意,脊髓压迫解除;手术后3个月随访,脊髓空洞病灶明显缩小（17例）,颅脊交界区骨痂形成、骨融合效果良好、颅颈复位无丢失（12例）,日本矫形外科评分13．08±1．40,与手术前评分（11．08±1．61）比较,差异有统计学意义（t=5．928,P=0．000）。结论前屈．后伸位MRI对判断颅脊交界区稳定性、选择适宜的手术方式具有重要意义。     

颈段动态MRI在脊髓型颈椎病早期诊断中的应用价值：8例报告*★

对有脊髓型颈椎病症状体征常规MRI无明显脊髓受压征象而动态MRI中整个序列脊髓受压呈现波浪样压迹或念珠样改变的8例患者进行颈椎后路单开门椎管成型手术治疗。8例患者仅1例因为病程较长（大于2年）、脊髓损伤症状比较严重（术前JOA评分5分），术后半年JOA评分改善率为25%外，其余患者术后症状都有不同程度的恢复，术后半年JOA评分改善率都在50%以上。术后1个月检查颈椎前凸角较术前减少4.5°~8.6°，3个月后患者去掉颈围制动，颈椎的前凸角逐渐向正常恢复，术后半年检查颈椎前凸角与术前基本相同。结果提示以颈段动态MRI结合临床表现早期诊断脊髓型颈椎病并以颈段动态MRI为依据对脊髓型颈椎病患者早期行颈椎后路手术，效果良好；颈椎生理曲度随访半年，结果与手术前无明显改变。     

颈椎病磁共振扩散张量成像的研究

目的探讨颈椎病磁共振扩散张量成像（MRDTI）的特点。方法应用3．0TMRI仪对颈椎病患者进行M_RDTI检查,根据MRI显示的脊髓受压严重程度将颈椎病患者分为轻度组、中度组、重度组及严重度组。分析各组纤维示踪（FT）图的特征及各定量参数的变化。结果60例颈椎病患者FT显示纤维束狭窄、离断、稀疏,随着脊髓受压程度的加重而加重。FA值、Ez值、E3值、E⊥值、MD值在各组之间均存在差异（P〈0．05）。随着MRI评估的脊髓受压程度加重,E2值、E3值、E⊥值、MD值逐渐升高,FA值逐渐降低。结论MRDTI可以定量、直观显示颈椎病的脊髓受压程度。     

颈椎后纵韧带骨化的CT与临床表现

颈椎后纵韧带骨化的ＣＴ与临床表现包头医学院一附院神经内科（０１４０１０）王颖慧，张茂林，段建平，曹桂华，张红宇颈椎后纵韧带骨化是近年来在我国发现的一种颈椎病［１］。可引起椎管狭窄，压迫脊髓，使脊髓动脉及椎动脉供血减少，出现一系列神经系统临床症状。现将...     

颈椎后纵韧带骨化症12例分析

颈椎后纵韧带骨化症是一种病因未明的少见疾病，是指后纵韧带在椎管内异常骨化造成椎管狭窄，出现脊髓受压症状，是近30～40年才被认识，现已明确将它作为一种独立的疾病。本病起病缓慢，临床表现多样化，易造成漏诊，现将我们发现的12例分析如下。     

椎板成形术治疗颈椎椎管狭窄性疾病

颈椎椎管狭窄有原发性(发育性)和继发性狭窄。前者由于椎弓根、关节小面和椎板这三个决定椎管矢状径的因素发育异常所致,后者则由于广泛的骨质增生、后纵韧带骨化、黄韧带肥厚等继发性病变所引起。颈前路手术不能解除椎管狭窄,广泛的椎板切除术是解除狭窄的合理方法,但有造成颈椎不稳定,半脱位,鹅颈畸形,瘢痕压迫脊髓以及病人颈后怕受压和心理上不安全感。为此,很多学者设计椎管成形术以扩大椎管而又保持椎管完整。我院自1986年5月至1988年5月共进行5例,并作了改进,效果较好,     

平山病的MRI诊断初探

目的研究平山病颈椎自然位和屈颈位MRI表现特点,了解该病的临床特征和发病机制,探讨MRI检查对此病的诊断价值。方法 6例经临床确诊的平山病患者,表现为上肢远端肌肉萎缩伴肌无力,5例单侧上肢萎缩无力,1例双侧不对称性受累。6例患者均行颈椎自然位MR平扫和屈颈位MR平扫及增强扫描。结果 6例患者在颈椎自然位MRI均可见颈椎生理曲度变直,4例下颈段脊髓萎缩变细;屈颈位MRI检查6例下颈段脊髓萎缩变细、前移,轴位示脊髓不同程度变扁平,硬膜囊向前移位,硬膜外间隙增宽,5例脊髓后硬膜外间隙可见异常信号影伴血管流空信号,增强扫描后明显强化。结论颈椎自然位和屈颈位MRI是诊断平山病的重要依据,尤其屈颈位MRI平扫及增强表现有其特征性。     

颈椎病的三维CT表现

目的 探讨三维CT(3DCT)在诊断颈椎病方面的价值。方法 采用3DCT技术检查了300例颈椎病患者。其中，神经根型145例，椎动脉型41例，脊髓型40例,混合型73例．食管压迫型1例。3DCT观察颈椎病患者的颈椎骨质增生、椎间孔大小、椎动脉和颈椎骨质增生的关系、骨性椎管狭窄的改变。结果 21．3％的惠者有颈椎椎体骨质增生．42．3％的钩突关节和16．2％的小关节突柱有骨质增生，另外有12个小关节突有错位改变。在145例神经根型颈椎病惠者中，发现狭窄的椎间孔438个。其中，C6—7和C5—6椎间孔狭窄占81．3％。椎间孔狭窄的原因有钩突关节骨质增生、椎间盘突出、椎体肥大、小关节突骨质增生／错位等。椎动脉型颈椎病表现为骨赘压迫椎动脉(22．0％)和椎动脉变细或粗细不均(65．9％)，12．1％的患者未见异常。脊髓型颈椎病3DCT表现有颈椎管狭窄、椎体后缘骨质增生、后纵韧带钙化、椎闻隙狭窄和颈椎问盘突出等。结论 3DCT能全面评价颈椎问盘退变及其产生的颈椎骨质增生对神经、血管和脊髓的影响，是一种诊断颈椎病的实用影像学检查方法.     

"Dynamic" MR imaging of the cervical cord in patients with cervical spondylosis and ossification of the posterior longitudinal ligament--significance of dynamic cord compression]

This investigation was designed to assess the influence of dynamic cord compression on severity and course of myelopathy. Sixty-seven patients studied comprised 54 cases of cervical spondylosis and 13 cases of ossification of the posterior longitudinal ligament. These patients underwent "dynamic" MR imaging of the cervical spine. MR images in the sagittal view were obtained in three different neck positions: flexion, neutral, and extension. MR imaging was performed with a 0.15 T resistive unit. For technical reasons, the body coil was used. The pulse sequence was 500/30 (Tr msec/echo time msec) for T1 images. The spinal cord compression was accelerated in 32 cases when extended, in 2 cases when flexed, and in 4 cases when both extended and flexed. In 21 cases, we compared myelograms with MR images in a same neck position. Findings of myelograms well corresponded with those of MR images on 83 percent of intervertebral levels. The patients with dynamic cord compression were proved to have severer long tract signs, and their disability was regressive or progressive case by case for an average of 21-month follow-up. The "dynamic" MR imaging can provide dynamic nature of spinal cord compression, and prognostic clues.     

Coflex植入系统在退变性腰椎管狭窄症中的应用

药物及物理治疗退变性腰椎管狭窄症效果不明显,但椎板切除减压等手术创伤较大,患者难以接受。德国GENERAL CARE医疗技术公司根据神经源性间歇性跛行患者症状随着腰椎后伸时加重,屈曲时缓解这一特点,设计了一种动态棘突间植入物-Coflex系统,这是一种非融合性植入物。Coflex植入系统是一种治疗腰椎管狭窄症和腰椎不稳微创治疗方法,该棘突间装置稳定了术中因减压术后引起的椎体不稳,可预防远期产生的不稳。Coflex植入系统的临床应用前景广阔,为退变性腰椎管狭窄症患者提供了一种安全有效的治疗方法。     

Spinal Cord MRI Hyperintensities in Cervical Spondylosis: An Ischemic Pathogenesis?

The pathophysiology of focal spinal cord MRI T2 hyperintensity (SCHI) in patients with cervical spondylosis is uncertain. This study was undertaken to determine the frequency and cause of SCHI. The authors reviewed serial cervical spine magnetic resonance imaging (MRI) reports and reviewed scans with spondylosis and cord compression or SCHI. The authors noted the location, shape, and extent of SCHI, and severity of spondylosis (expressed as a spondylosis score [SS]). The authors recorded the age and vascular risk factors for each patient. Nineteen of 273 scans (7%) with cervical spondylosis and 19 of 36 scans (53%) with cord compression had SCHI. The SCHI extended for one vertebral level from the compression in 12 patients and for three vertebral levels in 5 patients, and were distant from the compression in 2 patients. The SCHI had a focal, symmetrical, anterior spinal artery terminal zone location in 16 of 19 scans (84%). A rim isointense with normal cord separated all SCHI from the pial surface. Patients with SCHI were older (58.3 years ± 12.8 years versus 46.8 ± 8.1 years) (p = 0.007) and had a higher SS (5.7 ± 2.4 versus 3.9 ± 1.4) (p = 0.02) than patients without SCHI. The SCHI relates to the severity of cervical spondylosis. The anterior spinal artery territory location, the normal cord between SCHI and the compressive lesion, and the presence of SCHI at a distance from the compressive level all suggest an ischemic basis for SCHI.     

Queckenstedt test--pressure pattern analysis in spinal subarachnoidal block

Pressure pattern analysis of Queckenstedt test was performed to detect the partial subarachnoidal block in patients with spinal or dural canal stenosis. The Queckenstedt test was performed by lumbar puncture when the patient was in lateral recumbent posture with bilateral jugular compression in three different neck positions; neutral, flexion and extension. Lumbar subarachnoidal pressure was visually measured each successive 5 seconds during a 30 second period of jugular compression, followed by a succession of 5 second measurements for 30 seconds after release of compression. The pressure changes during the total 60 seconds were demonstrated by pressure-time graph. The pressure pattern during jugular compression in patients with neurosis, neuropathy or muscle disease (total 18 cases, Fig.1) who were thought to have no subarachnoidal block showed sudden steep rise of pressure which gradually slowed and rapidly returned to pre-compression level after release of compression. The normal pattern showed upward convexity-downward concave and was almost identical in three different neck positions. Therefore we considered the normal pressure pattern to be a parabola-like or an exponential curve like patterns. The patients group with cevical spondylotic radiculopathy (16 cases, Fig. 3A) showed nearly normal pressure pattern except for some loss of upward convexity during neck extension and neutral positions.(ABSTRACT TRUNCATED AT 250 WORDS)     

Superior sensitivity of motor over somatosensory evoked potentials in the diagnosis of cervical spondylotic myelopathy

Myelopathy secondary to cervical spondylosis is often a difficult clinical diagnosis. Furthermore, with the introduction of magnetic resonance imaging (MRI) an increasing number of patients are identified with spondylotic cervical spinal cord compression. We analyzed the value of functional assessment of the spinal cord by motor and sensory evoked potentials (MEP and SEP) in the detection of myelopathy, with special emphasis on the correlation of clinical and electrophysiological findings. Fifty-one patients with at least some degree of spinal cord compression because of cervical spondylosis, as shown by MRI, were included in the study, grouped according to clinical symptoms. We found that patients who had no clinical symptoms whatsoever indicating myelopathy (they were referred to MRI examination mostly because of cervical radiculopathy), had in the large majority normal MEP and SEP findings. Patients with slight, unspecific and non-confirmative symptoms without pyramidal signs had mostly abnormal MEP but normal SEP findings. This points to the superior sensitivity of MEP over SEP in detecting myelopathy in its early stages. Patients with obvious clinical signs of myelopathy, including pyramidal signs had both abnormal MEP and SEP findings. Altogether these findings may help clinicians in interpreting MRI signs of cervical spinal cord compression.     

Is juvenile spinal muscular atrophy of the distal upper limbs due to cervical flexion myelopathy? A case report

A 22-year-old woman developed a slowly progressive symmetric weakness and muscular atrophy of distal upper limbs at the age of 17. Radiography during anteflexion and retroflexion showed a hypermobile cervical spine with a maximum at the C5/6 disc level. Cervical myelography and postmyelographic computed tomography (CT) of the lower cervical spine demonstrated a remarkable anterior shift of the dural sac during anteflexion resulting in anteroposterior compression of the lower spinal cord. Postmyelographic CT and magnetic resonance imaging (MRI) revealed atrophy of the lower spinal cord with bilateral cystic lesions. We suppose that repetitive straining and compression of the lower cervical cord during neck flexion of the hypermobile cervical spine caused selective necrosis of anterior horn cells with secondary cystic transformation. Mechanically induced flexion myelopathy should be considered in all young patients presenting with muscular atrophy of the distal upper limb. Functional CT myelography or dynamic MRI of the cervical spine are appropriate to demonstrate lower spinal cord compression during flexion.     

How does the neck flexion affect the cervical MRI features of Hirayama disease?

Although flexion cervical MRI has been recommended for the diagnosis of Hirayama disease (HD), no study focused on the MR features at different neck flexion angles. Moreover, no uniform flexion angle has been confirmed in clinical practice. The purpose of this study is to quantitatively investigate the MRI typical signs of HD patients in different neck flexion degree and gives a suggestion to the MR scanning. Cervical MRI in neutral and different flexion positions (cervical flexion angle 20°, 25°, 30°, 35°, and 40°) were performed in 45 HD patients. Three MRI features including anterior shifting of the posterior wall of the cervical dural canal (ASD), widening of cervical epidural space, and epidural flow voids (EFV) at each flexed position were summarized. To evaluate ASD quantitatively, the widest cervical epidural space with the maximum sagittal diameters (d) and cervical canal sagittal diameter (D) at the same level were measured. The d/D values at different angles were calculated and compared. ASD was demonstrated in 34 out of 45 cases (75.6%) at 20° and in all cases (100%) at other 4 angles (χ (2)?=?25.728, P?相似文献   

Study of the effects of flexion on the position of the conus medullaris: follow-up study using MR imaging in non-human primates

Background  Previous anatomical and radiological studies of conus position with flexion and extension of the spine have had conflicting results. We previously performed a human cadaveric study with direct visualization of the conus during flexion and extension to further study this question and to potentially determine if flexion and extension of the spine during MRI may prove to be a diagnostic tool in occult tethered cord syndrome. We found no movement of the conus during flexion or extension. The present is a follow-up study using MR imaging of Rhesus (Macaca mulatta) monkeys to see if the conus moves in flexion or extension of the spine. Materials and methods  We placed three adult male Rhesus monkeys under general anesthesia into a 1.5 T Siemens MRI machine. Sagittal T2-weighted images were obtained through the lumbosacral spine during flexion and extension. The conus position was compared between studies. Results  In all animals, the conus terminated between L6 and S1, and the conus did not move from its neutral position in either flexion or extension of the spine. Conclusions  Flexion and extension of the non-human primate’s spine does not result in a change of position of the conus medullaris to change position. Therefore, it is unlikely that the conus would change position during flexion and extension MRI in an adult without a tethered spinal cord.