颈椎间盘突出症的磁共振表现及其临床意义

对86例经过手术治疗的颈椎间盘突出症患者的MRI表现进行了分析，并提出了分型。根据T1加权像结合横断面分为中央型及后外侧型突出；根据T1加权像结合矢状面分为Ⅰ型、Ⅱ型、Ⅲ型及Ⅳ型突出。并就分型与临床的关系，特别是对手术治疗的指导意义进行了阐述。     

New evaluation method using preoperative magnetic resonance imaging for cervical spondylotic myelopathy

A new method based on the score of preoperative magnetic resonance images (MRI) was devised to evaluate cervical spondylotic myelopathy and predict the results of cervical laminoplasty. On T1- and T2-weighted sagittal MRI, the intervertebral disc spaces at each level from the axis to the first thoracic spine were examined as to whether the anterior or posterior subarachnoid space would be maintained or not, and for the presence or absence of spinal cord deformity. The data were divided into six grades and rated, and the total score for all sites was regarded as the preoperative MRI cumulative score. In conclusion, our method was highly reliable and useful for a preoperative evaluation and prediction of results after cervical laminoplasty for cervical spondylotic myelopathy. Received: 18 December 2000     

颈椎间盘突出的动态MRI测量及意义

目的：通过对颈椎间盘突出的动态ＭＲＩ测量,了解突出椎间盘及椎管内软组织在颈椎过伸、中立、过屈三位置下的变化,并探讨其临床意义。方法：对３１例中立位ＭＲＩ扫描发现颈椎间盘突出者,行过屈、过伸位扫描。测量三位置下硬膜囊前间隙、脊髓中矢径、硬膜囊中矢径、突出椎间盘大小及椎管／椎体矢径,分析其动态变化。结果：１４例椎管、椎体比值小于０．７５,占４５．２％。３１例颈椎间盘突出的硬膜囊、脊髓中矢径及突出的椎间盘大小在三位置变化中有显著性差异（Ｐ＜０．０５或Ｐ＜０．０１）,而硬膜囊前间隙大小变化无显著性差异（Ｐ＞０．０５）。结论：发育性颈椎管狭窄者易患颈椎间盘突出,且好发于Ｃ４～Ｃ７节段,动态ＭＲＩ可为治疗颈椎多节段椎间盘突出前路非广泛减压植骨术提供帮助。     

Biomechanical evaluation of a metal-on-metal cervical intervertebral disc prosthesis

Background contextIn vitro nondestructive flexibility testing of the CerviCore total disc replacement (TDR) was performed. It was hypothesized that TDR would not significantly alter biomechanics relative to intact, whereas rigid fixation would cause significant changes.PurposeTo assess the ability of a cervical metal-on-metal saddle-shaped TDR to replicate normal biomechanics in vitro.Study designHuman cadaveric flexibility experiment.MethodsNine human cadaveric C3–T1 specimens were tested intact, after TDR and after anterior plating. Flexion, extension, lateral bending, and axial rotation were induced by pure moments; flexion-extension was then repeated using a simplified muscle force model with 70-N follower load. Optical markers measured three-dimensional intervertebral motion, and eight points of laminar surface strain were recorded near the left and right C5–C6 facet joints. Biomechanical parameters studied included range of motion (ROM), lax zone (LZ), angular coupling pattern, sagittal instantaneous axis of rotation (IAR), and facet loads normal to the facet joint plane. Mean values of parameters were compared statistically using repeated measures analysis of variance and Holm-Sidak tests.ResultsTotal disc replacement caused significant reduction in ROM during extension (p=.004) and significant reduction in LZ during lateral bending (p=.01). However, plating significantly reduced both ROM and LZ during flexion, extension, and lateral bending (p<.006). Sagittal IAR shifted relative to intact by 3.6 mm after TDR (p>.05) and 6.5 mm after plating (p>.05). Coupled axial rotation/degree lateral bending was 99% of intact after TDR but 76% of intact after plating (p=.15). Coupled lateral bending/degree axial rotation was 95% of intact after TDR but 85% of intact after plating (p=.43). Neither construct altered facet loads from intact.ConclusionsWith regard to ROM, LZ, IAR, and coupling, deviations from intact biomechanics were less substantial after TDR than after plating. Facet load alterations were minimal with either construct. Our results show that this particular TDR permits ROM and maintains some measures of kinematics in a cadaver model.     

颈椎间盘突出症的MRI表现及意义

探讨了１１８例颈椎间盘突出症的ＭＲＩ表现及异临床意义。在ＭＲＩ上，本病可分为中央型和侧方型。前者颈椎间盘从其后方中央部位突出，压迫颈髓前方，受压颈椎弯曲、变扁及向后移位；后者可见椎间盘从后外侧呈块状或碎片状突出，压迫颈髓前外侧，神经根向后外侧移位或消失。本组结果表明，ＭＲＩ可直接显示颈椎间盘突出症的部位、类型及颈髓和神经根的受损程度，为颈椎盘间突出症的诊断、鉴别诊断、治疗方法选择和预后判断提供可靠的方法。     

A comparison of magnetic resonance imaging with electrodiagnostic findings in the evaluation of clinical radiculopathy: a cross-sectional study

Purpose

The aim of this study was to evaluate the agreement of magnetic resonance imaging and electrodiagnostic studies by comparing their findings in patients with clinically suspected radiculopathy. The agreements between these two procedures and clinical findings were also examined.

Methods

In a 2-year cross-sectional study, a total of 114 patients with clinically suspected cervical or lumbosacral radiculopathy were included.

Results

The total agreements between clinical with MRI and EDX findings were 72 and 52 %, respectively while their agreements were similar in group definite (89 vs. 82 %). The agreement between EDX and MRI was 59.6 in total and 49 % with respect to clinical findings.

Conclusion

This study further supports that these two methods are complementary in general. It is reasonable to add EDX when there is discrepancy between MRI and clinical findings or when MRI neurologic findings are not visible.     

Magnetic resonance image findings in the early post-operative period after anterior cervical discectomy

If early neurological deterioration occurs following anterior cervical discectomy, the patient should be evaluated by urgent MRI scanning. In order to interpret such a scan it is essential to know what the normal post-operative MRI appearance is following an uncomplicated procedure. In the lumbar spine it is well recognized that early post-operative imaging following discectomy is difficult to interpret with a high rate of false positive scans.The normal appearance of MRI in the early post-operative period was evaluated prospectively in 15 patients undergoing anterior cervical discectomy without fusion for either cervical radiculopathy or myelopathy. MRI was performed on the first post-operative day, at 6 weeks and 6 months. The successful outcome of the procedure was validated by uniform improvement of Visual Analogue Scale measurement for neck and arm pain, the Neck Disability Index and European Myelopathy Score as appropriate.In contrast to the established findings following lumbar discectomy, only two cases showed a persistent epidural mass in the first post-operative scan and this had completely resolved at 6 months. All patients had foraminal narrowing and root or cord compression pre-operatively. Sixty six percent of cases showed persistent foraminal narrowing on sequential imaging up to 6 months despite showing good symptomatic improvement. All cases demonstrated high signal in the operated disc space on T2 weighted imaging on the first post-operative day and this finding persisted in 13 of 15 scans performed at 6 weeks. Post contrast imaging demonstrated no enhancement of operated disc space and adjacent vertebral body on the first post-operative day, whereas all scans at 6 weeks showed enhancement and such enhancement persisted at 6 months in 50%. Persistent epidural filling defects are uncommon following successful anterior cervical discectomy but persistence of foraminal narrowing is common despite successful outcome. Enhancement of the disc space is also common and does not in itself imply infection.     

炎性细胞在腹主动脉瘤形成中的作用

目的研究炎性细胞在腹主动脉瘤（ａｂｄｏｍｉｎａｌａｏｒｔｉｃａｎｅｕｒｙｓｍ,ＡＡＡ）组织中的浸润情况及其作用。方法２０例ＡＡＡ患者的动脉瘤组织及４例正常人腹主动脉组织,分别行弹力纤维和胶原纤维的特殊染色、单抗白细胞共同抗原（ＣＤ４５阳性）和巨噬细胞（ＣＤ６８阳性）的免疫组化染色,了解纤维组织的变化及炎性细胞的浸润程度;原位杂交方法观察ＡＡＡ组织中基质金属蛋白酶（ｍａｔｒｉｘｍｅｔａｌｏｐｒｏｔｅｉｎａｓｅｓ,ＭＭＰｓ）之ＭＭＰ９的ｍＲＮＡ表达。结果ＡＡＡ组织均有不同程度的炎性细胞浸润,炎性细胞浸润程度与基质弹力纤维的损伤程度呈平行趋势,正常腹主动脉组织无炎性细胞浸润;原位杂交结果显示２０例ＡＡＡ组织中的巨噬细胞和淋巴细胞均出现ＭＭＰ９ｍＲＮＡ的阳性表达,１３例（６５％）ＡＡＡ组织中的平滑肌细胞出现ＭＭＰ９ｍＲＮＡ的阳性表达。正常腹主动脉组织无ＭＭＰ９ｍＲＮＡ的阳性表达。结论炎性细胞在ＡＡＡ形成中通过复杂的生化、细胞及免疫等过程参与并促进了ＡＡＡ的形成。     

Clinical and radiographic outcomes of cervical disc replacement with a new prosthesis

Background contextAnterior cervical discectomy and interbody fusion was a classical treatment for cervical degenerative disc disease (CDDD). However, the rigid fusion also leads to a reduction in normal cervical spine motion and to increased biomechanical stress at adjacent levels, which in turn accelerates degenerative changes of the discs at these levels. Cervical disc replacement (CDR) is a new technology with the aim of addressing the limitations of fusion procession and preserving motion at the treated level. Discover prosthesis (DePuy Spine, Raynham, MA, USA) is a new type artificial disc and there are few reports about it.PurposeThe purpose of this study was to analyze the primary clinical and radiographic outcomes of CDR with Discover prosthesis to treat mono- or bi-segment CDDD in a Chinese population.Study designThe study design was prospective and single-center clinical trial of the Discover prosthesis in the treatment of patients with mono- or bi-segment CDDD.Patients sampleSeventy-nine patients with 102 Discover prosthesis arthroplasty performed (56 mono-segment and 23 bi-segment) were evaluated.Outcome measuresClinical outcomes based on Japanese Orthopaedic Association (JOA), visual analog scale (VAS) pain score, and Odom's scale and radiographic outcomes including the anterior disc heights (ADH), posterior disc heights (PDH), range of motion, and performance of heterotopic ossification (HO) of the operative segment were assessed.MethodsClinical and radiographic follow-up was performed. Preoperative and postoperative ADH, PDH, and range of motion were measured from lateral and flexion-extension radiographs. The paired t test was used to assess the difference of clinical and radiographic outcomes before and after operation. The performance of HO was observed by two independent MD.ResultsThe mean follow-up time for all the patients was 31.6 months, ranging from 24 to 43 months. Mean preoperative JOA score was 9.5, and VAS overall pain score was 7.2. At 2-, 6-, 12-, and 24-month follow-up, the mean JOA score was 14.1, 14.7, 15.3, and 14.9, whereas the mean VAS overall pain score was 1.9, 1.7, 1.8, and 1.4, respectively. Mean JOA and VAS scores showed statistical improvements in the postoperative period. Seven patients had mild dysphagia within the first month after operation. According to Odom's scale, 52 patients had excellent outcomes, 25 patients had good outcomes, and 2 patients had fair outcomes at 2-year follow-up. The Mean preoperative ADH and PDH of the operative segment were 4.9 mm and 3.1 mm. Compared with preoperative, there were significantly increased and maintenance well at 2- (7.5 mm, 5.1 mm), 6- (7.5 mm, 5.0 mm), 12- (7.4 mm, 4.9 mm) and 24-month (7.2 mm, 5.0 mm) follow-up. Range of motion of the operative segment in the postoperative follow-up was slightly increased than the preoperative follow-up but not statistically significant. Heterotopic ossification was presented in six replaced levels at 1-year follow-up including 4 Grade I and 2 Grade II and 18 replaced levels at the follow-up more than 2 years including 8 grade I and 10 grade II. No prosthesis subsidence or excursion was identified.ConclusionsThe use of Discover prostheses in our study resulted in satisfactory clinical and radiographic outcomes. The prostheses can restore and maintain interbody height, while preserve the motion of the treated segment. Although the results of this study demonstrate initial safety and effectiveness in a Chinese population, we need further studies to know more about the impact of CDR with Discover prosthesis, especially on HO and adjacent segment degeneration.     

Magnetic resonance imaging and management of a pineal region dermoid

We report the case of a 19-year-old man harboring a pineal region dermoid, of which only eight other cases have been reported. A diagnosis was made with magnetic resonance imaging (MRI), which showed a marked high signal intensity on both T-1 and T-2 weighted images that is consistent with the lipid character of the lesion. Residual tumor could be seen on postoperative MR images. MRI is an accurate, noninvasive modality for the diagnosis and follow-up evaluation of these tumors.     

新型钛合金金属橡胶颈椎间盘假体生物力学分析

【摘要】 目的：评估新型钛合金金属橡胶颈椎间盘假体的生物力学性能。方法：特殊绕丝机制作新型金属橡胶颈椎间盘假体,电镜观察假体表面结构并对假体力学性能、疲劳特性进行测试;将24个新鲜羊颈椎依次按C4/5完整标本、髓核摘除、假体置换、椎间盘切除植骨融合内固定（ACDF）处理后,给予2.5Nm载荷,分别测量其在屈曲、后伸、左右侧屈及左右旋转时的位移,通过计算得出角度变化值,观察置换节段和相邻上下节段的运动范围（ROM）。结果：假体孔隙率为60%～80%,孔径大小90～500μm,弹性模量7MPa,疲劳试验（循环极限次数500×104次,极限载荷设置为200N）后未见假体断裂、高度降低。手术节段ROM测定显示,髓核摘除组各向ROM均显著大于完整组（P＜0.05）,ACDF组的各向ROM均显著小于完整组（P＜0.05）,而假体置换组各向ROM均与完整组无显著性差异（P＞0.05）。对于相邻上位节段,假体置换组各向ROM与完整组无明显差异（P＞0.05）,而ACDF组ROM则大于完整组（P＜0.05）。相邻下位节段,假体置换组前屈ROM与完整组相比无明显差异,后伸ROM小于完整组（P＜0.05）,侧屈、扭转时ROM较完整组增加（P＜0.05）,但变化幅度小于ACDF组（P＜0.05）。结论：钛合金金属橡胶人工颈椎间盘假体保留了手术节段活动度,置入后对相邻椎间节段活动度及力学影响小,理论上可以成为较好的颈椎间盘置换假体。     

脊髓型颈椎病患者颈脊髓磁共振扩散张量成像的特点及临床意义

目的 :观察脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者磁共振扩散张量成像(diffusion tensor imaging,DTI)的特点,探讨DTI在评价颈脊髓慢性损伤的价值。方法:纳入2011年2月~2015年2月间收治的20例CSM患者(CSM组),并选择年龄匹配的42例健康志愿者作为对照组,均行颈椎磁共振DTI,测量CSM组病变节段以及对照组C2/3~C6/7节段颈脊髓的表观弥散系数(apparent diffusion coefficient,ADC)、各向异性分数(fractional aniostropy,FA)。比较对照组不同节段颈脊髓的ADC值和FA值,将CSM组和对照组颈脊髓的ADC值和FA值分别进行比较,并对CSM患者颈脊髓ADC、FA评分和颈椎改良JOA(m JOA)评分分别进行相关性分析。结果:对照组颈脊髓的ADC值自C2/3~C6/7节段呈上升趋势,而FA值呈下降趋势,C2/3节段颈脊髓的ADC值较C5/6和C6/7节段明显低,而FA值明显高(ADC:F=3.546,P=0.008;FA:F=13.82,P0.001)。CSM组颈脊髓的FA值与对照组比较显著性减小(P0.001),而ADC值则显著性增加(P0.001)。CSM组颈脊髓的ADC值与m JOA评分无显著相关性(r=-0.287,P=0.220),而颈脊髓的FA值与m JOA评分存在显著性正相关(r=0.359,P=0.005)。结论:CSM患者颈脊髓DTI与正常人群存在差异,其ADC值较正常人群升高,而FA值则明显降低;m JOA评分与FA值呈正相关。     

青年人颈椎间盘髓核T2弛豫值的特点

目的:观察青年人颈椎间盘髓核MRI T2弛豫时间的特点,探讨其量化椎间盘髓核信号的可行性。方法:2013年6~8月对40例健康青年志愿者(年龄18~30岁,平均25.8±3.1岁)行颈椎传统MR矢状位T2加权成像(T2 weighted images,T2WI),并采用T2弛豫时间成像技术扫描,生成正中矢状T2弛豫伪彩图。在MR T2WI序列上对颈椎间盘按Pfirrmann标准进行分级,再在C2~C7各节段椎间盘髓核内选取5个感兴趣区域(regions of interest,ROIs):前点、前中点、中点、中后点、后点,并复制和粘贴到T2弛豫伪彩图上,分别测量各节段椎间盘髓核内各区域T2弛豫值,并对不同Pfirrmann分级椎间盘、不同节段、不同区域的T2弛豫值进行统计学分析。结果:40例志愿者200个颈椎间盘中,Pfirrmann分级Ⅰ级87个(43.5%),Ⅱ级113个(56.5%)。相同节段Ⅰ级和Ⅱ级椎间盘髓核不同区域的T2弛豫值均从前点到中点有增大趋势,中点到后点有减少趋势。Ⅰ级椎间盘各节段髓核不同区域内T2弛豫值均比Ⅱ级椎间盘相应节段和部位高(P0.05)。Ⅰ级和Ⅱ级椎间盘各节段髓核前点和后点(除C5/6)的T2弛豫值均小于其他区域(P0.05),前中点、中点均高于其他区域的T2弛豫值(P0.05)。Ⅰ级椎间盘各节段髓核T2弛豫值95%可信区间分别为C2/3 67.71~80.92ms,C3/4 65.06~72.29ms,C4/5 68.92~76.07ms,C5/6 67.32~75.46ms,C6/7 69.86~76.05ms,Ⅱ级椎间盘各节段髓核T2弛豫值95%可信区间分别为C2/3 51.07~55.26ms,C3/4 52.87~56.11ms,C4/5 55.24~58.30ms,C5/6 56.39~60.38ms,C6/7 60.91~63.92ms。结论:青年人颈椎间盘Pfirrmann分级不同、节段及区域不同,其髓核内T2弛豫值不同;T2弛豫值能准确反映颈椎间盘髓核信号变化,可用来量化椎间盘髓核信号。     

MRI T2加权像伴有髓内高信号的轻度脊髓型颈椎病的治疗

目的分析比较MRI T2加权像伴有髓内高信号的轻度脊髓型颈椎病患者行手术治疗和非手术治疗的临床效果,初步探讨可能影响预后的相关因素。方法 2008年7月年-2011年6月,收治轻度脊髓型颈椎病患者91例符合纳入标准,进行回顾性研究,以日本骨科学会（Japanese Orthapaedic Association,JOA）评分改善率作为治疗后临床效果的评估指标,比较手术治疗和非手术治疗的情况。进一步将JOA评分改善率与治疗方式、性别、年龄、病程、节段性前凸角、C2-7活动度、脊髓受压程度进行相关及多元线性回归分析,筛选影响疗效的相关因素,并进一步明确其与治疗后临床效果的关系。结果根据治疗方法不同将本组病例分为2组,A组53例,采用颈前路减压植骨融合钢板内固定手术进行治疗,平均随访30.68个月。B组38例采用非手术治疗,平均随访34.68个月。对于MRI T2加权像伴有髓内高信号的轻度脊髓型颈椎病患者,手术治疗与非手术治疗相比,两者临床疗效差异无统计学意义。病程（P〈0.01）、节段性前凸角（P〈0.01）2个因素与JOA评分改善率之间存在显著相关性。多元线性回归结果表明,病程较短、节段性前凸角较大的患者治疗后效果较好。结论对于MRI T2加权像伴有髓内高信号的轻度脊髓型颈椎病患者,其手术治疗和非手术治疗并无显著差异,然而病程较短、节段性前凸角较大的患者治疗的效果优于病程较长、节段后凸的患者。     

The value of MR imaging in differentiating between hard and soft cervical disc disease: a comparison with intraoperative findings

The aim of this study is to assess the accuracy of MRI alone in the differentiation of soft cervical disc protrusion from osteophytic compression in cervical disc disease. In a retrospective study, the MRI scans of 41 patients with cervical disc disease, who had previously undergone surgery, were presented to three independent observers, randomly on two different occasions, to identify the accuracy of the diagnosis of the presence of hard or soft disc or both as a cause of compression. The observers (two neurosurgeons and one neuroradiologist) were not involved with the treatment of the cases at any stage and were unaware of the surgical findings. Their observations were compared with those of the surgeon recorded at operation. The intra-observer agreement was poor for diagnosis into three categories as hard or soft disc or both. In distinguishing between the presence or absence of hard disc, there was moderate to good (Kappa = 0.6) intra observer and fair to moderate (Kappa = 0.4) interobserver agreement. The sensitivity of diagnosis of a hard disc was high (87%) but specificity was low (44%), due to the overestimation of the presence of hard disc. There was a significantly higher incidence of hard disc in the elderly age group (76% over the fifth decade, P = 0.0073). It is concluded that MRI alone is not a very efficient diagnostic tool in distinguishing between hard and soft disc in the cervical disc disease. Received: 16 April 1998 Revised: 8 January 1999 Accepted: 18 January 1999     

Evaluation of intervertebral disc cartilaginous endplate structure using magnetic resonance imaging

Purpose

The cartilaginous endplate (CEP) is a thin layer of hyaline cartilage positioned between the vertebral endplate and nucleus pulposus (NP) that functions both as a mechanical barrier and as a gateway for nutrient transport into the disc. Despite its critical role in disc nutrition and degeneration, the morphology of the CEP has not been well characterized. The objective of this study was to visualize and report observations of the CEP three-dimensional morphology, and quantify CEP thickness using an MRI FLASH (fast low-angle shot) pulse sequence.

Methods

MR imaging of ex vivo human cadaveric lumbar spine segments (N = 17) was performed in a 7T MRI scanner with sequence parameters that were selected by utilizing high-resolution T1 mapping, and an analytical MRI signal model to optimize image contrast between CEP and NP. The CEP thickness at five locations along the mid-sagittal AP direction (center, 5 mm, 10 mm off-center towards anterior and posterior) was measured, and analyzed using two-way ANOVA and a post hoc Bonferonni test. For further investigation, six in vivo volunteers were imaged with a similar sequence in a 3T MRI scanner. In addition, decalcified and undecalcified histology was performed, which confirmed that the FLASH sequence successfully detected the CEP.

Results

CEP thickness determined by MRI in the mid-sagittal plane across all lumbar disc levels and locations was 0.77 ± 0.24 mm ex vivo. The CEP thickness was not different across disc levels, but was thinner toward the center of the disc.

Conclusions

This study demonstrates the potential of MRI FLASH imaging for structural quantification of the CEP geometry, which may be developed as a technique to evaluate changes in the CEP with disc degeneration in future applications.     

肝门部胆管癌的MRI诊断

肝门部胆管癌是指原发于胆囊管开口与左右二级肝管起始部之间的胆管癌,亦称Klatskin瘤.肝脏MRI及MRCP检查是目前重要的影像学诊断方法.本文回顾性分析2010年10月至2012年10月第二军医大学附属长海医院收治的42例和第二军医大学附属东方肝胆外科医院收治的18例同时进行过MRI及MRCP检查的肝门部胆管癌患者的临床资料,将胆管癌按其大体病理特点基本可分为管壁浸润型、肿块型及腔内生长型3个类型,根据其术前影像学表现和术中及术后病理检查结果按Bismuth-Corlette进行术前和术后分型.术前术后分型一致者35例,分型诊断符合率为89.7％ (35/39).同时术中及术后发现肝实质受侵犯19例(术前MRI检查发现16例),灵敏度为84.2％;血管受侵犯10例(术前MRI检查发现12例),灵敏度为83.3％;肝门部、腹膜后淋巴结转移6例(术前MRI检查发现4例),灵敏度为66.7％.MRI多技术多序列的联合应用,有利于肝门部胆管癌的诊断及鉴别诊断,对肿瘤的分期及治疗方案的制订具有重要的价值.     

单节段脊髓型颈椎病伴下颈椎不稳的影像学表现及预后因素分析

 目的 探讨单节段脊髓型颈椎病伴下颈椎不稳的MRI信号改变及影响预后的相关因素。方法 回顾性分析2005年1月至2008年6月采用前路减压植骨融合内固定术治疗的109例单节段脊髓型颈椎病患者的病例资料,根据是否存在下颈椎不稳将患者分为不稳定组、稳定组。比较两组T2WI脊髓高信号的等级、发生率及术后6个月日本骨科学会（Japanese Orthopaedic Association,JOA）评分改善率、由于症状反复或出现新的脊髓压迫症状而再次就诊的例数和时间,记录患者病程和体征,包括感觉减退或消失、Hoffmann征、Babinski征、腱反射。应用多元线性回归分析术后JOA评分改善率与性别、年龄、术前JOA评分、病程、临床体征数目、脊髓高信号等级的相关性。结果 不稳定组和稳定组患者性别、年龄的差异无统计学意义。（1）不稳定组T2WI脊髓高信号发生率为74.3％,稳定组为41.9％,两组差异有统计学意义。（2）不稳定组的病程、术前JOA评分、临床体征数目、术后JOA评分改善率、再次就诊时间分别为（26.9±15.1）个月、（10.0±2.5）分、（2.91±0.91）个、55.6%±14.9%、（29.1±6.8）个月;稳定组分别为（17.0±9.9）个月、（11.2±2.4）分、（2.42±0.83）个、69.0%±18.0%、（57.5±21.9）个月。不稳定组较稳定组的病程长、术前JOA评分低、临床体征数目多、术后JOA评分改善率低、再次就诊时间短,两组差异均有统计学意义。（3）术后JOA评分改善率与术前JOA评分、病程和临床体征数目相关。结论 单节段脊髓型颈椎病合并下颈椎不稳时,MRI T₂WI上脊髓高信号的发生率高,患者病程长且临床体征多,术后疗效较差。