脊髓造影螺旋CT重建对颈椎病诊治的临床研究

目的 探讨颈脊髓造影螺旋CT扫描(HCTM)多平面重建及三维重建的可行性及对颈椎病诊治的临床应用。方法 将一组手术治疗的颈椎病患者和无颈椎疾患的对照者进行腰穿造影、螺旋CT扫描、计算机图像重建，用于术前病情评价并进行术前计划、制定个体化手术方案。结果 造影剂在CSF内弥散均匀、显影良好，重建图像直观、逼真，提供全面颈椎细微骨性解剖和硬膜囊、脊髓、神经根袖等软组织受压信息，有助于建立个体化手术方案．各例患者手术进行顺利、无并发症、术后短期随访疗效满意。结论 HCTM及重建提供颈椎病细微解剖信息，有较高诊断效能和术前评估、指导术前计划职能，提高了颈椎手术的个体化程度、精确性和可控制性。     

120例颈椎病患者影像学分析

目的分析120例颈椎病患者影像学资料,提高诊疗水平。方法选择120例颈椎病患者的病历及影像学资料进行回顾性分析,全部病例均行X线平片检查和CT检查,85例行MRI检查。结果行X线平片检查表现为交感神经型颈椎而CT显示为椎动脉型颈椎病的有15例;表现为脊髓型颈椎病而CT表现为椎管狭窄、椎间盘突出或硬膜囊、脊髓受压、变形、移位的有18例;表现为神经根型颈椎病而CT表现为神经根受压／移位12例、食管型颈椎病9例;表现为椎动脉型颈椎病而CT表现为钩突肥大和钩椎关节骨质增生／横突孔变／b／分隔的有12例、混合型颈椎病54例。结论CT、MRI检查对于诊断用X线平片诊断较困难的颈椎病患者有一定临床价值。     

寰枢椎旋转性半脱位的诊断

目的：探讨X线检查,螺旋CT扫描以及三维影像重建在诊断寰枢椎旋转性半脱位的不同临床意义。方法：24例行颈椎张口位片检查,其中16例和5例对照组采用螺旋CT扫描。结果：平均50%以上2次摄片,部份齿状突与侧块间距显示不清。16例螺旋CT扫描均证实齿状突与寰椎侧块间距不等,三维影像重建立体地再现寰枢椎旋转性半脱位的移位程度和齿状突发育情况。5例对照组正常。结论：常规X线多能确诊,螺旋CT扫描及三维影像重建,可弥补6诊断上的困难,同时也有利于指导治疗。     

脊髓造影加CT与MRI对颈椎病及后纵韧带骨化诊断价值的比较

本文通过对３８例脊髓型颈椎病术前脊髓造影加ＣＴ和ＭＲＩ结果的比较分析，就此二种检查方法的诊断价值做出了评价。结果提示在显示颈椎间盘突出方面，ＭＲＩ明显优于脊髓造影加ＣＴ；在显示颈椎骨质增生、ＯＰＬＬ、颈神经很受压方面，ＭＲＩ不如脊髓造影加ＣＴ；在显示颈椎管狭窄蛛网膜下腔和脊髓受压方面，ＭＲＩ和脊髓造影加ＣＴ无明显差异。     

薄层MSCT椎管造影结合后期重建对诊断臂丛神经根损伤的优势研究

自2004年5月以来，我们对27例怀疑臂丛神经节前损伤的患者应用颈椎脊髓造影计算机断层扫描检查，其中20例应用多层螺旋CT扫描（层厚3mm）结合后处理重建；另外7例利用多层螺旋CT常规扫描（层厚6mm）。为寻找一种可以更加清晰显示椎管内神经根丝的影像学方法进行了有益的探索。     

螺旋CT三维重建诊断腰椎爆裂骨折的价值

目的探讨螺旋CT多模式三维重建诊断腰椎爆裂骨折(LBF)的价值。方法对54例LBF患者摄腰椎X线片;采用3～5 mm层厚连续螺旋CT扫描,1.5～2.5 mm间距后重建,于AW4.0工作站行SSD、MPR及MIP、仿真椎间盘镜(VMED)三维重建;34例行腰椎MRI检查;采用SSPS 16.0软件分析。结果螺旋CT与平片诊断LBF差异有统计学意义(χ2=4.167,P<0.05);SSD与MIP能取得清晰立体图,MPR能多向观察骨折细节,VMED能模拟MED显示椎管梗阻。MRI能清楚显示椎管受压及脊髓损伤。结论腰椎多模式三维重建对复杂性腰椎骨折诊断、分型与手术模拟等有重要价值。     

多层螺旋CT评价推拿治疗神经根型颈椎病椎间孔变化的价值

目的 探讨多层螺旋CT颈椎扫描重建在推拿手法治疗神经根型颈椎病疗效评价中的价值.方法 30例临床确诊的神经根型颈椎病患者,在推拿手法治疗前后分别进行颈椎多层螺旋CT检查,观察两次检查颈椎的椎间孔变化情况,并结合临床症状及体征进行分析.结果 推拿治疗前所观测的300个椎间孔中,发生狭窄的有80个,推拿治疗后狭窄的椎间孔...     

颈椎病前路减压与融合作用

临床上应用颈椎前路减压和融合治疗颈椎病伴神经根痛或脊髓痛,然而对是否置入钢板固定一直有争论。文章回顾性分析颈椎病前路减压术后继发症状的临床资料与影像学表现,比较分析使用前路融合钢板固定的危险性与效果。47例颈椎病患者平均58.1岁(28～76岁),其中25例男性,22例女性,所有病人经保守治疗(抗炎、牵引及理疗)无效后行外科手术。术前经颈椎平片、CT或MRI检查以确定脊神经受压情况。术后显     

MRI在颈椎病术前检查中的意义（附32例报告）

术前要对颈椎病的诊断、病史部位及严重程度等有明确的了解，普通Ｘ线片、脊髓造影、ＣＴ等检查部难以全部达到这些要求，本文通过对３２例颈椎病病人术前ＭＲＩ检查，认为ＭＲＩ可清楚地显示颈椎全貌，对病变部位、程度、范围等均能明确显示，可以排除肿瘤及脊髓病变，对指导手术有重要意义。     

枕-寰枢区疾患的影像学评价

枕-寰枢区由枕骨、寰椎、枢椎及相应的韧带、神经组成,解剖复杂,发育性畸形和伤病种类繁多,诊断很大程度上取决于影像学。枕-寰枢区疾患诊断的实质是用影像技术评价中枢神经系统(包括脊髓或延髓)横跨的骨性通道容量的大小。X线平片与脊髓造影技术已成为评估骨性通道大小的传统方法。常规CT诊断此区病变有一定困难,三维CT重建可完美显示齿状突和寰枢椎其它部位的形态,对诊断寰枢椎先天性畸形或发育不良具有独特的优势,与常规CT结合使用,可明显提高对多发、复杂骨折诊断的准确性和完整性[1]。MRI检查能直接显示中枢神经系统及受压的病理学…     

Diffusion tensor imaging predicts functional impairment in mild-to-moderate cervical spondylotic myelopathy

Background contextMagnetic resonance imaging (MRI) is the standard imaging modality for the assessment of cervical spinal cord; however, MRI assessment of the spinal cord in cervical spondylotic myelopathy patients has not demonstrated a consistent association with neurologic function or outcome after surgical or medical intervention. Thus, there is a need for sensitive imaging biomarkers that can predict functional impairment in patients with advanced cervical spondylosis.PurposeTo implement diffusion tensor imaging (DTI) as an imaging biomarker for microstructural integrity and functional impairment in patients with cervical spondylosis.Study designNonrandomized, single institution study.Patient sampleForty-eight cervical spondylosis patients with or without spinal cord signal change underwent DTI of the spinal cord along with functional assessment.Outcome measuresFunctional measures of neurologic function via modified Japanese Orthopedic Association (mJOA) score.MethodsA zoomed-echoplanar imaging technique and two-dimensional spatially selective radiofrequency excitation pulse were used for DTI measurement. Fractional anisotropy (FA), mean diffusivity (MD), radial and axial diffusion (AD) coefficient, AD anisotropy, ψ, defined as AD-MD, and the standard deviation (SD) of primary eigenvector orientation were evaluated at the site of compression.ResultsResults suggest average FA, transverse apparent diffusion coefficient, ψ, and SD of primary eigenvector orientation at the spinal level of highest compression were linearly correlated with mJOA score. Receiver-operator characteristic analysis suggested FA and ψ could identify stenosis patients with mild-to-moderate symptoms with a relatively high sensitivity and specificity.ConclusionsThe results of this study support the potential use of DTI as a biomarker for predicting functional impairment in patients with cervical spondylosis.     

一次性颈椎后路椎管扩大成形术加经硬脊膜入路髓核摘除术治疗脊髓钳夹型颈椎病

目的 探讨采用一次性颈椎后路单开门椎管成形术加经硬脊膜入路椎间盘髓核摘除术治疗脊髓钳夹型颈椎病的手术方法及观察其近期手术疗效.方法 本组6例脊髓钳夹型颈椎病患者术前均行X线片、CT和MRI检查确诊.手术方法均采用颈后路单开门椎管扩大成形术,然后在颈椎间盘突出相应的硬脊膜的位置上纵行切开硬脊膜,显露颈髓和上、下神经根及齿状韧带,切开纤维环取出髓核组织.结果 本组6例均获随访,按JOA评分标准平均提高3-6分,肌力平均提高2-3级,术前症状基本消失或缓解.术后予以X线片及MRI复查,无明显并发症,钳夹节段的颈髓均显示压迫解除.结论 一次性颈椎后路单开门椎管扩大成形术加经硬脊膜入路椎间盘髓核摘除术是治疗脊髓钳夹型颈椎病的一种可行有效的手术方法.它可避免多次手术的痛苦.     

颈椎动力位MRI在颈椎病临床诊治中的作用

目的通过颈椎动力位MRI检查测定颈椎病发生发展中的静力性和动力性因素,探讨动力位MRI埘颈椎病早期诊断并早期干预、手术治疗的指导意义。方法对15位被检者行日本骨科学会（Japanese Orthopaedic Association,JOA）评分、颈椎X线及MRI检查．测量Pavlov比值、腹背侧蛛下腔矢状径、脊髓及蛛下腔正中矢状径、脊髓及蛛下腔面积,蛛下腔狭窄度分级,计算脊髓／蛛下腔矢状径比、面积比．进行过屈、中立、过伸3种体位间比较。将JOA评分与部分测量指标进行相关性研究。结果Pavlov比值示8例骨性椎管狭窄。腹背侧蛛下腔狭窄程度在过屈位有一定缓解,过伸位有一定加重;过屈位与过伸位问差异有统计学意义（P〈0．05）。JOA评分与Pavlov比值、面积比有相关性。结论颈椎动力位MRI能反映颈椎在屈伸位变化时内部结构的变化,对临床诊断、干预及手术均有一定的意义。     

Significance of CSF area measurements in cervical spondylitic myelopathy

Mild clinical myelopathy can occur without cord compression, and asymptomatic cord compression seen on MRI is common. The aim of this study was to ascertain the MRI features which best correlate with early clinical myelopathy. The study was conducted on three groups: group A, 20 patients with clinical myelopathy and MRI evidence of cervical spondylosis; group B, 20 patients without myelopathy, but with other clinical and MRI evidence of cervical spondylosis; and group C, 10 normal volunteers with no MRI evidence of spondylosis. The cross-sectional area (CSA) of the spinal cord (SP-CSA), spinal canal (SC-CSA) and CSF space (CSF-CSA) were measured on T1-weighted axial images at the level of the most severe spinal canal stenosis. The severity of myelopathy was assessed using a simple scoring system giving a score from 0 (normal) to 11 (severe). Subjective demonstration of cord compression on sagittal images was an insensitive indicator of clinical myelopathy. All three measures of cross-sectional area were significantly smaller in Group A than in B (p<0.01). The reduction in SP-CSA was the only independent prognosticator for severity of myelopathy (p<0.005) accounting for 63% of the variation in myelopathy score. All three variables showed a significant correlation with the presence of myelopathy (p<0.01); however, logistic regression analysis showed a decrease in CSF-CSA to be the only independent significant prognosticator of the presence of clinical myelopathy (p<0.02). Reduction of the CSF space to less than 0.7 cm2 was associated with a 90% chance of clinical myelopathy (specificity 83%).     

颈椎病再次手术问题的探讨：附130例报告

报告１３０例颈椎手术治疗后的再手术，其中脊髓型颈椎病５４例，脊髓神经根型１７例，颈椎病合并椎管狭窄５１例，颈椎病合并后纵韧带骨化８例。根据临床表现和影像学征像及首次手术后变化，选择应用颈前路扩大减压植骨融合，颈后路椎管扩大和椎板成形术，有效率为８１．８％。对颈椎病再手术的适应证、手术方法选择等作了讨论。     

MRI对颈椎病的诊断价值

96例混合型颈椎病的MRI主要表现为椎间盘髓核失水、变性、椎间隙变窄，椎间盘膨出、突出和脱出，椎体后缘骨赘形成、黄韧带肥厚内招、椎管狭窄；脊髓受压移位、变形，脊髓水肿、变性、软化和囊肿形成，其横截面积缩小；椎间孔处颈神经根周围脂肪高信号减少或消失。不用对比剂的推动脉MR显影（MRA）可立即显示颈部双侧推动脉粗细、迂曲、受阻及动态状况。其中32例以脊髓型为主老同时作脊髓造影和CTM检查，并经手术证实。脊髓造影、CTM、MRI与手术所见符合率分别为60％、85％、96％。作者认为，MRI诊断颈椎病简捷准确，定位精确度高，可优化缩短诊疗全过程。     

The association of cervical spondylosis and multiple sclerosis.

The diagnostic and therapeutic considerations produced by the coexistence of cervical spondylosis and multiple sclerosis are complex. We have encountered six patients, affected by both multiple sclerosis and cervical spondylosis, in whom neurosurgical procedures were performed. The diagnosis of multiple sclerosis was confirmed by a combination of clinical, neuroimmunologic, electrophysiologic, and neuroradiologic findings. The diagnosis of spondylosis with spinal cord compromise was confirmed by myelography and computed tomographic scan in all cases, and by magnetic resonance imaging in four. Surgery was followed by lasting clinical improvement in two patients, transient improvement in one, and no change in the other three. Our experience confirms that multiple sclerosis and cervical spondylosis can coexist and suggests that this coexistence may result in an interaction that compounds the deleterious effect on the nervous system. Diagnostic evaluations of patients, particularly young patients, with symptoms of cervical spondylosis should include consideration of the possible coexistence of multiple sclerosis. The evaluation of a patient with known multiple sclerosis who develops new signs of cervical spinal cord dysfunction should always include spinal neuroimaging studies. When progression of symptoms coincides with documented progression of anatomic compression, surgical intervention can yield good results.     

The optimal radiologic method for assessing spinal canal compromise and cord compression in patients with cervical spinal cord injury. Part I: An evidence-based analysis of the published literature

STUDY DESIGN: An evidence-based analysis of published radiologic criteria for assessing spinal canal compromise and cord compression in patients with acute cervical spinal cord injury. OBJECTIVES: This study was conducted to determine whether literature-based guidelines could be established for accurate and objective assessment of spinal canal compromise and spinal cord compression after cervical spinal cord injury. SUMMARY OF BACKGROUND DATA: Before conducting multicenter trials to determine the efficacy of surgical decompression in cervical spinal cord injury, reliable and objective radiographic criteria to define and quantify spinal cord compression must be established. METHODS: A computer-based search of the published English, German, and French language literature from 1966 through 1997 was performed using MEDLINE (U.S. National Library of Medicine database) to identify studies in which cervical spinal canal and cord size were radiographically assessed in a quantitative manner. Thirty-seven references were included for critical analysis. RESULTS: Most studies dealt with degenerative disease, spondylosis, and stenosis; only 13 included patients with acute cervical spinal cord injury. Standard lateral radiographs were the most frequent imaging method used (23 studies). T1- and T2-weighted magnetic resonance imaging were used to assess spinal cord compression in only 7 and 4 studies, respectively. Spinal cord size or compression were not precisely measured in any of the cervical trauma studies. Interobserver or intraobserver reliability of the radiologic measurements was assessed in only 7 (19%) of the 37 studies. CONCLUSIONS: To date, there are few quantitative, reliable radiologic outcome measures for assessing spinal canal compromise or cord compression in patients with acute cervical spinal cord injury.     

The effect of renin-angiotensin system blockers on spinal cord dysfunction and imaging features of spinal cord compression in patients with symptomatic cervical spondylosis

BACKGROUND CONTEXTCervical spondylosis may lead to spinal cord compression, poor vascular perfusion, and ultimately, cervical myelopathy. Studies suggest a neuroprotective effect of renin-angiotensin system (RAS) inhibitors in the brain, but limited data exist regarding their impact on the spinal cord.PURPOSETo investigate whether RAS blockers and other antihypertensive drugs are correlated with preoperative functional status and imaging markers of cord compression in patients with symptomatic cervical spondylosis.STUDY DESIGNRetrospective observational study.PATIENT SAMPLEIndividuals with symptomatic degenerative cervical stenosis who underwent surgery.OUTCOME MEASURESImaging features of spinal cord compression and functional status (modified Japanese Orthopedic Association [mJOA] and Nurick grading scales).METHODSTwo hundred sixty-six operative patients with symptomatic degenerative cervical stenosis were included. Demographic data, comorbidities, antihypertensive medications, and functional status (including mJOA and Nurick grading scales) were collected. We evaluated canal compromise, cord compromise, surface area of T2 signal cord change, and pixel intensity of signal cord change compared with normal cord on T2-weighted magnetic resonance imaging sequences.RESULTSOf 266 patients, 41.7% were women, 58.3% were men; median age was 57.2 years; 20.6% smoked tobacco; 24.7% had diabetes mellitus. One hundred forty-nine patients (55.8%) had hypertension, 142 (95.3%) of these were taking antihypertensive medications (37 angiotensin-II receptor blockers [ARBs], 44 angiotensin-converting enzyme inhibitors, and 61 other medications). Patients treated with ARBs displayed a higher signal intensity ratio (ie, less signal intensity change in the compressed cord area) compared with untreated patients without hypertension (p=.004). Patients with hypertension had worse preoperative mJOA and Nurick scores than those without (p<.001). In the multivariate analysis, ARBs remained an independent beneficial factor for lower signal intensity change (p=.04), whereas hypertension remained a risk factor for worse preoperative neurological status (p<.01).CONCLUSIONSIn our study, patients with hypertension who were treated with RAS inhibitors had decreased T2-weighted signal intensity change than untreated patients without hypertension. Patients with hypertension also had worse preoperative functional status. Prospective case-control studies may deepen understanding of RAS modulators in the imaging and functional status of chronic spinal cord compression.