颈椎间盘突出的MRI测量及MRI临床应用价值

目的探讨颈椎间盘突出的MRI测量指标的科学性和临床应用价值.方法采用椎间盘突出的二个测量指数--矢状径和横径指数(STI)、矢径指数(SI)并对矢状T2WI图像脊髓信号异常及信号正常的60例颈椎间盘突出进行了测量和分析.结果颈椎间盘突出测量矢状T2WI脊髓信号异常及信号正常的STI均数之间有明显的差异(P<0.01),SI均数之间有非常显著性差异,(P<0.001).结论把矢状T2WI脊髓情况与STI、SI测量相结合,STI与SI指标作为衡量颈椎间盘突出程度及脊髓有无受压损伤的量化指标客观可靠,SI更简化更实用.可作为MRI间接评估颈椎间盘突出脊髓受压损伤的方法,并可指导临床治疗和评估预后.     

颈椎间盘突出致脊髓前动脉综合征的诊治

[目的]探讨颈椎间盘突出导致脊髓前动脉综合征的诊断、治疗方法及其疗效.[方法]本组患者男13例,女5例;平均年龄35.6岁,术前均行MRI检查显示颈椎间盘突出,临床症状进行性加重,具体表现为突出节段平面以下运动功能障碍同时伴有痛温觉消失,但本体感觉正常,符合脊髓前动脉综合征的特点.术前JOA评分4～10分,平均7.6分.17例患者发病后15 d内行颈椎前路减压融合术,1例按椎管内占位于外院行后路手术,效果不理想,1年后再次给予前路减压.[结果]术后随访12～24个月,平均15个月,疗效良好,术后JOA评分平均13.4分(7～15分),平均改善率61.7%,无1例出现并发症.[结论]突出的颈椎间盘可压迫脊髓前动脉使脊髓前2/3缺血而表现为脊髓前动脉综合征,患者的临床特征及MRI检查可帮助诊断,早期行前路减压融合术,效果良好.     

盘内注射胶原酶治疗颈椎间盘突出症

目的探讨突出椎间盘内注射胶原酶治疗颈椎间盘突出症的疗效及安全性。方法经CT或MRI证实的颈椎间盘突出160例(208个椎间盘),通过突出的椎间盘内注射胶原酶的方法进行治疗,并观察治疗后1个月和6个月时的疗效。结果136例(179个椎间盘)得到随访。术后1个月时,优良率为86%;6个月时,优良率为89.7%。CT结果显示原突出的179个椎间盘平均缩小73%;完全消失者101个(56%),缩小幅度超过50%者37个(21%),变化较小者(<50%)33个(19%),无变化者8个;优良率86%。结论颈椎间盘内注射胶原酶治疗椎间盘突出症疗效明显,简单安全,椎间盘溶解率高。     

急性创伤性无骨折脱位型颈髓损伤的临床研究

目的　探讨急性创伤性无骨折脱位型颈脊髓损伤的机制及治疗方法。方法　 75例患者行常规 X线摄片、CT扫描及 MRI检查。结果　常规 X线摄片及 CT扫描均不能确切了解颈脊髓损伤的病因及机理。根据 MRI检查分为两种类型 ,a)颈椎间盘突出颈脊髓损伤型 ,本组 6 2例。4 9例脊髓受压明显者予以手术治疗 ,13例脊髓受压较轻者予以非手术治疗。b)无颈椎间盘突出颈脊髓损伤型 ,13例均予以非手术治疗。随访 6 7例 ,随访时间 1～ 10 a,平均 4 a,除2例 Frankel A级、1例 Frankel B级无恢复外 ,其余患者神经功能均有不同程度恢复。结论　无骨折脱位型颈脊髓损伤应尽早行 MRI检查 ,以明确临床类型。对颈脊髓受压明显的颈椎间盘突出者 ,应尽早手术治疗 ,对无颈椎间盘突出者采用大剂量甲基强的松龙等非手术治疗 ,亦具有较好的疗效。     

颈脊髓压迫与脊髓空洞症的形成和临床研究

[目的]探讨颈椎间盘突出症和颈椎病引起脊髓严重受压于减压后脊髓空洞症的形成机理。[方法]观察46例颈椎间盘突出症和颈椎病的脊髓严重受压在减压后随访观察3.5～8.8a，行MRI4～21次分析观察。[结果]发现2例减压后9～27个月MRI显示受压段脊髓呈脊髓空洞样改变。[结论]慢性严重颈脊髓压迫减压后，有可能形成脊髓空洞症。     

Bryan颈椎间盘假体置换治疗硬膜外型颈椎间盘突出症

目的探讨Bryan人工颈椎间盘置换应用于硬膜外型颈椎间盘突出症的手术技巧并评价其近期临床疗效。方法2005年2月~2005年12月,对5例硬膜外型颈椎间盘突出症患者实施前路减压 Bryan颈椎间盘假体置换术。术前摄颈椎正、侧位和动力位X线片,颈椎CT、MRI并进行颈椎病JOA评分。术后1周复查颈椎X线片以了解假体位置及其活动功能情况;复查颈椎MRI,了解颈段脊髓减压情况。本组病例均获随访3~13个月(平均7个月),分别于术后6周、3个月重新进行JOA评分。结果本组患者均完成单节段椎间盘置换,术后无神经、血管损伤等并发症发生;颈椎MRI示所有患者颈脊髓减压彻底,术后临床症状均显著改善;术后6周及3个月的JOA评分较术前有明显提高。至最后一次随访复查,手术节段活动度无明显丢失,假体均无偏移、下沉等。结论对硬膜外型颈椎间盘突出症行Bryan颈椎间盘假体置换术时,在满足假体骨床的前提下,仍可获得充分的颈脊髓减压。     

METRx椎间盘镜下颈椎后路椎间孔切开减压术疗效研究

目的 探讨METRx椎间盘镜下颈椎后路椎间孔切开减压术对神经根型颈椎病及颈椎间盘突出症的治疗效果.方法 METRx椎间盘镜下颈椎后路椎间孔切开减压术治疗9例神经根型颈椎病及2例颈椎间盘突出症.结果 本组11例患者术后MRI检查显示突出椎间盘及神经根压迫消失.随访3个月后JOA脊髓功能评分和VAS评分,与术前比较差异有统计学意义(P<0.05).结论 METRx椎间盘镜下颈椎后路椎间孔切开减压术手术创伤小,术后恢复快,临床疗效优良.     

无骨折脱位颈脊髓损伤的实质探讨

目的 探讨无骨折脱位型颈脊髓损伤的实质。方法 54例无骨折脱位颈脊髓损伤,分析其MRI表现。采取摘除突出椎间盘或/和清除椎管后方致压物、扩大椎管的手术治疗,随访其术后疗效。结果 MRI显示外伤性颈椎间盘突出为主,同一节段黄韧带、棘间和棘上韧带等软组织损伤,导致脊髓压迫、挤压性损害。术后54例病人都有不同程度的康复。结论 外伤引起的颈椎间盘突出挤压脊髓和一过性损伤是无骨折脱位颈脊髓损伤的主要原因。     

颈脊髓损伤MRI的诊断分型(附66例手术所见分析)

本文报告66例急性颈髓损伤,通过MRI检查,有三种压迫颈髓情况:1.单纯椎间盘突出,2.椎间盘与骨折块一起压迫颈髓;3.单独骨折块压迫颈髓。在脊髓成像上显示的病理变化;1.硬脊膜与脊髓水肿,在T_2—wis上为明亮的高信号成像;2.脊髓信号呈暗淡的低信号成像;3.脊髓信号变化的脊段没有脊髓受压现象。在治疗上:单纯椎间盘突出患者效果比较满意,椎间盘与骨折块同时压迫者或单独骨折块压迫者效果比较差;脊髓信号变化与受压平面不一致者,可给予保守治疗,必要时,手术能获得满意效果。     

无骨折脱位颈脊髓损伤的实质探讨

目的：探讨无骨折脱位颈脊髓损伤的实质。方法：54例无骨折脱位颈脊髓损伤,分析其MRI表现。采取除突出椎间盘或／和清除椎管后方致压物、扩大椎管的手术治疗,随访其术后疗效。结果：MRI显示外伤性颈椎间盘突出为主,同一节段黄韧带、棘间和棘上韧带等软组织损伤,导致脊髓压迫、挤压性损害。术后54例病人都有不同程度的康复。结论：外伤引起的颈椎间盘突出挤压脊髓和一过性损伤是无骨折脱位颈脊髓损伤的主要原因。     

经胸腔侧前方入路治疗胸椎间盘突出症

本文报告经胸腔侧前方入路切除椎间盘治疗胸椎间盘突出症９例。均为中央型和旁中央型，经过脊髓造影、ＣＴＭ或ＭＲＩ检查确诊。随访１～４年，平均２年１０个月。根据Ｏｔａｎｉ分级方法标准，结果为优３例，良５例，一般１例，优良率达８９％，获得较满意效果。采用ＣＴＭ或ＭＲＩ诊断胸椎间盘突出有较高价值。该手术方法直接、充分地显露硬膜囊和神经结构，切除突出的椎间盘和刮除骨赘，减压较安全有效，同时对脊柱的稳定性和脊髓的血供影响较小。作者认为经胸腔侧前方入路进行椎间盘切除减压是治疗胸椎间盘突出症的一种安全有效的方法。     

腰椎间盘突出CT扫描三维定位诊断

目的：研究椎间盘突出的三维定位,为腰椎间盘突出患者提供更精确的诊断依据。方法：对40例椎间盘突出CT扫描后进行多平面重建,得到矢状位图像。用1－4四个数字代表突出髓核在横断位上的位置,在横断位或矢状位上测量髓核后突的程度,在矢状位上测量髓核上下移位的长度。按照左右、前后、上下的顺序来描述髓核突出的部位、后突程度和长度,并与手术结果对照。结果：三维定位提供的部位、程度和长度与手术结果相符。结论：多平面重建图像和三维定位方法是可靠的,可为椎间盘突出的诊断提供更精确可靠的依据。     

Presence and distribution of antigen-antibody complexes in the herniated nucleus pulposus.

STUDY DESIGN: Herniated tissue was studied by immunohistochemistry in eight patients with lumbar disc herniation. The results were compared with those of control subjects. OBJECTIVE: To assess the presence and distribution of possible antigen-antibody complexes in herniated disc tissue. SUMMARY OF BACKGROUND DATA: It has been suggested that the nucleus pulposus may be recognized as a foreign-body by the immune system and that this will lead to secondary nerve root disturbance. Such immunologic events should be initiated by binding of antibodies to a specific antigen in the disc tissue. However, the presence of antigen-antibody complexes in the herniated disc tissue has not been assessed. METHODS: Amplification of the peroxidase reaction produced in avidin-biotin-peroxidase complex immunostaining by diaminobenzidine was used to visualize antigen-antibody complexes in the herniated tissue. The authors used herniated tissue from eight patients with lumbar disc herniation and nucleus pulposus from five control subjects with nonlumbar disc herniation. Thin paraffin sections, prefixed in 4% paraformaldehyde, were incubated with anti-human IgG antibody to allow visualization of antigen-antibody complexes in the specimens. RESULTS: A brown deposit, indicating antigen-antibody complexes, could be observed in the pericellular capsule in herniated disc tissue but not in control discs or in the residual discs of the herniation patients. CONCLUSION: Antigen-antibody complexes seem to be commonly present in herniated disc tissue, but not in healthy discs. However, the pathophysiologic and clinical significance of this observation has to be elucidated further.     

Disc herniation in cervical fracture subluxation

Previous reports of computed tomographic scan with contrast myelography in cervical spinal cord injury have shown a rate of disc herniation of less than 5%. We hypothesized that injuries associated with forces adequate to cause bone or ligamentous injury in the region of the disc space could be associated with higher and more significant rates of disc herniation. Thirty-seven consecutive traumatic midcervical fracture subluxations were reviewed. Fracture subluxation was defined by fracture of the facet joints, pedicles, or vertebral bodies or more than 3.5 mm subluxation from C2-C3 to C7-T1. Reduction was achieved in 97% and was not associated with neurological deterioration. On the basis of plain films, tomograms, and plain computed tomographic scans, the injuries were classified as flexion dislocation, flexion compression, compression burst, or extension injuries. Twenty-five computed tomographic scans with contrast myelograms and one magnetic resonance imaging scan were obtained. All patients with partial neurological deficits were studied. A herniated disc was defined as that which deformed the thecal sac and/or nerve roots. Retrospectively, a neuroradiologist reviewed the studies for the presence of herniated disc. Disc herniation was seen at the level of injury in 9 (35%) patients and not seen in other patients. Forty-seven percent of the patients with partial deficits had herniated discs. Herniated disc was seen most frequently in flexion dislocation and flexion compression injuries. Three patients (20%) with partial deficits underwent discectomy. Patients with partial spinal cord injury and discectomy, on average, improved more than other patients with partial spinal cord injury.(ABSTRACT TRUNCATED AT 250 WORDS)     

Magnetic resonance imaging and contrast CT of the lumbar spine. Comparison of diagnostic methods and correlation with surgical findings

Thirty-two patients with suspected lumbar disc herniation were studied with magnetic resonance imaging (MRI) and contrast computed tomography (CT). One hundred disc levels were evaluated. Twenty-five patients underwent surgery on 31 discs, allowing anatomic confirmation of the diagnosis. Surgical findings supported the MRI diagnosis at 28 of 31 levels (90.3% accuracy), whereas the CT diagnosis correctly reflected only 24 of 31 levels (77.4% accuracy). Discrepancy between MRI and CT interpretation occurred at ten levels that were surgically explored. Computed tomography (CT) was incorrect at seven levels, and MRI was in error at three levels. The sensitivity of MRI was 91.7%, compared with 83.3% for CT, and the MRI specificity of 100% was superior to 71.4% for CT. This study demonstrates the clinical superiority of surface coil MRI over contrast CT in the evaluation of lumbar disc herniation. Surface coil MRI can be used as the initial diagnostic procedure for a suspected herniated lumbar disc, using invasive contrast studies and CT, if required, to clarify an equivocal MRI finding.     

MRI在急性颈椎骨折并发椎间盘突出中的应用

应用磁共振成像（ＭＲＩ）检查５０例急性颈椎骨折，其中伴有椎间盘突出３２例（６４％）。在过伸性 损伤１２例中，椎间盘突出７例（５８．３％）；屈伸性损伤３８例中，椎间盘突出２５例（６８．４％）。在ＭＲＩ上显 示３种情况：（１）单纯性椎间盘突出，硬膜囊与脊髓是高信号，表示脊髓水肿；（２）椎间盘与骨块一起 压迫脊髓，脊髓内有暗淡假信号，表示脊髓内出血或实质性损害；（３）椎间盘突出与脊髓信号变化不在 同一椎节平面，脊髓信号增高处可能是损伤的椎节。在治疗上，单纯性椎间盘突出患者的效果比较满 意。椎间盘与骨块同时压迫硬脊膜者，效果比较差；第三种患者可给予保守治疗，必要时手术，能获 得满意效果。     

Lumbar discography followed by computed tomography. Refining the diagnosis of low-back pain

Two hundred fifty patients with low-back pain who underwent lumbar discography followed by computed tomography (CT) are the subject of this prospective study. In 93% of the patients, these combined imaging techniques provided additional useful diagnostic information that affected patient management and the selection of treatment alternatives. Lumbar discography followed by CT proved valuable in determining the significance of equivocal or multiple level abnormalities, determining the type of disc herniation, defining surgical options, and evaluating the previously operated spine. In 94% of patients who had surgery, CT-discography correctly predicted the type of disc herniation as protruded, extruded, sequestrated, or internally disrupted. Computed tomography-discography may be more sensitive that magnetic resonance imaging (MRI) in the early stages of disc degeneration because 18 of 177 discs with a normal T2-weighted image were discographically abnormal and the CT-discogram revealed annular tears or radial fissuring. The radiographic morphology of the normal herniated and degenerative lumbar discs shown by CT-discography gives unique insight into the pathogenesis of disc degeneration. The complications that followed the 750 discograms were one case of urticaria and one disc space infection. Even with the availability of high resolution CT and MRI, lumbar discography remains the only pain provocation challenge to the lumbar disc.     

Anterior or posterior approach of thoracic disc herniation? A comparative cohort of mini-transthoracic versus transpedicular discectomies

Background contextThe optimal surgical treatment of thoracic disc herniations remains controversial and depends on the consistency of the herniation and its location related to the spinal cord.PurposeTo compare the outcomes of patients with symptomatic thoracic disc herniations treated with anterolateral mini-transthoracic approach (TTA) versus posterior transpedicular discectomy.Study designThis is a prospective comparative cohort study.Patient sampleOne hundred consecutive patients with symptomatic thoracic herniated discs were operated by mini-TTA (56 patients) or transpedicular discectomy (44 patients).Outcome measuresNeurologic assessment by American Spinal Injury Association (ASIA) Impairment Scale and patients' self reported perceived recovery and complications.MethodsThe consistency and location of the herniated disc in relation to the spinal cord was evaluated by preoperative computed tomography and magnetic resonance imaging. Patients were assessed neurologically before surgery and at regular outpatient controls at 2 months or later. Long-term follow-up was achieved by questionnaires sent by mail.ResultsIn both groups, most patients had symptoms of myelopathy and radicular pain; patients who underwent mini-TTA, more frequently suffered from spasticity. Fifty-eight percent of the herniated discs were calcified and 77% were larger than one-third of the spinal canal. All patients presented with ASIA Grade C or D (64%) or ASIA Grade E (36%). Postoperatively, 50% of the patients treated with mini-TTA and 37% of the transpedicular group improved at least one grade on the ASIA scale (p=.19). The duration of surgery, blood loss, hospital stay, and complication rate were significantly higher in patients treated with mini-TTA and were mainly related to the magnitude and consistency of the herniated disc. At long-term follow-up, 72% of the mini-TTA patients reported good outcome versus 76% of the transpedicular discectomy group (p=.80).ConclusionsSurgical treatment of a symptomatic herniated disc contributed to a clinical improvement in most cases. The approach is dependent on the location, the magnitude, and the consistency of the herniated thoracic disc. Medially located large calcified discs should be operated through an anterolateral approach, whereas noncalcified or lateral herniated discs can be treated from a posterior approach as well. For optimal treatment of this rare entity, the treatment should be performed in selected centers.     

A pathologic study of lumbar disc herniation in the elderly

Twenty-nine fragments from herniated lumbar discs of patients over 60 years of age were studied pathohistologically. For comparison, 109 discs from patients under 59 years of age also were observed. They were classified into seven types according to their composition. In 70% of discs from patients between 60 and 69 and in 80% of discs from patients over 70, the fragments were composed of the anulus fibrosus and the cartilaginous end-plate. The authors concluded that the cartilaginous end-plate had avulsed from the vertebral body and herniated with the anulus fibrosus in these cases. This type of herniation occurs more often than herniation of the nucleus pulposus over 30, and may be most common in elderly patients because of their advanced disc degeneration.     

腰椎间盘中血管内皮生长因子的表达及其意义

目的 :观察并探讨腰椎间盘中内源性血管内皮生长因子 (vascularendothelialgrowthfactor,VEGF)的表达分布规律及其意义。方法 :采用免疫组织化学技术检测 1 6例胎儿期、8例生长期、1 2例成熟退变期和 42例突出椎间盘中VEGF的表达。结果 :胎儿椎间盘脊索细胞和纤维环外层血管内皮细胞出现阳性免疫染色 ,阳性率为 87 5 % ;生长期和成人期椎间盘未见阳性表达 ;退变突出组总阳性率为 83 3 %。VEGF表达主要出现于破裂型和游离型椎间盘突出 (P <0 0 1 ) ,其细胞来源主要是突出椎间盘组织中毛细血管内皮细胞、髓核内的类软骨细胞及单核巨噬细胞。年龄与VEGF表达阳性率关系不大 (P >0 0 5)。病程超过 1年者VEGF阳性率明显低于 1年以内者 (P <0 0 5)。结论 :胎儿期和破裂型 (包括游离型 )突出椎间盘组织可产生内源性VEGF ,突出椎间盘中VEGF的阳性表达与病程、突出类型密切相关