颈椎间盘退变病因研究进展

目前关于颈椎间盘退变机制的研究报道很多 ,但其确切原因还不清楚 ,现将这方面的研究进展情况综述如下。1　颈椎间盘退变早期的影响因素1 1　软骨终板的改变软骨终板渗透是椎间盘营养供应的主要途径。年龄与应力等因素可引起软骨板内软骨细胞与基质成分的改变。成人软骨终板厚度约为 1mm ,随着年龄的增长而逐渐变薄 ,中年以后软骨终板可出现裂隙与破裂 ,且随年龄增长软骨终板血管数目减少 ,血流减慢淤积 ,蛋白多糖含量减少 ,终板逐渐钙化 ,出现不同程度的退变。这些改变不仅影响椎间盘细胞的营养供应 ,妨碍废物的排出 ,破坏基质代谢平衡 ,还…     

定量性MRI在椎间盘退变中的研究进展

<正>椎间盘退变是腰腿痛常见原因,严重影响了人们的日常生活和工作。传统的影像检查技术只能提供形态学上的病理变化,尚不能精确定量诊断早期椎间盘退变。磁共     

腰椎间盘退变的MRI分级评价方法研究进展

腰椎间盘退变过程中伴随着胶原和蛋白多糖的分解以及含水量的丢失,水分丢失情况可反映椎间盘退变的程度,而这可通过核磁共振成像（magnetic resonance imaging,MRI）信号的改变间接反映出来,这就使得可以根据MRI信号变化的差别对腰椎间盘退变的程度进行分级评价。有作者根据椎间盘MRI上T2加权像的表现,将椎间盘退变进行分级,也有作者根据髓核相对信号强度评估椎间盘退变,还有作者将不同的椎间盘MRI信号赋予不同的分值,通过评分来评价椎间盘的退变。但目前尚没有一种MRI分型系统能够完全反映椎间盘的退变改变、并能真正满足临床需要,理想的分型系统还需要进一步研究。     

椎间盘退变模型研究进展

椎间盘退变的生物学机制尚不明确,构建椎间盘退变模型是研究基础和关键。近年来国内外报道的新型椎间盘退变模型分为体外和体内培养模型两大类。体外模型包括椎间盘细胞模型和椎间盘组织块模型,多用于细胞生物学行为方面的研究,适用面较广,但培养要求较高,模拟体内环境有局限。体内模型有机械力学模型、外伤模型、酶化学模型、缺血模型、吸烟模型等,多用于采取特定干预措施的椎间盘退变模型的研究,适用面较窄,但干预技术较易实现。该文就近年来新型椎间盘退变模型的研究进展及各种模型的优缺点作一综述。     

椎间盘退变模型研究进展

椎间盘退变的生物学机制尚不明确,构建椎闯盘退变模型是研究基础和关键.近年来国内外报道的新型椎间盘退变模型分为体外和体内培养模型两大类.体外模型包括椎间盘细胞模型和椎间盘组织块模型,多用于细胞生物学行为方面的研究,适用面较广,但培养要求较高,模拟体内环境有局限.体内模型有机械力学模型、外伤模型、酶化学模型、缺血模型、吸烟模型等,多用于采取特定干预措施的椎间盘退变模型的研究,适用面较窄,但干预技术较易实现.该文就近年来新型椎间盘退变模型的研究进展及各种模型的优缺点作一综述.     

椎间盘退变动物模型研究进展

颈椎病、腰椎间盘突出症等疾病的根本病理变化是椎间盘退变,但其确切病因及病理生理机制目前仍不十分清楚。因此建立椎间盘退变实验动物模型,对于深入探讨椎间盘退变的病理过程,有效评价人为干预因素的影响,是十分必要的。     

椎间盘退变动物模型研究进展

椎间盘退变动物模型用于研究椎间盘退变机制和检测介入治疗手段的有效性。该文综述了腰椎间盘退变研究常用的几种动物实验模型的制作方法和原理,分析各种模型的优缺点及其与临床的相关性。     

椎间盘退变机制研究进展

椎间盘退变（intervertebral disc degeneration,IVDD）是一系列脊柱退行性疾病的前提和基础病理过程,临床上往往表现为椎管狭窄、脊柱节段不稳、腰腿痛、颈椎病、椎间盘突出等病症,患者相关的神经根、脊髓受压并产生一系列相应症状。目前引起椎间盘退变的确切机制尚无定论,国内外学者从不同角度（如分子生物学、生物化学、生物力学、免疫学等等）进行了深入的探讨,现将研究的进展简述如下。     

椎间盘退变动物模型研究进展

常用于研究椎间盘退变（intervertebral disc degeneration，IVDD）的发生机制和检测介入治疗手段有效性的动物实验模型可分为体内、体外和计算机模拟实验三种。体外实验模型和计算机模拟实验模型研究IVDD有明显的局限性，所以常用的实验方法仍然是体内研究。体内椎间盘退变模型可分为自发性和诱导性两种。自发性椎间盘退变模型是通过系统方法引起动物遗传改变，或通过改变喂养食物引起动物行为方式改变而引起IVDD发生。诱导性椎间盘退变模型又可分为机械性损害模型和结构性损害模型。为了更好地了解各种动物模型的优缺点，本对椎间盘退变动物模型进行了比较，分析其与人类可能的相关性。[第一段]     

椎间盘退变动物模型的研究进展

目的对国内外建立椎间盘退变动物模型的研究进展进行综述。方法广泛查阅近年来国内外有关椎间盘退变动物模型的文献,对不同的建模方法进行分类和综合分析。结果椎间盘退变的动物模型分为两大类:诱发性和自发性椎间盘退变模型。其中前者可分别通过改变椎间盘生物力学环境、损伤椎间盘自身结构以及用基因技术改变动物的遗传性状来诱发退变。在各类建模方法中,以鼠或兔制作的诱发性椎间盘退变模型应用最为广泛。结论椎间盘退变的动物模型是研究椎间盘退变性疾病发病机制的一种重要手段,同时为退变椎间盘的修复研究提供良好的实验载体。虽然目前报道的各类模型均具有一定的局限性,但随着动物模型和人类椎间盘退变之间的相关性和可比性逐渐明确,其在椎间盘退变性疾病的研究中具有广阔应用前景。     

Reliability of a magnetic resonance imaging-based grading system for cervical intervertebral disc degeneration

STUDY DESIGN: This was a radiographic reliability study of a novel grading system for cervical intervertebral disc degeneration. OBJECTIVES: This study aimed to develop and test the reliability of a reproducible grading system for cervical intervertebral disc degeneration on the basis of the routine magnetic resonance imaging (MRI). SUMMARY OF BACKGROUND DATA: Cervical disc degeneration is common after middle age, and the morphology of cervical disc degenerative disease has often been studied using MRI. There are few specific MRI-based grading systems for cervical intervertebral disc degeneration despite the clinical importance of this problem. This study proposes a novel reproducible grading system for cervical disc degeneration and demonstrates the reliability of this classification scheme. METHODS: A grading system for cervical intervertebral disc degeneration was developed based on relevant previous literature. MRI grading of 300 cervical intervertebral discs using T2-weighted sagittal images was performed by 4 spinal surgeons (observers) in a blinded fashion. Intraobserver and interobserver reliabilities were assessed by calculating kappa statistics. RESULTS: Grade I degeneration was observed in 27 discs (9.0%); grade II, in 56 (18.7%); grade III, in 124 (41.3%); grade IV, in 67 (22.3%); and grade V, in 26 (8.7%) discs. Kappa coefficients for intraobserver and interobserver agreements ranged from substantial to excellent (intraobserver, 0.907 to 0.950 and interobserver, 0.730 to 0.826). Complete agreement was obtained, on an average, in 72.1% of the discs. A difference of 1, 2, and 3 grades was observed in 22.4%, 3.3%, and 0.2% discs, respectively. CONCLUSIONS: This grading system is comprehensive and easily applicable with sufficient reproducibility. It can be used as a common nomenclature for research and discussions.     

椎间盘退变的磁共振弥散加权成像研究

目的运用磁共振弥散加权成像技术定量分析椎间盘退变,以期对椎间盘早期退变进行定量诊断。方法88例对象430个椎间盘纳入研究（排除磁敏感性伪影较重的10个椎间盘）,行PM分级后经GE 1．5T超导MRI对腰椎行常规（矢状面T1加权、12加权和横断面T2加权）和矢状面弥散加权成像（diffusion weightedi maging,DWI）。其中脊柱常规扫描采用快速自旋回波（fast spin echo,FSE）脉冲序列,弥散成像采用平面回波成像（echo—planar imaging,EPI）脉冲序列。根据正中矢状面他加权像椎间盘形态及信号变化,在ADW4．2后处理工作站使用Function tool图像处理软件对图像进行后处理,在DWI矢状面上分别对腰椎椎间盘手动画出感兴趣区并测量其信号强度与表观弥散系数（apparent diffusion coefficient,ADC）值。结果430个椎间盘纳入DWI研究,PM分级Ⅰ级0个,Ⅱ级166个;Ⅲ级146个;Ⅳ级69个;Ⅴ级49个。经Kruskal—Wallis秩和检验,ADC值与PM分级有相关性（P〈0．05）。以ADC=1．05×10-3mm2／s作为评价椎间盘状态定量指标,其灵敏度为73．48％,特异度为75．30％。结论磁共振弥散加权成像可定量评价椎间盘退变程度。     

Missed cervical disc bulges diagnosed with kinematic magnetic resonance imaging

Purpose

To determine if adding flexion and extension MRI studies to the traditional neutral views would be beneficial in the diagnosis of cervical disc bulges.

Methods

Five hundred patients underwent MRI in neutral, flexion and extension positions. The images were analyzed using computer software to objectively quantify the amount of disc bulge.

Results

Compared to the neutral position, cervical disc bulges were significantly increased in the extension position (P < 0.05), but on flexion position, there was no significant difference (P > 0.05). For patients without or <3 mm of disc bulge in neutral, 2.97 % demonstrated an increase in bulge to ≥3 mm bulge in flexion, and 16.41 % demonstrated an increase to ≥3 mm bulge in extension. For patients in the neutral view that had a baseline disc bulge of 3?5 mm, 3.73 % had increased bulges to ≥5 mm in flexion and 11.57 % had increased bulges to ≥5 mm in extension.

Conclusion

A significant increase in the degree of cervical disc bulge was found by examining extension views when compared with neutral views alone. Kinematic MRI views provide valuable added information, especially in situations where symptomatic radiculopathy is present without any abnormalities demonstrated on traditional neutral MRI.     

Comparison of magnetic resonance imaging and lumbar discography in the diagnosis of disc degeneration

A prospective comparison of 97 discs in 50 patients studied by both magnetic resonance imaging and discography showed a high correlation in the identification of the degenerative disc between these two modalities.     

挥鞭样损伤后期颈部软组织MRI的研究进展

挥鞭样损伤(Whiplash injury)是交通事故中常见的损伤.近年来,挥鞭样损伤已经成为一个影响公共健康的严重问题,尤其是挥鞭样损伤后期出现的系列慢性症状备受医学界关注.挥鞭样损伤经常导致颈痛及其他症状的持续发作,并且消耗大量的医疗和经济资源.虽然目前关于挥鞭样损伤有很多研究,但仍存疑问和争议,比如挥鞭样损伤的定义及分型,尤其是病理生理机制及诊断没有可靠的依据.最近,MRI在挥鞭样损伤后期研究中的作用引起广泛重视,笔者就此相关研究综述如下.     

Review of existing grading systems for cervical or lumbar disc and facet joint degeneration

The aim of this literature review was to present and to evaluate all grading systems for cervical and lumbar disc and facet joint degeneration, which are accessible from the MEDLINE database. A MEDLINE search was conducted to select all articles presenting own grading systems for cervical or lumbar disc or facet joint degeneration. To give an overview, these grading systems were listed systematically depending on the spinal region they refer to and the methodology used for grading. All systems were checked for reliability tests and those recommended for use having an interobserver Kappa or Intraclass Correlation Coefficient >0.60 if disc degeneration was graded and >0.40 if facet joint degeneration was graded. MEDLINE search revealed 42 different grading systems. Thirty of these were used to grade lumbar spine degeneration, ten were used to grade cervical spine degeneration and two were used to grade both. Thus, the grading systems for the lumbar spine represented the vast majority of all 42 grading systems. Interobserver reliability tests were found for 12 grading systems. Based on their Kappa or Intraclass Correlation Coefficients nine of these could be recommended for use and three could not. All other systems could neither be recommended nor not be recommended since reliability tests were missing. These systems should therefore first be tested before use. The design of the grading systems varied considerably. Five grading systems were beginning with the lowest degree of degeneration, 37, however, with the normal, not degenerated state. A 5-grade scale was used in six systems, a 4-grade scale in 24, a 3-grade scale in eight and a 2-grade scale in three systems. In 15 cases the normal, not degenerated state was assigned to grade 0, in another 15 cases, however, this state was assigned to grade 1. This wide variety in the design of the grading systems makes comparisons difficult and may easily lead to confusion. We would therefore recommend to define certain standards. Our suggestion would be to use a scale of three to five grades, to begin the scale with the not degenerated state and to assign this state to grade 0.An erratum to this article can be found at     

Pain and disability correlated with disc degeneration via magnetic resonance imaging in scoliosis patients

Prior imaging studies of scoliosis patients attempted to demonstrate a relationship between plain radiographic curve patterns and curve progression and pain, or used magnetic resonance imaging (MRI) to focus on spinal cord abnormalities. Pain in scoliosis patients may differ from nondeformity patients, yet may still be discogenic. The purpose of this study was to assess the possible relationship of degenerative disc findings on MRI to scoliosis patients’ pain. This prospective study enrolled scoliosis and control patients, all of whom had assessment for back pain (visual analog scale) and disability (Oswestry Index) and spinal MRI to identify prevalence and distribution of degenerative disc findings. Specifically, we assessed 60 consecutive pediatric and adult idiopathic scoliosis patients who had progressed to surgical treatment, 60 age- and gender-matched asymptomatic controls, and 172 nondeformity symptomatic degenerative disc disease patients who had progressed to surgical treatment. All subjects had independent analysis of their preoperative MRI for disc degeneration, disc herniation, Schmorl’s nodes, and inflammatory end plate changes. Imaging findings of the scoliosis patients were compared to those from asymptomatic and symptomatic control groups. Our results found that both pediatric and adult scoliosis patients had significantly more pain and disability than did asymptomatic controls (P < 0.001). The adult idiopathic scoliosis patients had pain and disability similar to those of surgical degenerative disc disease control groups. Disc degeneration and herniation (contained) were not related to pain. However, in the pediatric scoliosis patients, those with Schmorl’s nodes often had greater pain than those without (P = 0.01). Adults with painful scoliosis, typically occurring at the apex of the scoliosis or at the lumbosacral junction, had a significantly higher frequency of inflammatory end plate changes on MRI than did controls (P < 0.001). Prior studies have demonstrated a correlation of inflammatory end plate changes to lumbar discogenic pain. In conclusions, scoliosis patients who have progressed to surgical intervention, pediatric patients have varying degrees of pain, and those with Schmorl’s nodes may be at greater risk for pain. Adult scoliosis patients have multifactorial pain of which one component may be related to degeneration of the lower lumbar discs similar to that in nondeformity patients. Additionally, adult scoliosis patients may have MRI findings consistent with discogenic pain at the apex of their curvature, most commonly at the proximal lumbar levels.     

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。     

Anterior cervical fusion. A review of thirty-three patients with cervical disc degeneration.

Thirty-three patients who had undergone anterior cervical fusion for degenerative disc disease were reviewed to determine the efficacy of the procedure. Only patients who were available for examination and who had undergone operation at least one year previously were included in the review. Nearly all had had arm pain and three-quarters neck pain. Diminished neck movement and neurological abnormalities in the arms had been frequent findings. Diagnosis from the clinical features and plain radiographs is described. Myelography was not used routinely and discography was not used at all. Indications for operation and surgical technique are described. Results show that pain in the neck and arm was relieved in a high proportion of cases and that the neurological abnormalities often recovered. It is concluded that this operation is safe and has a definite place in the relief of pain from cervical disc degeneration resistant to conservative treatment.