软性椎间盘突出所致轻度脊髓型颈椎病患者保守治疗结果与磁共振成像表现之间的关系

Relationships between outcomes of conservative treatment and magnetic resonance imaging findings in patients with mild cervical myelopathy caused by soft disc herniations.

作者信息

Matsumoto M, Chiba K, Ishikawa M, Maruiwa H, Fujimura Y, Toyama Y

机构信息

Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan.

出版信息

Spine (Phila Pa 1976). 2001 Jul 15;26(14):1592-8. doi: 10.1097/00007632-200107150-00021.

DOI:10.1097/00007632-200107150-00021

PMID:11462093

Abstract

STUDY DESIGN

A retrospective follow-up study of conservatively treated patients with mild cervical myelopathy caused by cervical soft disc herniation.

OBJECTIVE

To investigate the outcome of conservative treatment for patients with mild myelopathy caused by cervical soft disc herniation and to evaluate usefulness of magnetic resonance findings in the prediction of the outcomes.

SUMMARY OF BACKGROUND DATA

Recent studies on conservative treatment for cervical soft disc herniation have focused mainly on radiculopathy, and not on myelopathy.

METHODS

Twenty-seven patients with mild cervical myelopathy secondary to cervical soft disc herniation were treated conservatively for more than 6 months by cervical bracing and restriction of daily activities. Of the 27 patients, 17 patients (Group A) underwent conservative treatment only and it was associated with improvement in their neurologic deficits, while the other 10 patients (Group B) ultimately underwent decompression surgery because of neurologic deterioration. Comparisons between the two groups were made in regard to JOA scores, patient satisfaction, and magnetic resonance findings, including location of the disc herniation (focal or diffuse in the sagittal plane, median or paramedian in the axial plane).

RESULTS

The JOA scores were 13.6 +/- 1.6 in Group A and 14.1 +/- 1.6 in Group B before treatment, 14.9 +/- 1.0 and 12.9 +/- 2.1, respectively, at 3 months, and 16.2 +/- 0.8 and 16.0 +/- 1.2, respectively, at the final follow-up. The JOA scores at 3 months were significantly lower in Group B than in Group A. Satisfaction with the results of treatment at the final follow-up was reported by 77% of the patients in Group A and 90% in Group B. Focal-type herniation was present in 47% of the patients in Group A and 70% in Group B, while median-type herniation was diagnosed in 77% in Group A and 30% in Group B. Follow-up magnetic resonance imaging of the patients in Group A showed spontaneous regression of a herniated mass in 10 patients (59%). Diffuse-type herniations were more likely to regress spontaneously than focal-type herniations (78% vs. 37%).

CONCLUSIONS

Conservative treatment is an effective treatment option for mild cervical myelopathy caused by cervical soft disc herniation. A good outcome can be expected in patients with a median-type and/or diffuse-type herniation on magnetic resonance imaging.

摘要

研究设计

对因颈椎软性椎间盘突出症导致轻度脊髓型颈椎病且接受保守治疗的患者进行回顾性随访研究。

目的

探讨因颈椎软性椎间盘突出症导致轻度脊髓病的患者接受保守治疗的效果，并评估磁共振成像结果在预测治疗效果方面的实用性。

背景数据总结

近期关于颈椎软性椎间盘突出症保守治疗的研究主要集中在神经根病，而非脊髓病。

方法

27例因颈椎软性椎间盘突出症继发轻度脊髓型颈椎病的患者通过颈部支具固定和限制日常活动进行了超过6个月的保守治疗。在这27例患者中，17例患者（A组）仅接受保守治疗，其神经功能缺损有所改善，而另外10例患者（B组）最终因神经功能恶化接受了减压手术。对两组患者的日本骨科协会（JOA）评分、患者满意度以及磁共振成像结果进行了比较，包括椎间盘突出的位置（矢状面为局灶性或弥漫性，横断面为中央型或旁中央型）。

结果

治疗前A组JOA评分为13.6±1.6，B组为14.1±1.6；3个月时，A组为14.9±1.0，B组为12.9±2.1；末次随访时，A组为16.2±0.8，B组为16.0±1.2。B组3个月时的JOA评分显著低于A组。末次随访时，A组77%的患者对治疗结果满意，B组为90%。A组47%的患者为局灶型突出，B组为70%；A组77%的患者为中央型突出，B组为30%。A组患者的随访磁共振成像显示10例患者（59%）的突出肿块自发消退。弥漫型突出比局灶型突出更易自发消退（78%对37%）。