Harrop James S, Naroji Swetha, Maltenfort Mitchell, Anderson D Greg, Albert Todd, Ratliff John K, Ponnappan Ravi K, Rihn Jeffery A, Smith Harvey E, Hilibrand Alan, Sharan Ashwini D, Vaccaro Alexander
From the Departments of *Neurological Surgery and †Orthopedic Surgery, Jefferson Medical College, Philadelphia, PA.
Spine (Phila Pa 1976). 2010 Mar 15;35(6):620-4. doi: 10.1097/BRS.0b013e3181b723af.
Retrospective analysis of a cohort of patients treated between April 2006 and January 2008, and diagnosed with cervical degenerative disease.
To determine the correlation of the clinical findings associated with cervical myelopathy to the presence of spinal cord compression or cord signal abnormalities on magnetic resonance imaging (MRI).
There are numerous reports describing the radiographic features of cervical spondylosis, however, no publication specifically describes the association between the physical signs of cervical myelopathy and the presenting imaging findings.
Myelopathy was defined as the presence of greater than one long-tract sign localized to the cervical spinal cord (Hoffman or Babinski signs, clonus, hyper-reflexia, crossed abductor sign, and/or gait dysfunction) on physical examination in the absence of other neurologic condition(s). The presence of these signs, MRI imaging features of spinal cord compression and hyperintense T2 intraparenchymal cord signal abnormality, and patient demographics were recorded.
One hundred three patients met inclusion criteria (age >18, symptomatic cervical degenerative disease and complete neurologic assessment). Of these, 54 had clinical findings of cervical myelopathy. Radiographic features of cord compression were present in 62% of patients, and 84% had myelopathy on examination. No patients without cord compression presented with myelopathy (P < 0.0001). Thirty-five percent of the patients presented with hyperintense signal on T2 MRI within the spinal cord parenchyma. This finding correlated with the presence of myelopathy (P < 0.0001). Multivariate analysis on the subset with cord compression indicates that the likelihood of myelopathy increased with the presence of cord signal hyperintensity (odds ratio [OR], 11.4), sensory loss (OR, 16.9), and age (OR, 1.10 per year).
The diagnosis of cervical myelopathy is based on presenting symptoms and physical examination. This analysis illustrates that radiographic cervical spinal cord compression and hyperintense T2 intraparen chymal signal abnormalities correlate with the presence of myelopathic findings on physical examination.
对2006年4月至2008年1月间接受治疗并被诊断为颈椎退行性疾病的一组患者进行回顾性分析。
确定与颈椎脊髓病相关的临床发现与磁共振成像（MRI）上脊髓受压或脊髓信号异常之间的相关性。
有许多报告描述了颈椎病的影像学特征，然而，没有出版物专门描述颈椎脊髓病的体征与呈现的影像学发现之间的关联。
脊髓病定义为在体格检查中存在大于一个局限于颈脊髓的长束征（霍夫曼或巴宾斯基征、阵挛、反射亢进、交叉外展肌征和/或步态功能障碍），且无其他神经系统疾病。记录这些体征的存在情况、脊髓受压的MRI成像特征和T2实质内脊髓信号异常情况以及患者人口统计学资料。
103例患者符合纳入标准（年龄>18岁、有症状的颈椎退行性疾病且进行了完整的神经学评估）。其中，54例有颈椎脊髓病的临床发现。62%的患者存在脊髓受压的影像学特征，84%的患者在检查时有脊髓病。没有脊髓受压的患者均未出现脊髓病（P<0.0001）。35%的患者在脊髓实质内的T2 MRI上出现高信号。这一发现与脊髓病的存在相关（P<0.0001）。对有脊髓受压的亚组进行多变量分析表明，脊髓病的可能性随着脊髓信号高信号的存在（优势比[OR]，11.4）、感觉丧失（OR，16.9）和年龄（OR，每年1.10）而增加。
颈椎脊髓病的诊断基于呈现的症状和体格检查。该分析表明，颈椎脊髓受压的影像学表现和T2实质内高信号异常与体格检查中脊髓病的发现相关。
