Sir Gangaram Hospital, New Delhi, India.
Spine (Phila Pa 1976). 2010 Oct 1;35(21):E1083-7. doi: 10.1097/BRS.0b013e3181df1a8e.
STUDY DESIGN: Retrospective case series review. OBJECTIVE: To determine the recovery and prevalence of myelopathic signs and their resolution in cervical spondylotic myelopathy after treatment by laminoplasty. SUMMARY OF BACKGROUND DATA: Myelopathic signs are an integral component of diagnosis of cervical myelopathy. Effect of surgical intervention (laminoplasty) on recovery of these reflexes has not been studied and remains undetermined. Their recovery and its rate remain unclear. This may be important because resolution may affect recovery, and reappearance may mark relapse. METHODS: Patients diagnosed as having cervical spondylotic myelopathy based on symptoms, corroborative imaging, and improvement of at least 1 grade in Nurick score were part of study. The patients were evaluated for a period of 1 year from surgery. Hyperreflexia and provocative signs (Hoffman, inverted brachioradialis reflex, clonus, and Babinski) and recovery (Nurick and mJOA) were noted at subsequent follow-up, and improvement was analyzed. RESULTS: Twenty-one patients had severe spondylotic myelopathy with Nurick score ≥ 3. Myelopathic signs were highly sensitive in diagnosing the presence of severe SCM, because 100% of the SCM patients revealed at least 1 sign on examination. The recovery of these signs was maximum within the first 6 months, with lesser than half of total occurring in immediate and major half in the subsequent 6 months. Beyond this, plateau was seen in recovery, with marginal improvement of these signs. Patients with adverse cord signal changes (t2 hyper/T1 low) had higher prevalence and persistence of individual myelopathic signs compared with patients with only T1 hyperintensity/normal cord in preoperative period and follow-up at the end of 1 year. CONCLUSION: At least 1 myelopathic sign is universal in severe SCM patients. However, individual myelopathic signs cannot alone diagnose disease in all patients. The benefit of laminoplasty is apparent in immediate postoperative period (<7 days), but it is maximum in first 6 months after which the recovery stabilized or these are a marginal improvement. Similarly, the resolution of signs is maximum in period of first 6 months, which parallels recovery. Babinski and inverted brachioradialis reflex revert to normal in most patients and can serve as markers of relapse in long follow-up. Hoffman is not a sensitive test and is likely to persist in patient with severe cord changes.
研究设计:回顾性病例系列研究。
目的:确定颈椎后纵韧带骨化症患者接受椎板成形术后脊髓病体征的恢复和发生率及其解决情况。
背景资料概要:脊髓病体征是颈椎脊髓病诊断的一个组成部分。手术干预(椎板成形术)对这些反射的恢复效果尚未得到研究,仍不确定。其恢复情况及其恢复率尚不清楚。这可能很重要,因为解决情况可能会影响恢复,而再次出现可能会标志着复发。
方法:根据症状、影像学检查结果和 Nurick 评分至少提高 1 级,将诊断为颈椎后纵韧带骨化症的患者纳入研究。术后对患者进行为期 1 年的评估。在随后的随访中记录过伸反射和激发征(Hoffman 征、反向桡骨反射、阵挛和 Babinski 征)和恢复情况(Nurick 和 mJOA),并进行分析。
结果:21 例患者有严重的后纵韧带骨化症,Nurick 评分≥3 分。脊髓病体征在诊断严重 SCM 时具有高度敏感性,因为 100%的 SCM 患者在检查中至少有 1 个体征。这些体征的恢复在最初的 6 个月内达到最大值,不到一半的恢复发生在即刻,大部分发生在接下来的 6 个月内。此后,恢复趋于平稳,这些体征的改善也很轻微。与术前和术后 1 年时仅 T1 高信号/正常脊髓的患者相比,脊髓信号改变(T2 高信号/T1 低信号)不良的患者有更高的发病率和单个脊髓病体征的持续时间。
结论:至少有 1 个脊髓病体征是严重 SCM 患者的普遍表现。然而,在所有患者中,单独的脊髓病体征并不能单独诊断疾病。椎板成形术的益处在术后即刻(<7 天)就很明显,但在术后 6 个月内达到最大值,此后恢复趋于稳定,或仅有轻微改善。同样,体征的解决情况在最初的 6 个月内达到最大值,与恢复情况相平行。在大多数患者中,Babinski 和反向桡骨反射恢复正常,可作为长期随访中复发的标志物。Hoffman 征不是一种敏感的测试,而且很可能在严重脊髓改变的患者中持续存在。
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