Argenson C, Frehel M, Lovet J, Griffet J, Deperetti F
Service d'Orthopédie-Traumatologie, Hôpital Saint-Roch, Nice.
Rev Chir Orthop Reparatrice Appar Mot. 1990;76(7):507-18.
The existence of cervical spinal cord injury without bony nor disco-ligamentous lesion rises pathogenic, prognostic and therapeutic challenges. The extent and localisation of cord injury, which depends on intensity and direction of the applied force, can explain the different clinical patterns: incomplete quadriplegia: 8 cases, incomplete Brown-Sequard-like quadriplegia: 2 cases, diplegia brachialis: 5 cases. We have not observed any complete quadriplegia. The presence of arthritic or congenital spinal canal stenosis has been found in 12 cases. We have used a coupled myelographic-CT Scan study. MRI has been employed more recently. This X-ray study has never found any major cord compression. Improvement of neurologic troubles, under medical treatment, was constant, but sequelae were always present, hands being most concerned; their importance was paralleled to the initial clinical feature. The Brown-Sequard-like quadriplegia were more pejorative. 3 patients, after an initial improvement, have presented a cervical myelopathic evolution and have been successfully operated on. On the other hand, the only initially operated on patient has been immediately worsened. Operation is indicated by the third week, when coexist: a spinal stenosis and a poor clinical evolution.
存在无骨质及椎间盘 - 韧带损伤的颈脊髓损伤会带来致病、预后及治疗方面的挑战。脊髓损伤的程度和部位取决于外力的强度和方向，这可以解释不同的临床模式：不完全四肢瘫8例，不完全布朗 - 塞卡尔样四肢瘫2例，臂丛瘫5例。我们未观察到完全性四肢瘫。12例患者存在关节炎性或先天性椎管狭窄。我们采用了脊髓造影 - CT扫描联合检查。最近使用了MRI。这项X线检查从未发现任何严重的脊髓受压情况。在药物治疗下，神经功能障碍有所改善，但后遗症始终存在，手部受影响最为严重；其严重程度与初始临床特征相关。布朗 - 塞卡尔样四肢瘫的预后更差。3例患者在初始改善后出现了颈椎病性进展，并成功接受了手术。另一方面，唯一最初接受手术的患者病情立即恶化。当存在椎管狭窄且临床进展不佳时，在第三周时应考虑手术。
