Boden S D, McCowin P R, Davis D O, Dina T S, Mark A S, Wiesel S
Department of Orthopaedic Surgery, George Washington University Medical Center, Washington, D.C. 20037.
J Bone Joint Surg Am. 1990 Sep;72(8):1178-84.
Previous investigations with plain radiography, myelography, and computed tomography have shown that degenerative disease of the cervical spine frequently occurs in the absence of clinical symptoms. We studied the magnetic resonance-imaging scans of sixty-three volunteers who had no history of symptoms indicative of cervical disease. The scans were mixed randomly with thirty-seven scans of patients who had a symptomatic lesion of the cervical spine, and all of the scans were interpreted independently by three neuroradiologists. The scans were interpreted as demonstrating an abnormality in 19 per cent of the asymptomatic subjects: 14 per cent of those who were less than forty years old and 28 per cent of those who were older than forty. Of the subjects who were less than forty, 10 per cent had a herniated nucleus pulposus and 4 per cent had foraminal stenosis. Of the subjects who were older than forty, 5 per cent had a herniated nucleus pulposus; 3 per cent, bulging of the disc; and 20 per cent, foraminal stenosis. Narrowing of a disc space, degeneration of a disc, spurs, or compression of the cord were also recorded. The disc was degenerated or narrowed at one level or more in 25 per cent of the subjects who were less than forty years old and in almost 60 per cent of those who were older than forty. The prevalence of abnormal magnetic-resonance images of the cervical spine as related to age in asymptomatic individuals emphasizes the dangers of predicating operative decisions on diagnostic tests without precisely matching those findings with clinical signs and symptoms.
先前使用X线平片、脊髓造影和计算机断层扫描进行的研究表明，颈椎退行性疾病经常在没有临床症状的情况下发生。我们研究了63名无颈椎病症状史的志愿者的磁共振成像扫描结果。这些扫描结果与37名有颈椎病症状性病变患者的扫描结果随机混合，所有扫描结果均由三名神经放射科医生独立解读。在无症状受试者中，19%的扫描结果被解读为显示异常：40岁以下者为14%，40岁以上者为28%。40岁以下的受试者中，10%有椎间盘突出，4%有椎间孔狭窄。40岁以上的受试者中，5%有椎间盘突出；3%有椎间盘膨出；20%有椎间孔狭窄。还记录了椎间盘间隙变窄、椎间盘退变、骨刺或脊髓受压情况。40岁以下的受试者中，25%在一个或多个节段出现椎间盘退变或变窄，40岁以上的受试者中这一比例近60%。无症状个体中颈椎磁共振成像异常与年龄的相关性强调了在没有将这些检查结果与临床体征和症状精确匹配的情况下，依据诊断检查做出手术决策的危险性。
