Hayashi Tetsuo, Daubs Michael D, Suzuki Akinobu, Scott Trevor P, Phan Kevin, Aghdasi Bayan, Ruangchainikom Monchai, Hu Xueyu, Lee Chris, Takahashi Shinji, Shiba Keiichiro, Wang Jeffrey C
*Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles, CA†Department of Orthopaedic Surgery, Japan Labour Health and Welfare Organization, Spinal Injuries Center, Fukuoka, Japan.
Clin Spine Surg. 2016 May;29(4):E196-200. doi: 10.1097/BSD.0b013e3182aab240.
This study was an in vivo kinematic magnetic resonance imaging analysis of cervical spinal motion in human subjects.
The objective of the study was to identify associations between disk degeneration in the subaxial cervical spine and upper cervical spinal motion in patients with general age-related cervical spondylosis.
The kinematic relationship between the occipital-atlantoaxial complex and subaxial cervical spine in patients with cervical spondylosis and decreased cervical motion is not well understood.
A total of 446 symptomatic patients who had neck pain with and without neurogenic symptoms were included in this study. Kinematic magnetic resonance imaging was performed with dynamic motion of the cervical spine in upright, weight-bearing neutral, flexion, and extension positions. Intervertebral disk degeneration for each segment from C2-3 to C7-T1 and sagittal angular motion between flexion and extension for each segment from Oc-C1 to C7-T1 was evaluated. Depending on the amount of sagittal subaxial angular motion, the patients were classified into 3 groups by sagittal angular motion using cutoff points based on tertile (<36-degree group: 149 cases; 36-47-degree group: 148 cases; and >47-degree group: 149 cases).
A significant correlation was found between subaxial angular motion and intervertebral disk degeneration, indicating that the subaxial motion decreases according to the degree of disk degeneration. Mean angular motion of the occipital-atlantoaxial complex, especially of Oc-C1, was significantly higher in the <36-degree and 36-47-degree group than in the >47-degree group, whereas no significant difference was found at C1-C2.
Our study demonstrates that decreased subaxial cervical spinal motion is associated with intervertebral disk degeneration in a symptomatic population. This decrease in mobility at the subaxial cervical spine is compensated for by an increase in angular mobility of the upper cervical spine at the occipital-atlantoaxial complex, especially at Oc-C1.
本研究是一项对人体受试者颈椎运动进行的体内运动学磁共振成像分析。
本研究的目的是确定一般年龄相关性颈椎病患者下颈椎椎间盘退变与上颈椎运动之间的关联。
颈椎病患者且颈椎活动度降低时，枕-寰枢复合体与下颈椎之间的运动学关系尚未完全明确。
本研究共纳入446例有或无神经症状的颈部疼痛症状性患者。在直立、负重中立位、屈曲和伸展位对颈椎进行动态运动时进行运动学磁共振成像。评估从C2-3至C7-T1每个节段的椎间盘退变情况以及从Oc-C1至C7-T1每个节段在屈曲和伸展之间的矢状角运动。根据下颈椎矢状角运动量，使用基于三分位数的分界点按矢状角运动将患者分为3组（<36度组：149例；36-47度组：148例；>47度组：149例）。
发现下颈椎角运动与椎间盘退变之间存在显著相关性，表明下颈椎运动随椎间盘退变程度而降低。枕-寰枢复合体的平均角运动，尤其是Oc-C1的平均角运动，在<36度组和36-47度组中显著高于>47度组，而在C1-C2处未发现显著差异。
我们的研究表明，在有症状的人群中，下颈椎运动减少与椎间盘退变有关。下颈椎活动度的这种降低通过枕-寰枢复合体处上颈椎角活动度的增加得到补偿，尤其是在Oc-C1处。
