Zeitoun Delphine, El Hajj Firass, Sariali Elhadi, Catonné Yves, Pascal-Moussellard Hugues
Radiologic Department, Pitié-Salpétrière Hospital, 47-83 Blvd de l'Hôpital, 75013 Paris, France.
Orthopaedic Department, Pitié-Salpétrière Hospital, 47-83 Blvd de l'Hôpital, 75013 Paris, France.
Spine J. 2015 Apr 1;15(4):668-74. doi: 10.1016/j.spinee.2014.12.001. Epub 2014 Dec 5.
BACKGROUND CONTEXT: Acquired cervical stenosis is caused by the combination of disc protrusion, facet joint degeneration, hypertrophy of the ligamentum flavum, and osteophyte formation. Although these mechanical factors seem to play an important role in the pathogenesis of myelopathy, the role of dynamic factors has been suggested by many authors. Based on these results, dynamic magnetic resonance imaging (MRI) was proposed to improve diagnostic techniques in patients with cervical myelopathy. PURPOSE: The purpose of the study was to evaluate the importance of dynamic MRI in the assessment of cervical canal stenosis and to determine the percentage of levels in which cord impingement was only visible in the extension MRI and the percentage of cases in which hyperintense intramedullary lesions (HILs) were identified only on the flexion MRI. STUDY DESIGN: This is a retrospective case series study. PATIENT SAMPLE: Patients with spondylotic myelopathy who had dynamic cervical MRI at our department from October 2005 to February 2007 were included. MATERIALS AND METHODS: Fifty-one consecutive patients with spondylotic myelopathy had MRI in the neutral, flexion, and extension positions of the cervical spine. OUTCOME MEASURES: The following entities were evaluated: canal stenosis (the evaluation of the stenosis was based on the Muhle classification) and the presence or absence of HILs. RESULTS: Two hundred fifty-five levels were evaluated in the three positions. At each level, the stages in extension were higher than the stages in neutral and flexion positions (p<.05). From C3 to C6, around 22.5% of Stage 3 levels in the extension were Stage 1 in the neutral position. In flexion, HILs are better identified than in neutral and extension positions (p<.05). In 10% of the patients, HILs were identified only in the flexion T2-weighted sequence. CONCLUSIONS: Extension MRI helps to identify significant cervical canal stenosis that is partially or completely absent on neutral and flexion MRI and to determine the exact number of levels to decompress surgically. Flexion MRI permits better visualization of HILs on T2-weighted sequences.
背景：获得性颈椎管狭窄是由椎间盘突出、小关节退变、黄韧带肥厚和骨赘形成共同作用引起的。尽管这些机械因素似乎在脊髓病的发病机制中起重要作用，但许多作者也提出了动态因素的作用。基于这些结果，有人提出采用动态磁共振成像（MRI）来改进颈椎病患者的诊断技术。 目的：本研究旨在评估动态MRI在评估颈椎管狭窄中的重要性，并确定仅在伸展位MRI上可见脊髓受压的节段百分比以及仅在屈曲位MRI上发现脊髓内高信号病变（HILs）的病例百分比。 研究设计：这是一项回顾性病例系列研究。 患者样本：纳入2005年10月至2007年2月在我院接受颈椎动态MRI检查的脊髓型颈椎病患者。 材料与方法：连续51例脊髓型颈椎病患者在颈椎中立位、屈曲位和伸展位进行了MRI检查。 观察指标：评估以下项目：椎管狭窄（狭窄评估基于Muhle分类）以及HILs的有无。 结果：在三个体位共评估了255个节段。在每个节段，伸展位的分级高于中立位和屈曲位（p<0.05）。从C3至C6，伸展位3级节段中约22.5%在中立位为1级。在屈曲位，HILs比在中立位和伸展位更易识别（p<0.05）。10%的患者仅在屈曲位T2加权序列上发现HILs。 结论：伸展位MRI有助于识别在中立位和屈曲位MRI上部分或完全未显示的明显颈椎管狭窄，并确定手术减压的准确节段数。屈曲位MRI能在T2加权序列上更好地显示HILs。
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