Nouri Aria, Tetreault Lindsay, Dalzell Kristian, Zamorano Juan J, Fehlings Michael G
Division of Neurosurgery and Spine Program, Toronto Western Hospital, Toronto, Ontario, Canada.
Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada.
Neurosurgery. 2017 Jan 1;80(1):121-128. doi: 10.1227/NEU.0000000000001420.
Degenerative cervical myelopathy encompasses a group of conditions resulting in progressive spinal cord injury through static and dynamic compression. Although a constellation of changes can present on magnetic resonance imaging (MRI), the clinical significance of these findings remains a subject of controversy and discussion.
To investigate the relationship between clinical presentation and quantitative MRI features in patients with degenerative cervical myelopathy.
A secondary analysis of MRI and clinical data from 114 patients enrolled in a prospective, multicenter study was conducted. MRIs were assessed for maximum spinal cord compression (MSCC), maximum canal compromise (MCC), signal changes, and a signal change ratio (SCR). MRI features were compared between patients with and those without myelopathy symptoms with the use of t tests. Correlations between MRI features and duration of symptoms were assessed with the Spearman ρ.
Numb hands and Hoffmann sign were associated with greater MSCC ( P < .05); broad-based, unstable gait, impairment of gait, and Hoffmann sign were associated with greater MCC ( P < .05); and numb hands, Hoffmann sign, Babinski sign, lower limb spasticity, hyperreflexia, and T1 hypointensity were associated with greater SCR ( P < .05). Patients with a T2 signal hyperintensity had greater MSCC and MCC ( P < .001).
MSCC was associated with upper limb manifestations, and SCR was associated with upper limb, lower limb, and general neurological deficits. Hoffmann sign occurred more commonly in patients with a greater MSCC, MCC and SCR. The Lhermitte phenomenon presented more commonly in patients with a lower SCR and may be an early indicator of mild spinal cord involvement. Research to validate these findings is required.
退行性颈椎脊髓病包括一组通过静态和动态压迫导致脊髓进行性损伤的病症。尽管磁共振成像（MRI）上可出现一系列变化，但这些发现的临床意义仍存在争议并有待讨论。
探讨退行性颈椎脊髓病患者临床表现与MRI定量特征之间的关系。
对一项前瞻性多中心研究中114例患者的MRI和临床数据进行二次分析。评估MRI的脊髓最大压迫（MSCC）、椎管最大狭窄（MCC）、信号变化及信号变化率（SCR）。采用t检验比较有和无脊髓病症状患者的MRI特征。用Spearman ρ评估MRI特征与症状持续时间之间的相关性。
手部麻木和霍夫曼征与更大的MSCC相关（P <.05）；宽基底、不稳定步态、步态障碍和霍夫曼征与更大的MCC相关（P <.05）；手部麻木、霍夫曼征、巴宾斯基征、下肢痉挛、反射亢进和T1低信号与更大的SCR相关（P <.05）。T2信号高强化的患者有更大的MSCC和MCC（P <.001）。
MSCC与上肢表现相关，SCR与上肢、下肢及一般神经功能缺损相关。霍夫曼征在MSCC、MCC和SCR更大的患者中更常见。莱尔米特现象在SCR较低的患者中更常见，可能是轻度脊髓受累的早期指标。需要进行研究以验证这些发现。
