Shigematsu Hideki, Cheung Jason Pui Yin, Mak Kin-Cheung, Bruzzone Mauro, Luk Keith D K
Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China; Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan.
Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
J Orthop Sci. 2017 Jan;22(1):22-26. doi: 10.1016/j.jos.2016.09.008. Epub 2016 Oct 3.
Patients with pre-existing cervical spinal canal stenosis (CSCS) may have minimal or no symptoms. However, performing preventive decompression is controversial as the incidence of CSCS leading to severe cord injury is unknown. Hence, this study aims to revisit the threshold for surgery in "silent" CSCS by reviewing the neurologic outcomes of patients with undiagnosed CSCS who sustained a cervical spinal cord injury (CSCI).
Two groups of subjects were recruited for analysis. Firstly, patients with trauma-induced CSCI without fracture or dislocation were included. Pre-existing CSCS was diagnosed by MRI measurements. The second group consisted of asymptomatic subjects recruited from the general population who also had MRIs performed. Canal sizes were compared between this control group and the patient group. Within the patient group, neurological assessments and outcomes by Frankel classification were performed in patients treated surgically or conservatively.
32 patients with CSCS were recruited. The mean spinal canal sagittal diameter (disc-level) of all CSCS cases was 5.3 ± 1.4 mm (1.3-8.2). In comparison, the diameter was 10.5 ± 1.7 mm (6.6-14.6) in the 47 asymptomatic individuals recruited from the general population. Decompression was performed in 17 patients and conservative treatment in 15. Mean follow-up was 19.3 ± 17.0 months (6-84). At the final follow-up, 3 patients (9.3%) returned to their pre-injury Frankel grade, whereas 26 patients (83.3%) lost one or more neurological grade. Three patients (9.3%) died.
Majority of patients with "silent" CSCS who sustained cervical cord injuries did not return to their pre-injury neurological status. All of these subjects have pre-existing canal stenosis hence the risk of cord injury. Given the poor neurological outcome of CSCS, a lower threshold for surgery could be indicated to avoid these disastrous injuries. However, before making any conclusive recommendation we must first identify the prevalence of "silent" CSCS in the general population and the risk of developing spinal cord injury with more prospective population-based studies.
患有既往存在的颈椎管狭窄（CSCS）的患者可能症状轻微或无症状。然而，由于导致严重脊髓损伤的CSCS发生率未知，进行预防性减压存在争议。因此，本研究旨在通过回顾未诊断出CSCS但发生颈椎脊髓损伤（CSCI）的患者的神经学结果，重新审视“无症状”CSCS的手术阈值。
招募两组受试者进行分析。首先，纳入无骨折或脱位的创伤性CSCI患者。通过MRI测量诊断既往存在的CSCS。第二组由从普通人群中招募的无症状受试者组成，他们也进行了MRI检查。比较该对照组与患者组之间的椎管尺寸。在患者组中，对接受手术治疗或保守治疗的患者进行Frankel分类的神经学评估和结果评估。
招募了32例CSCS患者。所有CSCS病例的平均椎管矢状径（椎间盘水平）为5.3±1.4mm（1.3 - 8.2）。相比之下，从普通人群中招募的47例无症状个体的椎管直径为10.5±1.7mm（6.6 - 14.6）。17例患者进行了减压，15例进行了保守治疗。平均随访时间为19.3±17.0个月（6 - 84个月）。在最后随访时，3例患者（9.3%）恢复到受伤前的Frankel分级，而26例患者（83.3%）失去了一个或多个神经学分级。3例患者（9.3%）死亡。
大多数发生颈髓损伤的“无症状”CSCS患者未恢复到受伤前的神经学状态。所有这些受试者都存在既往的椎管狭窄，因此有脊髓损伤的风险。鉴于CSCS的神经学结果较差，可能需要较低的手术阈值以避免这些灾难性损伤。然而，在做出任何确定性建议之前，我们必须首先通过更多基于人群的前瞻性研究确定普通人群中“无症状”CSCS的患病率以及发生脊髓损伤的风险。
