Fortin Maryse, Dobrescu Octavian, Courtemanche Matthew, Sparrey Carolyn J, Santaguida Carlo, Fehlings Michael G, Weber Michael H
McGill University Health Centre, Montreal General Hospital Site, Department of Orthopedic Surgery, Montreal, Quebec, Canada.
PERFORM Centre, Concordia University, Montreal, Quebec, Canada.
Spine (Phila Pa 1976). 2017 Feb 15;42(4):232-239. doi: 10.1097/BRS.0000000000001704.
A cross-sectional study.
The aim of this study was to assess fatty infiltration and asymmetry of the multifidus (MF), semispinalis cervicis (SCer), semispinalis capitis (SCap), and splenius capitis (SPL) muscles in patients with degenerative cervical myelopathy (DCM), and evaluate their correlations with clinical symptoms and functional scores.
Cervical muscle alterations have been reported in patients with chronic neck pain, but the assessment of cervical muscle morphology has been overlooked in patients with DCM.
Thirty-eight patients diagnosed with DCM and spinal cord compression at C4-C5 or C5-C6 (first level of compression) were included. Cervical muscle measurements of cross-sectional area (CSA) and ratio of functional CSA (fat-free area, FCSA) to total CSA were obtained from T2-weighted axial images at the level above, same, and level below the most cranial level of spinal cord compression. Muscle fatty infiltration and asymmetry was assessed at every level and their associations with respect to clinical signs and symptoms and functional scores were investigated.
There was a significant increase in fatty infiltration (decrease in FCSA/CSA ratio) of the MF (P = 0.001) and SPL (P < 0.001) muscles at the level below the spinal cord compression. A significant increase in MF CSA asymmetry was also observed at the level below the compression. Lower MF FCSA/CSA ratio was associated with longer 30-m walking test time. Lower SCer FCSA/CSA was associated with corticospinal distribution motor deficits and atrophy of the hands. Greater asymmetry in SCap CSA was associated with higher Neck Disability Index (NDI) scores, whereas lower asymmetry in MF CSA was associated with a positive Hoffman sign and weakness.
A significant increase in muscle fatty infiltration and CSA asymmetry at the level below the compression was observed in patients with DCM. Our results also suggest an association between cervical muscle morphology and DCM clinical symptoms and functional status.
横断面研究。
本研究旨在评估退行性颈椎病（DCM）患者多裂肌（MF）、颈半棘肌（SCer）、头半棘肌（SCap）和头夹肌（SPL）的脂肪浸润及不对称性，并评估它们与临床症状和功能评分的相关性。
慢性颈部疼痛患者中已报道有颈部肌肉改变，但DCM患者的颈部肌肉形态评估被忽视。
纳入38例诊断为DCM且脊髓在C4-C5或C5-C6水平受压（第一受压水平）的患者。从脊髓受压最头端水平的上方、同一水平和下方水平的T2加权轴向图像中获取颈部肌肉横截面积（CSA）以及功能性CSA（无脂肪区域，FCSA）与总CSA的比值测量值。在每个水平评估肌肉脂肪浸润和不对称性，并研究它们与临床体征和症状以及功能评分的相关性。
脊髓受压水平以下的MF（P = 0.001）和SPL（P < 0.001）肌肉脂肪浸润显著增加（FCSA/CSA比值降低）。在受压水平以下还观察到MF CSA不对称性显著增加。较低的MF FCSA/CSA比值与30米步行试验时间延长相关。较低的SCer FCSA/CSA与皮质脊髓束分布的运动功能障碍和手部萎缩相关。SCap CSA的更大不对称性与更高的颈部功能障碍指数（NDI）评分相关，而MF CSA的较低不对称性与霍夫曼征阳性和肌无力相关。
DCM患者在受压水平以下观察到肌肉脂肪浸润和CSA不对称性显著增加。我们的结果还表明颈部肌肉形态与DCM临床症状和功能状态之间存在关联。
2级。
