Sadeh Menachem, Dabby Ron
Department of Neurology, Wolfson Medical Center, Sackler School of Medicine, Tel Aviv University, Holon, Israel.
J Clin Neurosci. 2018 Jan;47:111-115. doi: 10.1016/j.jocn.2017.10.071. Epub 2017 Oct 31.
Hand weakness and wasting in the setting of mid-cervical spondylosis and disc herniation without radiological evidence for compression of the C8 or T1 roots has been rarely reported. We retrospectively studied the data of patients with hand weakness and mid-cervical spondylosis. The clinical and radiological findings were compared to a control group of patients with weakness of the arm or forearm muscles and similar mid-cervical spondylosis. We found 19 patients with weakness and atrophy of the intrinsic hand muscles, and 13 patients with weakness proximal to the hand muscles to serve as a control group. Eleven patients (58%) had lower limb hyperreflexia or Babinski sign. Nine patients (47%) had compression of the C7 root, 12 patients (63%) had compression of C6, 8 patients (42%) had compression of C5, and 2 patients (11%) had compression of the root C4. In all but three patients (84%), magnetic resonance imaging (MRI) showed cord compression. In the control group, five patients (38%) showed hyperreflexia of the lower limbs and Babinski sign. Five patients (38%) had compression of the C7 root, eight patients (62%) had compression of C6, and twelve patients (92%) had compression of C5. Cord compression was found in eight patients (62%). Hand muscle weakness and wasting due to mid-cervical spondylosis seems to be more common than usually believed. The lack of clinical-radiological correlation should not mislead the clinician from the correct diagnosis, and should not delay the surgical decompression of the cord and the roots.
在没有C8或T1神经根受压影像学证据的情况下，中颈椎颈椎病和椎间盘突出症患者出现手部无力和肌肉萎缩的情况鲜有报道。我们回顾性研究了手部无力和中颈椎颈椎病患者的数据。将临床和影像学结果与一组患有手臂或前臂肌肉无力且中颈椎颈椎病相似的对照组患者进行比较。我们发现19例手部固有肌肉无力和萎缩的患者，以及13例手部肌肉近端无力的患者作为对照组。11例患者（58%）有下肢反射亢进或巴宾斯基征。9例患者（47%）有C7神经根受压，12例患者（63%）有C6神经根受压，8例患者（42%）有C5神经根受压，2例患者（11%）有C4神经根受压。除3例患者外（84%），磁共振成像（MRI）均显示脊髓受压。在对照组中，5例患者（38%）出现下肢反射亢进和巴宾斯基征。5例患者（38%）有C7神经根受压，8例患者（62%）有C6神经根受压，12例患者（92%）有C5神经根受压。8例患者（62%）发现脊髓受压。中颈椎颈椎病导致的手部肌肉无力和萎缩似乎比通常认为的更为常见。临床与影像学缺乏相关性不应误导临床医生做出正确诊断，也不应延迟脊髓和神经根的手术减压。
