Departments of Orthopedic Surgery (K.D., E.O., N.F., M.N., M.M., and K.W.) and Diagnostic Radiology (H.F.), Keio University School of Medicine, Tokyo, Japan.
Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan.
J Bone Joint Surg Am. 2018 May 16;100(10):843-849. doi: 10.2106/JBJS.17.01347.
Few studies have addressed in detail long-term degenerative changes in the cervical spine. In this study, we evaluated the progression of degenerative changes of the cervical spine that occurred over a 20-year period in an originally healthy cohort. We also sought to clarify the relationship between the progression of cervical degenerative changes and the development of clinical symptoms.
For this prospective follow-up investigation, we recruited 193 subjects from an original cohort of 497 participants who had undergone magnetic resonance imaging (MRI) of the cervical spine between 1993 and 1996. The subjects were asked about the presence or absence of cervical spine-related symptoms. Degenerative changes of the cervical spine were assessed on MRI using an original numerical grading system. The relationship between the progression of degenerative changes and the onset of clinical symptoms was evaluated by logistic regression analysis.
Degeneration in the cervical spine was found to have progressed in 95% of the subjects during the 20-year period. The finding of a decrease in signal intensity of the intervertebral disc progressed in a relatively high proportion of the subjects in all age groups and occurred with similar frequency (around 60%) at all intervertebral disc levels. The rate of progression of other structural failures on MRI increased with age and was highest at C5-C6. The progression of foraminal stenosis was associated with the onset of upper-limb pain (odds ratio, 4.71 [95% confidence interval, 1.02 to 21.7]).
A progression of degenerative changes in the cervical spine on MRI over the 20-year period was detected in nearly all subjects. There was no relationship between the progression of degeneration on MRI and the development of clinical symptoms, with the exception of an association found between foraminal stenosis and upper-limb pain.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
鲜有研究详细探讨颈椎的长期退行性变化。本研究评估了 20 年间一组健康人群颈椎退行性变化的进展情况，并试图阐明颈椎退行性变化的进展与临床症状发展之间的关系。
本前瞻性随访研究共纳入 193 名受试者，他们均来自 1993 年至 1996 年间行颈椎磁共振成像（MRI）检查的 497 名参与者的原始队列。询问受试者是否存在与颈椎相关的症状。采用原始数字分级系统对颈椎 MRI 上的退行性变化进行评估。采用逻辑回归分析评估退行性变化进展与临床症状出现之间的关系。
20 年间，95%的受试者颈椎发生退变。所有年龄段的受试者中，椎间盘信号强度降低的发生率都较高（约 60%），且在所有椎间盘水平的发生率相似。MRI 上其他结构失败的进展率随年龄增长而增加，在 C5-C6 最高。椎间孔狭窄的进展与上肢疼痛的发生相关（比值比，4.71[95%置信区间，1.02 至 21.7]）。
在 20 年的时间里，几乎所有受试者的颈椎 MRI 上均观察到退行性变化的进展。除了发现椎间孔狭窄与上肢疼痛之间存在关联外，MRI 上退变的进展与临床症状的发展之间无相关性。
预后 III 级。有关证据水平的完整描述，请参见作者说明。
