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退行性颈脊髓病:初级保健中的诊断和管理。

Degenerative cervical myelopathy: Diagnosis and management in primary care.

机构信息

Family physician practising at the Centre for Family Medicine in Kitchener, Ont.

Research consultant at the Centre for Family Medicine.

出版信息

Can Fam Physician. 2019 Sep;65(9):619-624.


DOI:
PMID:31515310
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6741789/
Abstract

OBJECTIVE: To raise awareness about degenerative cervical myelopathy (DCM) and to help family physicians identify, diagnose, and manage DCM more effectively. SOURCES OF INFORMATION: A PubMed search was conducted for articles published between 1970 and October 2017, using the terms and with or . MAIN MESSAGE: Owing to limited knowledge of DCM in primary care, along with the large variability of the disease, the diagnosis of DCM is often missed or delayed. The natural course of DCM presents as a stepwise decline, with symptoms ranging from muscle weakness to complete paralysis. All individuals with signs and symptoms should be referred to a spine surgeon for consideration of surgery; those with mild DCM might be offered conservative treatment but should receive a surgical evaluation and opinion nonetheless. Asymptomatic patients with evidence of cord compression on magnetic resonance imaging might need to be referred for assessment; however, surgery is not advised. It is critical to closely monitor asymptomatic individuals or those with mild DCM for neurologic deterioration. CONCLUSION: Degenerative cervical myelopathy is the most common cause of spinal cord dysfunction in adults. This review helps streamline its diagnosis in primary care, allowing for improved chances of early diagnosis and prevention of further neurologic decline among patients.

摘要

目的:提高对退行性颈椎脊髓病(DCM)的认识,并帮助家庭医生更有效地识别、诊断和治疗 DCM。

信息来源:对 1970 年至 2017 年 10 月间发表的文章进行了 PubMed 检索,使用的检索词为 和 ,并用 或 进行连接。

主要信息:由于初级保健中对 DCM 的了解有限,加上该病的变异性很大,因此 DCM 的诊断经常被遗漏或延迟。DCM 的自然病程呈进行性下降,症状从肌无力到完全瘫痪不等。所有出现症状和体征的患者都应转至脊柱外科医生处考虑手术治疗;那些轻度 DCM 的患者可能会接受保守治疗,但仍应接受手术评估和意见。有磁共振成像显示脊髓受压但无症状的患者可能需要进行评估;然而,不建议手术。密切监测无症状患者或轻度 DCM 患者的神经功能恶化至关重要。

结论:退行性颈椎脊髓病是成年人脊髓功能障碍的最常见原因。本综述有助于简化其在初级保健中的诊断,提高早期诊断的机会,并防止患者的神经功能进一步下降。

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[9]
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[10]
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本文引用的文献

[1]
Degenerative cervical myelopathy.

BMJ. 2018-2-22

[2]
Imaging Evaluation of Degenerative Cervical Myelopathy: Current State of the Art and Future Directions.

Neurosurg Clin N Am. 2018-1

[3]
The Natural History of Degenerative Cervical Myelopathy.

Neurosurg Clin N Am. 2018-1

[4]
Neurologic Complications in Managing Degenerative Cervical Myelopathy: Pathogenesis, Prevention, and Management.

Neurosurg Clin N Am. 2018-1

[5]
Significant Predictors of Outcome Following Surgery for the Treatment of Degenerative Cervical Myelopathy: A Systematic Review of the Literature.

Neurosurg Clin N Am. 2018-1

[6]
A Clinical Practice Guideline for the Management of Patients With Degenerative Cervical Myelopathy: Recommendations for Patients With Mild, Moderate, and Severe Disease and Nonmyelopathic Patients With Evidence of Cord Compression.

Global Spine J. 2017-9

[7]
Change in Function, Pain, and Quality of Life Following Structured Nonoperative Treatment in Patients With Degenerative Cervical Myelopathy: A Systematic Review.

Global Spine J. 2017-9

[8]
A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury and Central Cord Syndrome: Recommendations on the Timing (≤24 Hours Versus >24 Hours) of Decompressive Surgery.

Global Spine J. 2017-9

[9]
A Look at Traumatic Spinal Cord Injury in Canada: Rick Hansen Spinal Cord Registry (RHSCIR).

J Spinal Cord Med. 2017-11

[10]
Current Diagnosis and Management of Cervical Spondylotic Myelopathy.

Global Spine J. 2017-9

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