Takeshima Yasuhiro, Okamoto Ai, Yokoyama Shohei, Nakagawa Ichiro, Nakase Hiroyuki
Neurosurgery, Nara Medical University, Kashihara, JPN.
Cureus. 2021 Apr 1;13(4):e14238. doi: 10.7759/cureus.14238.
Cervical spondylotic myelopathy (CSM) is a common age-related disease, but little is known concerning the impact of cervical facet degeneration in patients suffering from CSM without degenerative cervical spondylolisthesis or cervical instability. We report an instructive case of CSM with rapid neurological deterioration in which unilateral degenerative facet joint pathology at the affected spinal level and impressive radiological findings were observed. A 70-year-old female progressively developed C5 segmental myelopathy without any trauma within a two-week period. Radiological findings revealed C3-4 spinal canal stenosis with the emergence of increased intramedullary signal intensity on T2-weighted magnetic resonance imaging, articular surface damage at the left C3-4 facet joint on computed tomography, and unilateral "facet joint gap" on cervical radiogram, but did not meet the criteria of cervical instability or spondylolisthesis. This case suggests that some types of severe degenerative changes in cervical facet joints may contribute to cervical myelopathy, especially in cases with progressive neurological deterioration.
脊髓型颈椎病（CSM）是一种常见的与年龄相关的疾病，但对于在没有退行性颈椎滑脱或颈椎不稳的脊髓型颈椎病患者中，颈椎小关节退变的影响却知之甚少。我们报告了一例具有快速神经功能恶化的脊髓型颈椎病的典型病例，在该病例中观察到了患侧脊髓节段的单侧小关节退变病变以及显著的影像学表现。一名70岁女性在两周内逐渐出现C5节段脊髓病，无任何外伤史。影像学检查发现，T2加权磁共振成像显示C3 - 4椎管狭窄，脊髓内信号强度增加，计算机断层扫描显示左侧C3 - 4小关节关节面损伤，颈椎X线片显示单侧“小关节间隙”，但不符合颈椎不稳或椎体滑脱的标准。该病例表明，颈椎小关节的某些严重退变类型可能导致颈椎脊髓病，尤其是在伴有进行性神经功能恶化的病例中。
