Funaba Masahiro, Imajo Yasuaki, Suzuki Hidenori, Nishida Norihiro, Nagao Yuji, Sakamoto Takuya, Fujimoto Kazuhiro, Sakai Takashi
J Neurosurg Spine. 2021 Jul 9;35(3):308-319. doi: 10.3171/2020.11.SPINE201626. Print 2021 Sep 1.
Neurological and imaging findings play significant roles in the diagnosis of degenerative cervical myelopathy (DCM). Consistency between neurological and imaging findings is important for diagnosing DCM. The reasons why neurological findings exhibit varying sensitivity for DCM and their associations with radiological findings are unclear. This study aimed to identify associations between radiological parameters and neurological findings in DCM and elucidate the utility of concordance between imaging and neurological findings for diagnosing DCM.
One hundred twenty-one patients with DCM were enrolled. The Japanese Orthopaedic Association (JOA) score, radiological parameters, MRI and kinematic CT myelography (CTM) parameters, and the affected spinal level (according to multimodal spinal cord evoked potential examinations) were assessed. Kinematic CTM was conducted with neutral positioning or at maximal extension or flexion of the cervical spine. The cross-sectional area (CSA) of the spinal cord, dynamic change in the CSA, C2-7 range of motion, and C2-7 angle were measured. The associations between radiological parameters and hyperreflexia, the Hoffmann reflex, the Babinski sign, and positional sense were analyzed via multiple logistic regression analysis.
In univariate analyses, the upper- and lower-limb JOA scores were found to be significantly associated with a positive Hoffmann reflex and a positive Babinski sign, respectively. In the multivariate analysis, a positive Hoffmann reflex was associated with a higher MRI grade (p = 0.026, OR 2.23) and a responsible level other than C6-7 (p = 0.0017, OR 0.061). A small CSA during flexion was found to be significantly associated with a positive Babinski sign (p = 0.021, OR 0.90). The presence of ossification of the posterior longitudinal ligament (p = 0.0045, OR 0.31) and a larger C2-7 angle during flexion (p = 0.01, OR 0.89) were significantly associated with abnormal great toe proprioception (GTP).
This study found that the Hoffmann reflex is associated with chronic and severe spinal cord compression but not the dynamic factors. The Babinski sign is associated with severe spinal cord compression during neck flexion. The GTP is associated with large cervical lordosis. These imaging features can help us understand the characteristics of the neurological findings.
神经学和影像学检查结果在退行性颈椎脊髓病（DCM）的诊断中起着重要作用。神经学和影像学检查结果之间的一致性对于DCM的诊断很重要。目前尚不清楚神经学检查结果对DCM表现出不同敏感性的原因及其与放射学检查结果的关联。本研究旨在确定DCM患者放射学参数与神经学检查结果之间的关联，并阐明影像学和神经学检查结果的一致性在诊断DCM中的作用。
纳入121例DCM患者。评估日本骨科协会（JOA）评分、放射学参数、MRI和动态CT脊髓造影（CTM）参数，以及受累脊髓节段（根据多模式脊髓诱发电位检查）。动态CTM在颈椎中立位或最大伸展或屈曲位进行。测量脊髓横截面积（CSA）、CSA的动态变化、C2-7活动范围和C2-7角度。通过多因素逻辑回归分析，分析放射学参数与反射亢进、霍夫曼征、巴宾斯基征和位置觉之间的关联。
在单因素分析中，上肢和下肢JOA评分分别与霍夫曼征阳性和巴宾斯基征阳性显著相关。在多因素分析中，霍夫曼征阳性与较高的MRI分级相关（p = 0.026，OR 2.23），且责任节段不是C6-7（p = 0.0017，OR 0.061）。屈曲时较小的CSA与巴宾斯基征阳性显著相关（p = 0.021，OR 0.90）。后纵韧带骨化的存在（p = 0.0045，OR 0.31）和屈曲时较大的C2-7角度（p = 0.01，OR 0.89）与大脚趾本体感觉异常（GTP）显著相关。
本研究发现，霍夫曼征与慢性和严重脊髓压迫相关，但与动态因素无关。巴宾斯基征与颈部屈曲时的严重脊髓压迫相关。GTP与颈椎前凸较大相关。这些影像学特征有助于我们了解神经学检查结果的特点。
