Zakaria Mohamad Zamzuri, Sharifudin Mohd Ariff, Din Hishamudin, Abd Aziz Azian, Karupiah Rajandra Kumar
Orthopaedics, Traumatology & Rehabilitation, International Islamic University Malaysia, Kuantan, MYS.
Orthopaedics and Traumatology, Universiti Sultan Zainal Abidin, Kuala Terengganu, MYS.
Cureus. 2021 Oct 16;13(10):e18826. doi: 10.7759/cureus.18826. eCollection 2021 Oct.
Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction. Magnetic resonance imaging (MRI) remains the imaging modality of choice, but its findings are not completely specific for clinically significant CSM. This cross-sectional study aims to determine the pathoanatomy of CSM in patients and analyze the correlations between clinical key symptoms, myelopathic signs, and MRI findings.
Patients with CSM aged 30 to 80 years old with no previous cervical spine disease or injuries were recruited. Clinical parameters include myelopathic hand signs and other clinical-specific tests. The MRI findings were analyzed for level of compression, underlying degenerative pathology, and parameters for cord compression.
Thirty patients were recruited. The most common myelopathic signs observed were positive Hoffmann's sign and the presence of reverse brachioradialis reflex. All patients had either degenerative or prolapse disc changes on MRI. There was a positive correlation between the clinical key features with MRI parameters for canal and cord diameter. The transverse cord diameter, cord compression ratio, and approximate cord area were the only independent variables related to almost all the positive clinical specific tests. All three have a moderate to strong correlation with the clinical findings.
The MRI parameters such as canal and cord size of the cervical spine are an objective reflection of compression on the spinal cord. Correlations observed indicate cord compression that plays a major role in the pathophysiology of CSM. These measurements are sensitive indicators of canal stenosis and play a significant role in predicting the severity and outcome of CSM.
脊髓型颈椎病（CSM）是脊髓功能障碍最常见的原因。磁共振成像（MRI）仍然是首选的成像方式，但其结果对于具有临床意义的CSM并不完全具有特异性。这项横断面研究旨在确定CSM患者的病理解剖结构，并分析临床关键症状、脊髓病体征和MRI结果之间的相关性。
招募年龄在30至80岁之间、既往无颈椎病或颈椎损伤的CSM患者。临床参数包括脊髓病手部体征和其他临床特异性检查。对MRI结果进行分析，包括压迫水平、潜在的退行性病变以及脊髓压迫参数。
共招募了30名患者。观察到的最常见脊髓病体征是霍夫曼征阳性和肱桡肌反射倒转。所有患者在MRI上均有退行性或椎间盘突出改变。临床关键特征与椎管和脊髓直径的MRI参数之间存在正相关。脊髓横径、脊髓压迫率和近似脊髓面积是几乎所有阳性临床特异性检查的唯一独立变量。这三者与临床结果均有中度至高度相关性。
颈椎的椎管和脊髓大小等MRI参数是脊髓受压的客观反映。观察到的相关性表明脊髓压迫在CSM的病理生理学中起主要作用。这些测量是椎管狭窄的敏感指标，在预测CSM的严重程度和预后方面发挥着重要作用。
