Regenbogen V S, Rogers L F, Atlas S W, Kim K S
AJR Am J Roentgenol. 1986 Feb;146(2):277-84. doi: 10.2214/ajr.146.2.277.
Eighty-eight patients over age 40 with traumatic cervical spinal cord injuries were clinically and radiographically evaluated, and comparison was made with 35 spinal cord injury patients under age 36. While most older patients sustained obvious bony and/or ligamentous damage commensurate with their neurologic findings, 25 (28%) of the 88 patients had no demonstrable bony abnormalities and 17 (20%) of the 88 patients had only minimal evidence of bony injury. Of particular interest are the patients with severe cord injuries, yet no bony abnormalities, who seem to form a distinct subgroup of the cervical spinal cord injury patient on the basis of radiographic and clinical features. Of these 25 patients, 24 (96%) had severe cervical spondylosis. Fourteen (56%) of the 25 patients were injured in falls, five (36%) of these 14 being of a seemingly trivial nature. Of the 42 patients with minimal or no demonstrable bony abnormalities, 33 (79%) were evaluated with plain tomography and no occult fractures or other significant pathology was demonstrated. Pantopaque myelography in 27 (64%) of the 42 cases revealed no extruded disk or other surgical lesion in any patient. In large measure, these injuries can be attributed to cervical spondylosis, which narrows the canal and makes the cord more susceptible to compression by the bulging ligamenta flava during hyperextension.
对88例40岁以上的创伤性颈脊髓损伤患者进行了临床和影像学评估，并与35例36岁以下的脊髓损伤患者进行了比较。虽然大多数老年患者有与神经学表现相符的明显骨质和/或韧带损伤，但88例患者中有25例（28%）没有明显的骨质异常，88例患者中有17例（20%）只有轻微的骨质损伤迹象。特别值得关注的是那些脊髓损伤严重但无骨质异常的患者，根据影像学和临床特征，他们似乎构成了颈脊髓损伤患者中的一个独特亚组。在这25例患者中，24例（96%）患有严重的颈椎病。25例患者中有14例（56%）因跌倒受伤，其中14例中有5例（36%）看似损伤轻微。在42例骨质异常轻微或无明显骨质异常的患者中，33例（79%）接受了普通断层扫描评估，未发现隐匿性骨折或其他重大病变。42例患者中有27例（64%）进行了碘苯酯脊髓造影，未发现任何患者有椎间盘突出或其他手术病变。在很大程度上，这些损伤可归因于颈椎病，颈椎病会使椎管变窄，使脊髓在过伸时更容易受到膨出的黄韧带的压迫。
