Penning L, Wilmink J T, van Woerden H H, Knol E
AJR Am J Roentgenol. 1986 Apr;146(4):793-801. doi: 10.2214/ajr.146.4.793.
CT myelographic data in 80 patients with clinical evidence of nerve-root involvement or long tract signs attributed to degenerative disorders of the cervical spine were classed into five diagnostic groups, and their clinical significance was assessed. Unilateral flattening of the cord by a spondylotic mass or bulging disk in a normally wide canal (group 1) was considered nonspecific because nerve-root signs were nearly as often contralateral as unilateral to the radiologic findings, and none of the patients had long tract signs. As a rule, conventional myelography showed only minor root-sleeve deformity. Concentric compression of the cord in a narrow (stenotic) canal (group 2) proved to produce long tract signs only after the cross-sectional area of the cord had been reduced by about 30% to a value of about 60 mm2 or less. In most cases, nerve-root swelling (group 3) coincided with the side of nerve-root symptoms. A 100% correlation was found between the side of disk herniation with occlusion of the corresponding foramen (group 4) and the side of nerve-root symptoms. In 24 patients, cord and nerve roots showed no abnormalities (group 5). If stenosis of the spinal canal, nerve root swelling, and disk herniation are considered specific CT myelographic signs in nerve-root symptomatology, a specific diagnosis could be made in about 40% of the cases.
对80例有神经根受累临床证据或有因颈椎退行性疾病所致长束征的患者的CT脊髓造影数据进行分类，分为五个诊断组，并评估其临床意义。在正常宽大椎管内，椎体骨质增生块或椎间盘膨出导致脊髓单侧扁平（第1组）被认为是非特异性的，因为神经根体征在放射学表现的对侧与同侧出现的频率几乎相同，且所有患者均无长束征。通常，传统脊髓造影仅显示轻微的神经根袖畸形。在狭窄（狭窄性）椎管内脊髓的同心性受压（第2组），只有在脊髓横截面积缩小约30%至约60平方毫米或更小后才会产生长束征。在大多数情况下，神经根肿胀（第3组）与神经根症状的一侧相符。在椎间盘突出伴相应椎间孔闭塞（第4组）与神经根症状的一侧之间发现了100%的相关性。在24例患者中，脊髓和神经根未显示异常（第5组）。如果椎管狭窄、神经根肿胀和椎间盘突出被视为神经根症状学中的特异性CT脊髓造影征象，则约40%的病例可作出特异性诊断。
