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[颈椎管狭窄症——症状性椎管狭窄和神经根管狭窄的诊断与治疗]

[Cervical stenosis-Diagnostics and treatment of symptomatic spinal canal stenosis and neuroforaminal stenosis].

作者信息

Begrich Daniel, Jäger Marcus

机构信息

Wirbelsäulenzentrum, St. Marien Hospital Mülheim a.d.R., Kaiserstr. 50, 45468, Mülheim, Deutschland.

Lehrstuhl für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Deutschland.

出版信息

Orthopadie (Heidelb). 2024 Aug;53(8):617-628. doi: 10.1007/s00132-024-04526-2. Epub 2024 Jul 8.

DOI:10.1007/s00132-024-04526-2
PMID:38976023
Abstract

Cervical stenosis is a clinical picture that is regularly encountered by both hospital physicians and orthopedic surgeons in the daily clinical practice. While advanced cervical spinal canal stenosis may lead to myelopathic symptoms in cases of sufficient manifestation and spinal cord injury, neuroforaminal stenosis leads to radicular symptoms due to compression of the nerve roots. The clinical examination can provide initial clues as to the suspected cause of the patient's symptoms; however, reliable diagnostics are based only on sectional imaging of the cervical spine. Depending on the extent of the symptoms, the treatment options vary between nonsurgical treatment for moderate symptoms without neurological deficits and surgical decompression of the spinal cord or nerve roots. The surgical treatment can be performed from anterior or posterior depending on the findings. Surgery can lead to an improvement of the neurological symptoms; however, the primary aim of surgical treatment is to avoid deterioration of the neurological deficits.

摘要

颈椎管狭窄是医院医生和骨科医生在日常临床实践中经常遇到的一种临床表现。虽然严重的颈椎管狭窄在表现充分且脊髓损伤的情况下可能导致脊髓病症状,但神经孔狭窄由于神经根受压会导致神经根症状。临床检查可以为患者症状的疑似病因提供初步线索;然而,可靠的诊断仅基于颈椎的断层成像。根据症状的严重程度,治疗选择在无神经功能缺损的中度症状的非手术治疗与脊髓或神经根的手术减压之间有所不同。根据检查结果,手术治疗可从前路或后路进行。手术可改善神经症状;然而,手术治疗的主要目的是避免神经功能缺损的恶化。

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本文引用的文献

1
Clinical and Research MRI Techniques for Assessing Spinal Cord Integrity in Degenerative Cervical Myelopathy-A Scoping Review.评估退行性颈椎脊髓病中脊髓完整性的临床与研究性磁共振成像技术——一项范围综述
Biomedicines. 2022 Oct 18;10(10):2621. doi: 10.3390/biomedicines10102621.
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7 Tesla and Beyond: Advanced Methods and Clinical Applications in Magnetic Resonance Imaging.7 特斯拉及更高场强:磁共振成像的高级方法和临床应用
Invest Radiol. 2021 Nov 1;56(11):705-725. doi: 10.1097/RLI.0000000000000820.
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The Effectiveness of Fluoroscopically Guided Cervical Transforaminal Epidural Steroid Injection for the Treatment of Radicular Pain; a Systematic Review and Meta-analysis.
荧光引导下颈椎椎间孔硬膜外类固醇注射治疗根性疼痛的疗效:系统评价和荟萃分析。
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Global Spine J. 2017 Sep;7(3 Suppl):8S-20S. doi: 10.1177/2192568217701715. Epub 2017 Sep 5.
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A Clinical Practice Guideline for the Management of Patients With Degenerative Cervical Myelopathy: Recommendations for Patients With Mild, Moderate, and Severe Disease and Nonmyelopathic Patients With Evidence of Cord Compression.退行性颈椎脊髓病患者管理临床实践指南:针对轻度、中度和重度疾病患者以及有脊髓受压证据的非脊髓病患者的建议
Global Spine J. 2017 Sep;7(3 Suppl):70S-83S. doi: 10.1177/2192568217701914. Epub 2017 Sep 5.
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Tandem Spinal Stenosis: A Systematic Review.串联性脊柱狭窄:一项系统评价
JBJS Rev. 2017 Sep;5(9):e2. doi: 10.2106/JBJS.RVW.17.00007.
8
Comparison of inter- and intra-observer reliability among the three classification systems for cervical spinal canal stenosis.三种颈椎管狭窄分类系统的观察者间和观察者内可靠性比较。
Eur Spine J. 2017 Sep;26(9):2290-2296. doi: 10.1007/s00586-017-5187-3. Epub 2017 Jun 13.
9
[Clinical and Radiological Results after Anterior Cervical Corpectomy with Cage Fusion - a Retrospective Comparison of PEEK vs. Titanium Cages].前路颈椎椎体次全切除并椎间融合器融合术后的临床及影像学结果——聚醚醚酮与钛椎间融合器的回顾性比较
Z Orthop Unfall. 2017 Apr;155(2):201-208. doi: 10.1055/s-0042-118717. Epub 2017 Jan 10.
10
The Significance of the Trömner Sign in Cervical Spondylotic Myelopathy Patient.特伦纳征在脊髓型颈椎病患者中的意义
Clin Spine Surg. 2017 Nov;30(9):E1315-E1320. doi: 10.1097/BSD.0000000000000412.