Pacciani E, Salsano M L, Donnetti L, Urso S
Servizio di Radiologia, Ospedale Bambino Gesù, Presidio di Palidoro, Roma.
Radiol Med. 1996 May;91(5):570-6.
Patients with spontaneous neck pain, headache, dizziness and/or pain to the upper limbs are frequently observed. Common cervicodynia, due to the involvement of arthromuscular structures of the cervical spine, was diagnosed in the patients with these symptoms in the absence of trauma or neurologic signs. The authors investigated the clinical-radiologic correlation in a series of 130 symptomatic patients and considered it a metameric disorder. The frequent association of many radiographic signs at the same level often prevents single radiographic signs from being assessed individually; therefore, the authors selected some patients with just one radiographic change per functional unit, to assess its relationship with clinical symptoms. The patients underwent anteroposterior, lateral and functional (flexion-extension) radiographs of the cervical spine. Vertebral rotation, detected on antero-posterior views as a spinous process deviation, was the most frequent isolated sign (79/130 cases) per metameric level, with strong clinical correlation (70/79 cases). Vertebral rotation was probably due to unilateral muscular stiffness. Other single radiologic signs per functional unit with strong clinical correlation follow: atloaxial rotation (13/130 with clinical-radiologic agreement of 12/13), functional blockage (13/130 with clinical-radiologic agreement of 11/13), angular flexion (21/130 with clinical-radiologic agreement of 19/21) and overall disc space thinning (12/130 with clinical-radiologic agreement of 10/12). Atloaxial rotation is represented as an asymmetry of the spaces between the odontoid and the lateral masses of the atlas; functional blockage consists of insufficient or lacking physiological width of the occipito-atlantoid or interspinous space in functional tests. Angular flexion consists of a single flexion angle of the cervical spine in functional tests; two or more angles indicate normal flexion of the cervical spine. This study confirmed the poorer clinical impact of degenerative changes, mostly interapophyseal arthrosis, than of other radiologic signs. Interapophyseal arthrosis alone was isolated in single functional units in 46/130 patients, mostly at C7-D1, with clinical-radiologic agreement in 19/46 patients. Clinical-radiologic correlation proved the high diagnostic value of anteroposterior, lateral and functional radiographs of the cervical spine in common cervicodynia, which make them a valuable tool for the clinician.
经常观察到有自发性颈部疼痛、头痛、头晕和/或上肢疼痛的患者。在无创伤或神经体征的情况下，对出现这些症状的患者诊断为常见的颈痛，其病因是颈椎关节肌肉结构受累。作者对130例有症状的患者进行了临床与放射学相关性研究，并认为这是一种节段性疾病。同一水平上许多放射学征象的频繁关联常常妨碍对单个放射学征象进行单独评估；因此，作者选择了每个功能单元仅有一处放射学改变的一些患者，以评估其与临床症状的关系。患者接受了颈椎的前后位、侧位和功能位（屈伸位）X线片检查。在前后位片上检测到的椎体旋转表现为棘突偏移，是每个节段水平最常见的孤立征象（79/130例），与临床有很强的相关性（70/79例）。椎体旋转可能是由于单侧肌肉僵硬所致。每个功能单元其他与临床有很强相关性的单一放射学征象如下：寰枢椎旋转（13/130例，临床与放射学一致的有12/13例）、功能障碍（13/130例，临床与放射学一致的有11/13例）、角状屈曲（21/130例，临床与放射学一致的有19/21例）以及椎间盘间隙整体变窄（12/130例，临床与放射学一致的有10/12例）。寰枢椎旋转表现为齿突与寰椎侧块之间间隙的不对称；功能障碍表现为在功能试验中枕寰间隙或棘突间间隙的生理宽度不足或缺失。角状屈曲表现为功能试验中颈椎的单一屈曲角度；两个或更多角度表明颈椎屈曲正常。本研究证实，与其他放射学征象相比，退变改变（主要是椎间关节病）对临床的影响较小。在130例患者中，有46例在单个功能单元中仅发现椎间关节病，主要在C7 - D1水平，19/46例患者临床与放射学一致。临床与放射学相关性证明了颈椎前后位、侧位和功能位X线片在常见颈痛诊断中的高价值，这使其成为临床医生的一项有价值的工具。
