Matsumoto M, Fujimura Y, Toyama Y
Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan.
J Spinal Disord. 1996 Aug;9(4):317-21.
We retrospectively analyzed neurological signs of 106 patients with cervical myelopathy caused by single-level soft disc herniation. Neurological signs that were intensively analyzed were deep tendon reflexes, the uppermost level of impaired pinprick sensation, the uppermost weak muscle, and region of numbness in the hands. Characteristic signs for each intervertebral level were deduced, and sensitivity, specificity, and accuracy of these signs were calculated. Deep tendon reflexes were specific signs for each intervertebral level, although not as sensitive as the neurological signs. Muscle weakness and pinprick sensation were neither sensitive nor specific. Hand numbness was moderately sensitive and specific. On the whole, there was no neurological sign that was both highly sensitive and specific for an intervertebral level, and therefore, neurological level diagnosis in cervical myelopathy should be performed comprehensively according to more specific signs, i.e., deep tendon reflexes and hand numbness.
我们回顾性分析了106例因单节段软性椎间盘突出导致的脊髓型颈椎病患者的神经学体征。重点分析的神经学体征包括深腱反射、针刺觉受损的最高节段、最上方的肌无力以及手部麻木区域。推导了每个椎间节段的特征性体征，并计算了这些体征的敏感性、特异性和准确性。深腱反射是每个椎间节段的特异性体征，尽管不如神经学体征敏感。肌无力和针刺觉既不敏感也不具有特异性。手部麻木具有中等程度的敏感性和特异性。总体而言，没有一种神经学体征对椎间节段既具有高度敏感性又具有高度特异性，因此，脊髓型颈椎病的神经节段诊断应根据更具特异性的体征，即深腱反射和手部麻木进行综合判断。
