Wharton S B, Chan K K, Pickard J D, Anderson J R
Department of Histopathology, Addenbrookes Hospital, Cambridge, UK.
J Neurol Neurosurg Psychiatry. 1996 Nov;61(5):461-5. doi: 10.1136/jnnp.61.5.461.
Cervical spine disorders are common in the older population. The paravertebral muscles are essential to the support and stabilisation of the cervical spine but have been little studied. The aim was to determine whether pathological changes develop in these muscles in patients with severe cervical spine disease, which, if present, might contribute to the pathogenesis and symptomatology of their disorder.
Open biopsies of superficial and deep paravertebral muscles were obtained during the course of surgical procedures to alleviate cervical myelopathy. Most of these patients had cervical spondylosis or rheumatoid arthritis involving the cervical spine. The biopsies were compared with muscle obtained at necropsy from patients without a history of cervical spine or neuromuscular disorder.
Muscle from both the study and control groups showed a similar range and severity of abnormalities. In several patients, grouped fibre atrophy suggested chronic partial denervation. Most biopsies showed type 1 fibre predominance and selective type 2 fibre atrophy. Ragged red fibres were a frequent finding and electron microscopy disclosed accumulations of mitochondria, a small proportion of which contained rounded, or longitudinally oriented, single osmiophilic inclusions. Fibres containing core-like areas were also frequent. These pathological features were seen with increasing severity and frequency with increasing age.
The paravertebral cervical muscles develop pathological abnormalities with increasing age with both neurogenic and myopathic features, the pathogenesis of which is probably multifactorial. Such a muscle disorder would be expected to be accompanied by functional impairment which may contribute to the development and symptomatology of cervical spine disease with increasing age.
颈椎疾病在老年人群中很常见。椎旁肌对颈椎的支撑和稳定至关重要，但此前研究较少。本研究旨在确定严重颈椎疾病患者的这些肌肉是否会发生病理变化，若存在病理变化，则可能与该疾病的发病机制和症状学有关。
在缓解颈椎病的外科手术过程中，获取浅、深椎旁肌的开放性活检样本。这些患者大多患有颈椎病或累及颈椎的类风湿性关节炎。将活检样本与无颈椎或神经肌肉疾病病史患者尸检时获取的肌肉进行比较。
研究组和对照组的肌肉均显示出相似范围和严重程度的异常。在部分患者中，成组纤维萎缩提示慢性部分失神经支配。大多数活检样本显示Ⅰ型纤维占优势以及选择性Ⅱ型纤维萎缩。破碎红纤维很常见，电子显微镜检查发现线粒体聚集，其中一小部分含有圆形或纵向排列的单个嗜锇包涵体。含有核心样区域的纤维也很常见。随着年龄增长，这些病理特征的严重程度和出现频率增加。
随着年龄增长，颈椎椎旁肌出现具有神经源性和肌病性特征的病理异常，其发病机制可能是多因素的。预计这种肌肉疾病会伴有功能损害，这可能随年龄增长导致颈椎疾病的发生和症状加重。
