Watson J C, Broaddus W C, Smith M M, Kubal W S
Department of Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, USA.
J Neurosurg. 1997 Jan;86(1):159-61. doi: 10.3171/jns.1997.86.1.0159.
Myelopathy from cervical spondylosis is often accompanied by hyperreflexia of the upper-extremity deep tendon reflexes (DTRs). Reflexes such as the pectoralis jerk and the deltoid jerk may only be apparent in the context of hyperreflexia. Although the nerve roots involved in the reflex arcs are well described, levels of cervical spinal cord compression that lead to the hyperreflexia are not as clear. This is of particular significance for patients with multilevel cervical spondylosis in determining the levels responsible for their symptoms. The authors examined 15 consecutive patients who presented for treatment of cervical myelopathy. The clinical examination was then correlated with levels of cervical spinal cord compression by cervical magnetic resonance imaging or computerized tomography with intrathecal contrast enhancement. The presence of a prominent pectoralis jerk was seen only in patients with spinal cord compression at the C2-3 and/or C3-4 levels (nine patients). No patient with compression at or below the C4-5 disc space without coexisting compression at a higher level had hyperactive pectoralis reflexes. This association between the C3-4 level and a hyperactive pectoralis reflex was significant (p < 0.004, Fisher's exact test). The deltoid reflex was tested in the last nine consecutive patients. It was present in patients with compression of the upper spinal cord at levels C3-4 and C4-5 (four of five patients) but appeared in only one of four patients with compression below C4-5. This association did not attain statistical significance. The presence of a hyperactive pectoralis reflex is specific for lesions of the upper cervical spinal cord. Examination of upper-extremity DTRs may be helpful in planning the appropriate levels for surgical decompression in patients with multilevel spondylosis and myelopathy.
颈椎病所致脊髓病常伴有上肢深腱反射（DTR）亢进。胸肌反射和三角肌反射等反射可能仅在反射亢进的情况下才明显。尽管反射弧中涉及的神经根已有详细描述，但导致反射亢进的颈脊髓受压水平尚不清楚。这对于患有多节段颈椎病的患者确定其症状的责任节段尤为重要。作者检查了15例连续就诊治疗颈脊髓病的患者。然后将临床检查结果与通过颈椎磁共振成像或鞘内造影增强的计算机断层扫描所确定的颈脊髓受压水平进行关联。仅在C2 - 3和/或C3 - 4水平脊髓受压的患者中观察到明显的胸肌反射（9例患者）。在C4 - 5椎间盘间隙或其以下水平受压且无更高节段并存受压的患者中，没有胸肌反射亢进的情况。C3 - 4水平与胸肌反射亢进之间的这种关联具有显著性（p < 0.004，Fisher精确检验）。对最后9例连续患者进行了三角肌反射测试。在C3 - 4和C4 - 5水平上颈脊髓受压的患者中出现了三角肌反射（5例患者中的4例），但在C4 - 5以下水平受压的4例患者中仅出现了1例。这种关联未达到统计学显著性。胸肌反射亢进对颈上段脊髓病变具有特异性。检查上肢DTRs可能有助于为患有多节段颈椎病和脊髓病的患者规划合适的手术减压节段。
