Mochida K, Komori H, Okawa A, Muneta T, Haro H, Shinomiya K
Department of Orthopaedic Surgery, Tokyo Medical and Dental University School of Medicine, Japan.
Spine (Phila Pa 1976). 1998 May 1;23(9):990-5; discussion 996-7. doi: 10.1097/00007632-199805010-00005.
A retrospective study of cervical disc herniation using results of repeated magnetic resonance imaging examinations.
To clarify the cervical disc herniation morphological changes over time in order to establish a strategy for treatment.
In the authors' previous magnetic resonance imaging follow-up study of patients with lumbar disc herniation, spontaneous regression was observed in the sequestration-type lesions, and it was found that the tendency toward regression differed based on the anatomic position of extruded disc material.
Thirty-eight patients with cervical disc herniation who underwent repeated magnetic resonance imaging examinations were studied. The changes over time in herniated disc size were evaluated using this imaging technique. Evaluation showed the characteristics of those in whom spontaneous regression was found, such as extrusion pattern, and the clinical outcome was evaluated by symptoms.
In 15 patients (40%), the volume of herniated material was decreased. The interval from onset of symptoms to the initial examination was significantly shorter in the regression group than in the group that showed no change in disc herniation. By extrusion pattern, cervical disc herniation, which was divided into migration type on sagittal view and lateral type on axial view, most frequently exhibited spontaneous regression. All of the patients with radicular pain and upper limb amyotrophy were treated successfully with conservative therapy.
Although the possibility of the combination of hemorrhage and disc material could not be denied, active resorption of herniated material probably occurred during the acute phase. Extruded material exposed to the epidural space may be resorbed more quickly than that beneath the ligament. Vascular supply probably plays a role in the mechanism of resorption. The phase and position of extrusion were the significant factors affecting cervical disc herniation resorption. It was demonstrated that examination performed during the acute phase using magnetic resonance imaging is necessary for elucidation of the pathogenesis of cervical disc herniation, and that migrating, lateral-type herniations regress so frequently that conservative treatment should be chosen not only for patients with radicular pain, but also for those with upper limb amyotrophy.
一项利用重复磁共振成像检查结果对颈椎间盘突出症进行的回顾性研究。
明确颈椎间盘突出症随时间的形态学变化，以制定治疗策略。
在作者之前对腰椎间盘突出症患者进行的磁共振成像随访研究中，观察到游离型病变存在自发消退现象，且发现椎间盘突出物的消退趋势因突出物的解剖位置而异。
对38例接受重复磁共振成像检查的颈椎间盘突出症患者进行研究。利用该成像技术评估突出椎间盘大小随时间的变化。评估显示了发现自发消退的患者的特征，如突出类型，并通过症状评估临床结果。
15例患者（40%）突出物体积减小。消退组从症状出现到初次检查的间隔时间显著短于椎间盘突出无变化的组。按突出类型划分，颈椎间盘突出症在矢状面上分为移位型、轴位上分为外侧型，其中移位型最常出现自发消退。所有神经根性疼痛和上肢肌萎缩患者经保守治疗均获成功。
尽管不能排除出血与椎间盘物质合并存在的可能性，但急性期可能发生突出物的主动吸收。暴露于硬膜外间隙的突出物可能比韧带下方的突出物吸收更快。血管供应可能在吸收机制中起作用。突出的阶段和位置是影响颈椎间盘突出症吸收的重要因素。结果表明，急性期利用磁共振成像进行检查对于阐明颈椎间盘突出症的发病机制是必要的，并且移位型、外侧型突出症消退频繁，因此不仅对于神经根性疼痛患者，而且对于上肢肌萎缩患者都应选择保守治疗。
