Muhle C, Bischoff L, Weinert D, Lindner V, Falliner A, Maier C, Ahn J M, Heller M, Resnick D
Department of Diagnostic Radiology, Christian-Albrechts-University Kiel, Germany.
Invest Radiol. 1998 May;33(5):279-88. doi: 10.1097/00004424-199805000-00005.
The authors evaluate the functional changes in patients with cervical radiculopathy and increasing symptoms after provocative maneuvers at flexion, extension, axial rotation, and coupled motions of the cervical spine.
Twenty-one patients with cervical disc herniation (n = 17) or cervical spondylosis (n = 4) in whom symptoms were elicited at flexion, extension, axial rotation, and coupled motions of the cervical spine were studied. The patients were examined inside a positioning device by using a circular surface coil for signal reception. At neutral position (0 degrees) and at provocative positions sagittal T2-weighted turbo spin-echo, axial T2-weighted two-dimensional flash sequence, sagittal three-dimensional (3D) fast imaging with steady state precision sequence and coronal 3D double-echo-in-the-steady-state sequences were obtained. The 3D sequences were reformatted in the axial and oblique coronal planes perpendicular to the exiting nerve roots. The images were evaluated for the size of disc herniations, the foraminal size and cervical cord rotation or displacement at provocative position compared with neutral position (0 degrees).
Compared with neutral position (0 degrees), change in size of disc herniation was not found in any (0%) of the provocative positions. In five (24%) patients cervical cord rotation or displacement was noted at axial rotation. The foraminal size increased at flexion, axial rotation to the opposite side of pain and flexion combined with axial rotation to the opposite side of the pain. The foraminal size decreased at extension combined with axial rotation to the side of the pain. A decrease or no change in foraminal size was observed at either extension or axial rotation to the side of the pain.
In patients with cervical disc herniation or cervical spondylosis, exacerbated pain at defined provocative maneuvers is related more to changes in the foraminal size and to nerve root motion with, in some cases, cervical cord rotation or displacement than to changes in the size of herniated discs.
作者评估了神经根型颈椎病患者在颈椎前屈、后伸、轴向旋转及耦合运动等激发性动作后症状加重时的功能变化。
对21例颈椎间盘突出症患者（n = 17）或颈椎病患者（n = 4）进行研究，这些患者在颈椎前屈、后伸、轴向旋转及耦合运动时会引发症状。患者在定位装置内接受检查，使用环形表面线圈接收信号。在中立位（0度）及激发位获取矢状面T2加权快速自旋回波序列、轴位T2加权二维快速成像序列、矢状面三维稳态进动快速成像序列及冠状面三维双回波稳态序列。将三维序列在垂直于穿出神经根的轴位和斜冠状面进行重排。评估图像以观察激发位与中立位（0度）相比时椎间盘突出的大小、椎间孔大小以及颈髓旋转或移位情况。
与中立位（0度）相比，在任何激发位均未发现椎间盘突出大小有变化（0%）。在5例（24%）患者中，轴向旋转时出现颈髓旋转或移位。椎间孔大小在前屈、轴向旋转至疼痛对侧以及前屈联合轴向旋转至疼痛对侧时增大。后伸联合轴向旋转至疼痛侧时椎间孔大小减小。在轴向旋转至疼痛侧或后伸时，椎间孔大小减小或无变化。
对于颈椎间盘突出症或颈椎病患者，特定激发性动作时疼痛加剧更多与椎间孔大小变化及神经根运动有关，在某些情况下还与颈髓旋转或移位有关，而非与椎间盘突出大小变化有关。
