神经根型颈椎病椎间孔狭窄特点及MSCT诊断价值分析

Characteristics of Intervertebral Foramen Stenosis in Cervical Spondylotic Radiculopathy and Its Diagnostic Value by MSCT

目的探讨神经根型颈椎病椎间孔狭窄特点及多层螺旋CT(MSCT)诊断价值。方法选取我院2015年1月-2018年8月收治38例神经根型颈椎病患者作为研究对象,收集所有患者临床、影像学资料,总结神经根型颈椎病图像表现特征,并分析其椎间孔狭窄特点。结果C5-C6节段椎间孔狭窄发生率最高,椎间孔狭窄发生率最低为C3-C4节段;1个节段发生椎间孔狭窄比例最高,且在30-50岁人群中,1个节段和2个节段发生椎间孔狭窄最为常见,而60岁以上人群3个节段发生椎间孔狭窄机率较高(P<0.05)。MSCT检查38例神经根性颈椎病患者诊断符合率和椎间孔狭窄检出率分别为94.74%和97.56%,与手术病理学检查比较无差异(P<0.05)。MSCT中神经根型颈椎病可表现为前缘和后缘骨质增生骨赘形成,且均呈不规则致密影,其中椎体后缘增生骨赘主要可呈现不同程度的正中椎管矢状径狭窄;颈椎椎间盘突出主要表现为椎体后方局限性软组织密度影;黄韧带肥厚其椎管后方椎板内缘可见明显高密度影。后纵韧带骨化椎体可合并椎管狭窄,以椎体后缘致密影为其主要表现。存在许氏结节形成椎体4个,横突孔变窄椎体2个以及含有空气征椎体1个。结论C5-C6节段椎间孔狭窄发生率最高,其次为C4-C5节段,椎间孔狭窄发生率最低为C3-C4节段。年龄越大患者其椎间孔狭窄机率和范围更大。MSCT对于神经根型颈椎病具有较高的诊断率和椎间孔狭窄检出率,更有利于指导临床治疗。

Objective To investigate the characteristics of intervertebral foramen stenosis in cervical spondylotic radiculopathy and the diagnostic value of multi-slice spiral CT(MSCT).Methods A total of 38 patients with cervical spondylotic radiculopathy treated in our hospital from January 2015 to August 2018 were enrolled into the study.The clinical and imaging data of all patients were collected,and the imaging features of cervical spondylotic radiculopathy were summarized,and the characteristics of stenosis of intervertebral foramen were analyzed.Results The incidence rate of stenosis of intervertebral foramen in C5~C6 segment was the highest,and the incidence rate of stenosis of intervertebral foramen in C3~C4 segment was the lowest.The ratio that stenosis of intervertebral foramen occurred in one segment was the highest.For people that was 30-50 year old,the phenomenon that stenosis of intervertebral foramen occurred in one segment and two segments was the most common,and for people over 60 years old,the incidence rate of stenosis of intervertebral foramen in 3 segments was higher(P<0.05).The diagnostic coincidence rate and the detection rate of stenosis of intervertebral foramen in 38 patients with cervical spondylotic radiculopathy were 94.74%and 97.56%,respectively,and there was no difference with the surgical pathological examination(P<0.05).Cervical spondylotic radiculopathy in MSCT can be characterized by the formation of the anterior and posterior osteophytes,and all of them exhibit irregular and dense shadows.The hyperplasia of the posterior vertebral body can mainly show stenosis of median sagittal diameter of spinal canal with different degrees.Cervical disc herniation mainly showed a limited density shadow of soft tissue behind the vertebral body.Ligamentum flavum was hypertrophic,in which clear high-density shadow was seen on the inner edge of the posterior vertebral plate of the spinal canal.The ossified vertebral body of posterior longitudinal ligament can be combined with spinal stenosis,and the dense shadow of the posterior margin of the vertebral body was the main manifestation.There were 4 vertebral bodies formed by the Xu’s nodules,2 vertebral bodies,of which transverse foramen narrowed,and 1 vertebral body with air sign.Conclusion The incidence rate of stenosis of intervertebral foramen was the highest in C5~C6 segment,followed by C4~C5 segment,and the incidence rate stenosis of intervertebral foramen was the lowest in C3~C4 segment.The older the patient is,the greater the probability and range of intervertebral foramen stenosis is.MSCT has high diagnostic rate and detection rate of foramen stenosis for cervical spondylotic radiculopathy,which is conducive to guiding clinical treatment.