颈椎病椎管狭窄及脊髓受压不同体位MRI动态观察

MRI dynamic observation of spinal stenosis and compression in patients with cervical spondylosis in neutral, flexion and extension positions

目的 评价颈椎病病人椎管狭窄程度、脊髓功能性受压在中立位、屈伸位MRI检查中的动态变化规律及临床意义。方法 44例颈椎病病人均行中立、前屈、后伸位MRI检查，观察颈椎椎管的狭窄程度、脊髓功能性受压的变化并进行对比分析。结果 与中立位比较，后伸位出现颈椎椎管狭窄加重30例，无明显变化12例，狭窄减轻2例；前屈位狭窄加重10例，无变化20例，减轻14例；后伸位较前屈位更容易导致或加重椎管狭窄（P〈0．001）。随着先天性椎管管径的减小（以中立位颈7椎体中部水平椎管中矢径为准），后伸位出现脊髓功能性受压的比例增高。结论 颈椎动态MRI扫描可以揭示颈椎椎管的潜在致压因素，后伸位对常规检查的的补充价值较大。

Objective To study the dynamic changes of spinal stenosis and compression in neutral, flexion and extension positions in patients with cervical spondylosis with MRI. Methods Forty-four patients with cervical spondylosis were examined with MRI in neutral, flexion and extension positions of neck. The dynamic changes of spinal stenosis and functional compression were observed and analyzed in all MRI images. Results Compared with neutral position, at extension, spinal stenosis was aggravated in 30 patients, had no change in 12 patients and was alleviated in 2 patients; at flexion, spinal stenosis was aggravated in 10 patients, had no change in 20 patients and was alleviated in 14 patients; spinal stenosis was more severe at extension than at flexion （P〈0.001）. With the diminishing of congenital vertebral canal diameter （sagittal diameter at the middle level of C7 cervical vertebra）, the incidence of spinal compression increased in extension position. Conclusion MRI at flexion and extension can provide potential information for understanding the pathogenesis, progression of cervical spondylosis, especially the imaging at extension provides more value for routine MRI than at flexion.