颈段动态MRI在脊髓型颈椎病早期诊断中的应用价值:8例报告

Dynamic cervical MRI in the early diagnosis of cervical spondylotic myelopathy: A report of 8 cases

对有脊髓型颈椎病症状体征常规MRI无明显脊髓受压征象而动态MRI中整个序列脊髓受压呈现波浪样压迹或念珠样改变的8例患者进行颈椎后路单开门椎管成型手术治疗。8例患者仅1例因为病程较长(大于2年)、脊髓损伤症状比较严重(术前JOA评分5分),术后半年JOA评分改善率为25%外,其余患者术后症状都有不同程度的恢复,术后半年JOA评分改善率都在50%以上。术后1个月检查颈椎前凸角较术前减少4.5°～8.6°,3个月后患者去掉颈围制动,颈椎的前凸角逐渐向正常恢复,术后半年检查颈椎前凸角与术前基本相同。结果提示以颈段动态MRI结合临床表现早期诊断脊髓型颈椎病并以颈段动态MRI为依据对脊髓型颈椎病患者早期行颈椎后路手术,效果良好;颈椎生理曲度随访半年,结果与手术前无明显改变。

Eight patients with clinical manifestation of cervical spondylotic myelopathy were selected. Their conventional MRI of cervical spondylotic myelopathy was normal but their dynamic cervical MRI displayed that the spinal cord was compressed wtih bead or wave appearance. The patients underwent cervical posterior open-door laminoplasty. The improvement rate of JOA score was 25% in one case with long course of disease （more than 2 years） and severe spinal cord injury （5 marks in JOA before surgery） 6 months after surgery. All the other patients recovered at various extents, and their improvement rate in JOA was above 50%. One month after surgery, the cervical lordosis of C-spine decreased 4.5°-8.6°; 3 months later, the patients were independent to neck immobilization, and the cervical lordosis of C-spine restored 6 months after surgery, which was nearly the same to pre-operation, The results of the study indicate the clinic effect of cervical spondylotic myelopathy early diagnosed and treated by dynamic cervical MRI in combination with clinical manifestation is very good. C-spine physiologic curvature does not markedly alter in the half-year follow up postoperatively.