颈椎病致脊髓前动脉综合征

Anterior spinal artery syndrome caused by cervical spondylotic myelopathy

目的报告一组因颈椎病引起的脊髓前动脉综合征，分析其临床表现，并探讨其机制和影像学表现特点和治疗。方法共25例，男16例，女9例；平均年龄53．2岁。在典型的脊髓型颈椎病基础上无外伤等明显诱因，短期内症状急剧加重19例，逐渐加重6例。除脊髓型颈椎病的体征外，均出现浅感觉丧失或减退，而深感觉存在的“感觉分离”现象。下肢痉挛性瘫痪。其中12例伴有不同程度的肛门、膀胱功能失控。X线片和CT显示颈椎不同程度的退变。其中伴有颈椎管狭窄10例、颈椎不稳12例、颈椎后纵韧带骨化6例。MR检查发现均为椎间盘中央型突出，脊髓前中央受压迫。脊髓多有不同程度地萎缩。大部分病例在脊髓前2／3T1WI信号稍低或无明显变化，T2WI高信号或稍高信号，但有6例T1WI和T2WI信号均无改变。在缓慢起病的患者中，有3例脊髓前2／3囊性变。前路减压24例，后路减压1例，采用JOA评分评估疗效。结果平均随访16个月，术后疗效优（脊髓功能恢复率≥75％）11例，良（50％-74％）7例，一般（25％-49％）6例，差（≤24％）1例。结论在无明显诱因下颈椎病椎间盘中央型突出可引起脊髓前动脉综合征。“感觉分离”是诊断此疾病的基础，同时结合病史、临床症状和其他体征以及影像学检查给予确诊。及时减压可取得较佳的疗效。

Objective To investigate the image feature and treatment for anterior spinal artery syndrome caused by cervical spondylotic myelopathy and find the underlying mechanism. Methods Twenty five patients with anterior spinal artery syndrome that due to cervical spondylotic myelopathy were collected, including 16 males, 9 females, with the average age of 53.2 years. The syndrome in 19 patients exacerbated acutely and presented progressively in the other 6. All found physical sign such as motor palsy and dissociated sensory loss below the level of the lesion, accompanied by bladder or intestinal dysfunction. Both X- film and CT image showed different degree degeneration of cervical spine, with 10 cases showed spinal canal stenosis, 12 cases cervical instability and 6 cases ossification of posterior longitudinal ligament. On MRI film, central intervertebral disc protrusion and anterior central spinal cord compression were found, with different degree spinal cord atrophy, most cases showed low intensity sign on T1WI film and high intensity sign on T2WI film at anterior 2/3 spinal cord, but 6 eases didn＇t find abnormal sign both on T1WI and T2WI film. In the 6 cases that presented progressive sign, 3 showed cystoid drgeneration at anterior 2/3 spinal cord. All patients were treated with decompression and fusion operation, 24 anterior approaches and 1 posterior approach. All patients were evaluated according to JOA standard. Results All patients were followed up 13 to 22 months （mean 16 months）. Most patients gained good curative effect after operation, excellent 11 cases （spinal cord function recovery ratio over 75%）, favorable 7 cases （spinal cord function recovery ratio between 50%-74%）, mild 6 cases （spinal cord function recovery ratio between 25%-49%）, bad 1 case （spinal cord function recovery ratio lower than 24%）. Conclusion The chronic compression of anterior central spinal cord by intervertebral disc protrusion is the important cause of anterior spinal artery syndrome. This disease can be diagnosed by patients＇ syndrome combinated with physical examination and image finding. For this disease timely decompression can gain excellent effect.