C5/6与C6/7单节段脊髓型颈椎病影像学对比研究

Radiological study of single-segment cervical spondylotic myelopathy in C5/6 and C6/7 segments

目的对比研究C5/6与C6/7单节段脊髓型颈椎病X线、CT以及MRI影像学特点,分析两者解剖参数、脊髓压迫的静动态因素及脊髓损害差异。方法收集2017年1月至2021年7月郑州大学第一附属医院两个病区接受颈椎前路椎间盘切除融合术的C5/6或C6/7单节段脊髓型颈椎病患者的影像学资料,共85例。其中C5/6节段脊髓型颈椎病57例(C5/6组),C6/7节段脊髓型颈椎病28例(C6/7组)。比较两组患者颈椎X线、CT和MRI测量的影像学指标,包括静态因素(椎间盘退变、黄韧带肥厚、骨赘增生和椎体滑移)、动态因素(颈椎活动度、颈椎节段活动度、椎体不稳和项韧带骨化)、脊髓受压情况(压迫位置、压迫性质、压迫程度和脊髓信号改变)和解剖参数(颈椎曲度、棘突长度和Pavlov比值)。结果两组患者性别、年龄、身高和体质量比较差异未见统计学意义(P>0.05)。在解剖参数方面,两组间颈椎曲度、棘突长度和Pavlov比值差异未见统计学意义(P>0.05)。在静态因素方面,C5/6组椎体滑移发生率高于C6/7组[(21.05%,12/57)比(3.57%,1/28),P<0.05],C5/6组黄韧带肥厚评分低于C6/7组(0.26分比0.89分,P<0.05),两组间骨赘增生和椎间盘退变差异未见统计学意义(P>0.05)。在动态因素方面,C5/6组颈椎活动度大于C6/7组[(47.28±10.33)°比(39.06±6.25)°,P<0.05],C5/6组C5/6节段活动度大于C6/7组C6/7节段[(10.44±3.81)°比(7.69±2.38)°,P<0.05],C5/6组颈椎不稳发生率高于C6/7组[(26.32%,15/57)比(7.14%,2/28),P<0.05],C5/6组项韧带骨化发生率高于C6/7组[(40.35%,23/57)比(17.86%,5/28),P<0.05]。两组间压迫位置和脊髓信号改变差异有统计学意义(P<0.05),而两组间压迫性质和压迫程度比较差异未见统计学意义(P>0.05)。结论 C5/6单节段脊髓型颈椎病容易发生节段滑移、项韧带骨化和脊髓信号改变,而C6/7单节段脊髓型颈椎病易出现后方黄韧带压迫,提示生物力学因素在两者发病机制中存在显著差异。

Objective To compare the imaging characteristics of C5/6 and C6/7 single-segment cervical spondylotic myelopathy(CSM)on X-ray,CT and MRI,and to analyze the differences in anatomical parameters,static and dynamic factors of spinal cord compression and spinal cord damage.Methods The imaging data of 85 patients with C5/6 or C6/7 single-segment CSM who underwent anterior cervical discectomy and fusion in two wards of the First Affiliated Hospital of Zhengzhou University from January 2017 to July 2021 were collected.Among them,there were 57 patients with C5/6 single-segment CSM(C5/6 group)and 28 patients with C6/7 single-segment CSM(C6/7 group).The imaging indexes measured by cervical X-ray,CT and MRI,including static factors(intervertebral disc degeneration,ligamentum flavum hypertrophy,osteophytesand cervical spondylolisthesis),dynamic factors(cervical range of motion,cervical segmental range of motion,cervical instability and ossification of the nuchal ligament),spinal cord compression(compression position,compression nature,compression degree and spinal cord signal changes)and anatomic parameters(cervical curvature,spinous process length and Pavlov ratio)were analyzed.Results There was no significant difference in gender,age,height and weight between the two groups(P>0.05).In terms of anatomical parameters,there was no significant difference in cervical curvature,spinous process length and pavlov ratio between the two groups(P>0.05).In terms of static factors,the incidence of vertebral slippage in the C5/6 group was higher than that in the C6/7 group[(21.05%,12/57)vs.(3.57%,1/28),P<0.05],and the ligamentum flavum hypertrophy score in the C5/6 group was lower than the C6/7 group(0.26 vs.0.89,P<0.05).There was no significant difference in osteophytes and intervertebral disc degeneration between the two groups(P>0.05).In terms of dynamic factors,the range of motion of the cervical spine in the C5/6 group was greater than that in the C6/7 group[(47.28±10.33)°vs.(39.06±6.25)°,P<0.05],the range of motion of the C5/6 segment in the C5/6 group was larger than that of the C6/7 segment in the C6/7 group[(10.44±3.81)°vs.(7.69±2.38)°,P<0.05],the incidence of cervical instability in the C5/6 group was higher than that in the C6/7 group[(26.32%,15/57)vs.(7.14%,2/28),P<0.05],and the incidence of nuchal ligament ossification in the C5/6 group was higher than that in the C6/7 group[(40.35%,23/57)vs.(17.86%,5/28),P<0.05].There were statistically significant differences in compression position and spinal cord signal changes between the two groups(P<0.05).However,there was no significant difference in the compression nature and degree between the two groups(P>0.05).Conclusions C5/6 single-segment CSM is prone to cervical spondylolisthesis,ossification of the nuchal ligament and spinal cord signal changes,while C6/7 single-segment CSM is prone to be compressed by ligamentum flavum hypertrophy.Biomechanical factors have significant differences in the pathogenesis of the two segments.