本科教材:由于颈椎退变结构压迫脊髓或压迫供应脊髓的血管而出现一系列症状,包括四肢感觉、运动、反射以及二便功能障碍的综合征,为颈椎病最严重的类型,由于下颈段椎管相对较小(脊髓颈膨大处),且活动度大,故退变亦发生较早、较重,脊髓受压也易发生在下颈段。 病人出现上肢或下肢麻木无力、僵硬、双足踩棉花感、束带感,双手精细动作障碍。后期可出现二便功能障碍。检查时可有感觉障碍平面,肌力减退,四肢腱反射活跃或亢进,而浅反射减弱或消失。Hoffmann征、Babinski等病理征可呈阳性。 01 JOA评分和mJOA评分 JOA 17分。 mJOA 18分。 脊髓功能障碍严重程度 AOSpine指南 02 脊髓压迫的细微结构 髓鞘损伤 慢性脊髓损伤会导致髓鞘损伤,而髓鞘损伤特异性地影响锥体外系的脊髓束,主要集中在腹侧和侧颈髓区域。影响协调能力。 存在动态压迫 脊髓细微结构变化 03 脊髓颈椎病的查体和鉴别诊断 01 02 1.Jajeh H, Lee A, Charls R, et al. A clinical review of hand manifestations of cervical myelopathy, cervical radiculopathy, radial, ulnar, and median nerve neuropathies. J Spine Surg 2024;10:120–34. 2.Filimonova E, Abdaev M, Vasilenko I, et al. Evaluation of the structural integrity of different spinal cord tracts with magnetization transfer ratio in degenerative cervical myelopathy. Neuroradiology. Epub ahead of print March 5, 2024. DOI: 10.1007/s00234-024-03327-w. 3.Kim MW, Kang C-N, Choi SH. Update of the Natural History, Pathophysiology, and Treatment Strategies of Degenerative Cervical Myelopathy: A Narrative Review. Asian Spine J 2023;17:213–21. 4.Nouri A, Tessitore E, Molliqaj G, et al. Degenerative Cervical Myelopathy: Development and Natural History [AO Spine RECODE-DCM Research Priority Number 2]. Global Spine Journal 2022;12:39S-54S. 5.Badhiwala JH, Ahuja CS, Akbar MA, et al. Degenerative cervical myelopathy — update and future directions. Nat Rev Neurol 2020;16:108–24. 6.Lao L, Daubs MD, Scott TP, et al. Missed cervical disc bulges diagnosed with kinematic magnetic resonance imaging. Eur Spine J 2014;23:1725–9. 7.Fehlings MG, Wilson JR, Kopjar B, et al. Efficacy and Safety of Surgical Decompression in Patients with Cervical Spondylotic Myelopathy: Results of the AOSpine North America Prospective Multi-Center Study. Journal of Bone and Joint Surgery 2013;95:1651–8. 8.Baba H, Maezawa Y, Uchida K, et al. Plasticity of the spinal cord contributes to neurological improvement after treatment by cervical decompression. A magnetic resonance imaging study. J Neurol 1997;244:455–60. 9.Benzel EC, Lancon J, Kesterson L, et al. Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy. J Spinal Disord 1991;4:286–95. |
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