Relationships between outcomes of conservative treatment and magnetic resonance imaging findings in patients with mild cervical myelopathy caused by soft disc herniations
Relationships between outcomes of conservative treatment and magnetic resonance imaging findings in patients with mild cervical myelopathy caused by soft disc herniations
复制标题
DOI：
10.1097/00007632-200107150-00021
复制
发表时间：
2001-07-15
期刊：
影响因子：
3
通讯作者：
Toyama, Y
中科院分区：
文献类型：
--
作者：
Matsumoto, M;Chiba, K;Toyama, Y
研究设计。对保守治疗的颈椎间盘突出症所致轻度颈脊髓病患者进行回顾性随访研究。目的探讨颈椎软椎间盘突出症所致轻度脊髓病的保守治疗效果，并评价磁共振结果对预后的预测作用。背景资料摘要。最近关于颈椎软椎间盘突出症保守治疗的研究主要集中在神经根病，而不是脊髓病。对27例继发于颈椎间盘突出症的轻度颈椎脊髓病患者，采用颈椎支具及限制日常活动保守治疗6个月以上。在27例患者中，17例患者（A组）仅接受了保守治疗，并与神经功能缺损的改善有关，而另外10例患者（B组）因神经功能恶化最终接受了减压手术。比较两组患者对JOA的恐惧程度、患者满意度和磁共振表现，包括椎间盘突出的位置（矢状面为局灶性或弥漫性，腋面为中位或旁位）。治疗前A组JOA评分为13.6 +/- 1.6分，B组为14.1 +/- 1.6分，3个月时JOA评分分别为14.9 +/- 1.0分和12.9 +/- 2.1分，末次随访时JOA评分分别为16.2 +/- 0.8分和16.0 +/- 1.2分。3个月时，B组JOA评分明显低于A组，A组77%的患者对治疗结果满意，B组90%的患者对治疗结果满意。A组47%的患者出现局灶型疝，B组70%的患者出现局灶型疝。A组中位型疝为77%，B组为30%，A组随访磁共振成像显示10例（59%）患者疝块自发消退。弥漫性疝比局灶性疝更容易自发消退（78%对37%）。保守治疗是治疗颈椎间盘突出症引起的轻度颈椎病的有效方法。磁共振成像显示中位型和/或弥漫性疝的患者预后良好。
Study Design. A retrospective follow-up study of conservatively treated patients with mild cervical myelopathy caused by cervical soft disc herniation.Objective. To investigate the outcome of conservative treatment for patients with mild myelopathy caused by cervical soft disc herniation and to evaluate usefulness of magnetic resonance findings in the prediction of the outcomes.Summary of Background Data. Recent studies on conservative treatment for cervical soft disc herniation have focused mainly on radiculopathy, and not on myelopathy.Methods. Twenty-seven patients with mild cervical myelopathy secondary to cervical soft disc herniation were treated conservatively for more than 6 months by cervical bracing and restriction of daily activities. Of the 27 patients, 17 patients (Group A) underwent conservative treatment only and it was associated with improvement in their neurologic deficits, while the other 10 patients (Group B) ultimately underwent decompression surgery because of neurologic deterioration. Comparisons between the two groups were made in regard to JOA scares, patient satisfaction, and magnetic resonance findings, including location of the disc herniation (focal or diffuse in the sagittal plane, median or paramedian in the axil plane).Results. The JOA scores were 13.6 +/- 1.6 in Group A and: 14.1 +/- 1.6 in Group B before treatment, 14.9 +/- 1.0 and 12.9 +/- 2.1, respectively, at 3 months, and 16.2 +/- 0.8 and 16.0 +/- 1.2, respectively, at the final follow-up. The JOA scores at 3 months were significantly lower in Group B than in Group A. Satisfaction with the results of treatment at the final follow-up was reported by 77% of the patients in Group A and 90% in Group B. Focal-type herniation was present in 47% of the patients in Group A and 70% in Group B, while median-type herniation was diagnosed in 77% in Group-A and 30% in Group B Follow-up magnetic resonance imaging of the patients in Group A showed spontaneous regression of a herniated mass in 10 patients (59%). Diffuse-type herniations were more likely to regress spontaneously than focal-type herniations (78% vs. 37%).Conclusions. Conservative treatment is an effective treatment option for mild cervical myelopathy caused by cervical soft disc herniation. A goad outcome can be expected in patients with a median-type and/or diffuse-type herniation on magnetic resonance imaging.