Some Unsolved Problems of Cervical Spondylosis*
Some Unsolved Problems of Cervical Spondylosis*
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颈椎病的一些未解决的问题*
DOI：
10.1136/bmj.1.5333.771
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发表时间：
1963
影响因子：
--
通讯作者：
L. Brain
中科院分区：
文献类型：
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作者：
L. Brain
几乎不用说，我认为受邀发表与威廉·高尔斯爵士的名字有关的演讲是多么荣幸——这个名字如此众所周知，如此杰出，我无法用言语来增添它的光彩。高尔斯是一位伟大的临床医生，他将所有神经病学纳入他的领域，并在具有持久价值的书籍中阐述了他的经验，因为在医学上，无论我们对它的解释如何发展，真实的观察仍然是真实的。因此，高尔斯仍然是临床智慧的宝库，在我开始颈椎病讲座之前，让我们先在高尔斯查一下。你在那里找不到这个名字，因为当时还没有发明它，也没有研究过椎间盘的病理学。然而，Gowers (1899) 认识到了这种情况。在“椎骨外生骨疣”标题下，他说：“外生骨疣有时从椎体生长到脊髓，并可能压迫脊髓或神经。然而，这种情况极为罕见。症状可能是缓慢压迫脊髓，或主要表现为疼痛……其主要特征是极度慢性……与其他类型的外生骨疣相比，外生骨疣对外科医生来说是一个更有前途的领域。” 椎体肿瘤。其中许多的放置位置使得拆除是可行的。如果位于脊髓前面，一些神经根的分裂，至少在背部区域，可能会允许生长。”当时，椎骨外生骨疣被认为是由脊柱产生的，不区分椎体和椎间盘。高尔斯也承认脊柱关节炎是神经疾病的一个原因，但他只提到了类风湿性关节炎。 “在慢性类风湿性关节炎中，”他写道，“有时会累及椎间关节。症状是局部疼痛、压痛和活动受限，如果发生强直，可能会导致绝对固定，特别是在颈部区域……脊髓几乎不会被压缩，但椎间孔变窄可能会损伤神经根。人们会记得，关节突形成了椎骨的一侧。 椎间孔因此会被骨头的任何增大所侵占。因此，神经可能会受到压迫或刺激，并产生放射痛，有时甚至会出现下行神经炎。”我们不能确定他是否将类风湿性关节炎与其他形式的颈椎关节炎区分开来，因为他没有提到其他形式，但他说，“必须记住，脊椎病有时单独存在，并且可能会导致颈椎病。”
I need hardly say how great an honour I consider it to be invited to deliver a lecture associated with the name of Sir William Gowers-a name so well known, and so distinguished, that nothing I could say would add to its lustre. Gowers was a great clinician who took all neurology for his province and set out his experience in books which are of lasting value, because in medicine true observation remains true, however our interpretation of it may develop. So Gowers is still a mine of clinical wisdom, and before I begin my lecture on cervical spondylosis let us look it up in Gowers. You will not find the name there, because it had not then been invented, and the pathology of the intervertebral disk had not been studied. Nevertheless, Gowers (1899) recognized the condition. Under the heading " vertebral exostoses " he said: "Exostoses sometimes grow from the bodies of the vertebrae into the spinal cord, and may compress the cord or nerves. They are, however, extremely rare. The symptoms may be those of slow compression of the cord, or of irritation, expressed chiefly by pain. .. . Their chief characteristic is extreme chronicity. . . Exostoses constitute a more promising field for the surgeon than other kinds of vertebral tumour. Many of them are so placed that their removal is feasible. If situated in front of the cord, the division of some nerve roots, at least in the dorsal region, might permit access to the growth." Vertebral exostoses were then regarded as arising from the spine without distinction between the vertebral bodies and the intervertebral disks. Gowers also recognized arthritis of the spine as a cause of nervous disease, but he mentioned only rheumatoid arthritis. " In chronic rheumatoid arthritis," he wrote, " the intervertebral articulations are sometimes involved. The symptoms are local pain, tenderness, and limitation of movement, which may go on to absolute fixation, especially in the cervical region, if ankylosis occurs.... The cord is scarcely ever compressed, but the narrowing of the foramina may damage the nerve roots. The articular processes, it will be remembered, form one side of the intervertebral foramina, which are thus encroached on by any enlargement of the bones. The nerves may thus be compressed or irritated, and radiating pains are produced, sometimes even a descending neuritis." We cannot be sure whether he distinguished rheumatoid arthritis from other forms of arthritis of the cervical spine, since he mentioned no others, but he said, "it must be remembered that the vertebral affection sometimes exists alone, and it may