Neurologic level diagnosis of cervical stenotic myelopathy
Neurologic level diagnosis of cervical stenotic myelopathy
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DOI：
10.1097/01.brs.0000219475.21126.6b
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发表时间：
2006-05-20
期刊：
影响因子：
3
通讯作者：
Nakamura, K
中科院分区：
文献类型：
--
作者：
Seichi, A;Takeshita, K;Nakamura, K
研究设计。横断面分析。客观的。目的：探讨神经学水平诊断颈椎管狭窄症的准确性。脊髓型颈椎病的神经学水平诊断尚未完全确立。本研究共纳入106例颈椎管狭窄症患者，术前、术后MRI均证实为单平面髓内高信号区。我们根据神经学体征(最上面的肌肉无力、深肌腱反射减弱或夸大、上肢感觉障碍的最高水平)进行水平诊断，并与T2加权MRI的水平诊断进行比较。计算神经学指标对各椎间水平的敏感性、特异性和准确性。其敏感性、特异性和准确性分别为42%、80%和70%，深肌腱反射为66%、89%和83%，感觉区为74%、91%和87%。肌腱深部反射阳性预测值为66%，阴性预测值为91%；感觉障碍区阳性预测值为74%，阴性预测值为91%。基于肌肉无力的诊断准确率较低，原因是在许多患者中，最上面的肌肉无力是指总伸肌或手的内在肌肉，这导致敏感性较低。结论。基于我们提出的指数进行神经水平诊断的平均准确率为>；=70%。根据感觉障碍区域进行平面诊断的准确率最高(87%)。
Study Design. A cross-sectional analysis.Objective. To elucidate the accuracy of neurologic level diagnosis of cervical stenotic myelopathy.Summary of Background Data. Neurologic level diagnosis in cervical myelopathy has not been well established.Methods. A total of 106 patients with cervical stenotic myelopathy, with a single-level intramedullary high-intensity area confirmed on both preoperative and postoperative T2-weighted magnetic resonance imaging (MRI), were included in this study. We performed a level diagnosis on the basis of neurologic signs (the uppermost muscle with weakness, diminished or exaggerated deep tendon reflex, the uppermost level of sensory disturbance of the upper extremities) and compared it with a level diagnosis made by T2-weighted MRI. The sensitivity, specificity, and accuracy of neurologic signs on our index corresponding to each intervertebral level were calculated.Results. The averages of sensitivity, specificity, and accuracy were 42%, 80%, and 70%, respectively, in the uppermost muscle with weakness, 66%, 89%, and 83% in deep tendon reflex, and 74%, 91%, and 87% in the sensory disturbance area. The positive and negative predictive values were 40% and 91%, respectively, in the uppermost muscle with weakness, 66% and 89% in deep tendon reflex, and 74% and 91% in the sensory disturbance area. Accuracy of a diagnosis based on muscle weakness was less high, the reason being that in many patients, the uppermost muscle with weakness was extensor digiti communis or the intrinsic muscles of the hands, and this led to a lower sensitivity. Conclusions. The average accuracy of neurologic level diagnosis based on the index we proposed was >= 70%. The level diagnosis by a sensory disturbance area showed the highest accuracy (87%).