颈椎病病例分析
Case
• 男性，82岁 • 肩颈部疼痛伴右手麻木10余年，加重伴行走踩棉花感半年 • 查体：右上肢hoffman征可疑阳性，四肢腱反射（++），
右手指感觉稍减退，肌力正常，压颈试验阴性，患肢牵拉 试验阴性。 • 辅检：EMG+NCV提示：双上肢神经源性损害（累及左侧 C7及右侧C5-C7水平）
for unrelated ailments. • Lack of awareness of this entity and often presents
a diagnostic dilemma
• Most frequently in the vicinity of the sacro-iliac joint.
Clinical symptoms
• Typically do not cause any symptoms • Although some patients do report pain in the
region, the origin of the pain is often obscured by the coexistence of degenerative changes in the area.
右
中
左
右
中
左
L/2
L2/3
C3/4
C4/5
C5/6
右
中
左
C3/4
C4/
治疗
• 前路ACDF ? • 前路ACCF ？ • 后路单开门 ？
右
中
左
右
中
左
右
中
左
• 前路ACDF ? • 前路ACCF ？ • 后路单开门
治疗
what are the lesions ?
C5
C3
• Other proposed etiologies include spontaneous gas accumulation and secondary gas accumulation in a simple fluid-filled cyst
• smaller lesions (2-5mm) without spinal degeneration in a younger population.
右
中
左
C3
C5
右
中
左
Cervical pneumatocysts
• Ramirez et al first described in 1984 • Benign cyst-like lesion • Consists predominantly of nitrogen gas • Incidental discoveries in patients being evaluated
X-rays
• Appear as juxta-articular transradiant lesions with a thin sclerotic rim
MRI
• Due to absence of protons within the lesion, they are markedly hypointense on both T1- and T2weighted images
process or the lateral mass • The posterolateral corner of the vertebral body is
the most preferred site.
C3
C5
• Recently, two retrospective CT studies have shown that the lesion is not as rare as once believed.
• A few intraosseous pneumatocysts have been reported in the vertebrae, humeral head, clavicle, cervical rib, scapula, acetabulum and pubis.
Cervical pneumatocysts
• Manifestation in the cervical spine is uncommon • Mostly in the lower cervical vertebrae, C5 and C6
were most frequently locations • May occur in the vertebral body, the spinous
• One study examined the cervical spine on CT scans from 89 patients and reported a prevalence of 9%.
• A second and larger study of 500 CT scans showed a prevalence of 42%.
Pathogenesis
• Not fully understood • One theory is that gas accumulation in the intervertebral
disk, known as the vacuum phenomenon, extends into the vertebral body through a defect in a degenerated end plate • Consistent with the higher prevalence of these lesions in the older population, and its coexistence with degenerative joint disease • Relatively larger lesions (>5mm) in an older population
• Lesions containing fluid or granulation tissue appear hyperintense on T2-weighted images and hypointense on T1-weighted images.