Spine J:MRI神经根沉降征可判定腰椎管狭窄保守治疗预后

2014-04-23 佚名 丁香园

腰椎管狭窄自1954年报道以来,尽管关于其临床、影像及其它诊断标准的研究很多。但至今尚无有症状的腰椎管狭窄的影像学或病理诊断标准。而且,何种诊断标准能对治疗的决策发挥辅助作用,尚有争论,其治疗决策包括保守或手术治疗以及手术方式的选择。 2010年提出的神经根沉降征,指严重的腰椎管狭窄患者的平卧位MR横切面上,神经根不随重力而沉降至背侧,依然停留在硬膜囊腹侧和中央。神经根沉降征能很好的区分有症

腰椎管狭窄自1954年报道以来,尽管关于其临床、影像及其它诊断标准的研究很多。但至今尚无有症状的腰椎管狭窄的影像学或病理诊断标准。而且,何种诊断标准能对治疗的决策发挥辅助作用,尚有争论,其治疗决策包括保守或手术治疗以及手术方式的选择。

2010年提出的神经根沉降征,指严重的腰椎管狭窄患者的平卧位MR横切面上,神经根不随重力而沉降至背侧,依然停留在硬膜囊腹侧和中央。神经根沉降征能很好的区分有症状的腰椎管狭窄患者和非特异性腰痛的对照。

德国阿斯克勒庇俄斯医院骨科的学者,继成功提出神经根沉降征的概念后,进行了其临床验证的研究,提示神经根沉降征有助于保守治疗的腰椎管狭窄预后的判定,文章于2014年4月发表在Spine J上。



该回顾性队列研究共纳入118例诊断为腰椎管狭窄的连续病例,其中52%为女性,平均随访时间2年。所有病例依据临床和影像学表现而采取保守治疗(理论和药物)或手术治疗(减压和/或融合)。



测定病例的基准和随访期Oswestry残障指数(ODI)和腰腿痛视觉模拟量表(VAS)情况,并将其与神经根沉降征阳性和阴性进行对比。

结果显示,69例手术治疗的患者,39例神经根沉降征阳性者的平均ODI提高了29.0点,30例阴性者则提高了28.4点,两组在ODI和VAS改善上无统计学差异。49例保守治疗者,18例神经根沉降率阳性者的平均ODI提高了0.6点,31例阴性者提高了17.7。神经根沉降征阳性病例的ODI和VAS改善程度,较阴性者轻。

上述结果显示,神经根沉降征有助于具有临床意义的腰椎管狭窄的诊断,并能帮助医生确定手术效果好的患者。其应用不增加额外费用,简单且快捷。对于通常需手术治疗的腰椎管狭窄患者,神经根沉降征不能预测手术效果。对保守治疗的患者,神经根沉降征阳性则提示保守治疗效果之有限,手术治疗可能有效。

本研究虽为神经根沉降征进行了临床验证,但由于所有病例均为该概念提出之前,采用传统的诊断手术而进行的治疗,并不能依据神经根沉降征确定哪些病例手术效果好,哪些不好。如何将神经根沉降征应与于不同的临床背景,包括多阶段的腰椎管狭窄,以及集测试与治疗于一体的前瞻性病例分析,都有待进一步研究。

原始出处:

Barz T1, Staub LP2, Melloh M3, Hamann G4, Lord SJ5, Chatfield MD5, Bossuyt PM6, Lange J7, Merk HR4.Clinical validity of the nerve root sedimentation sign in patients with suspected lumbar spinal stenosis.Spine J. 2014 Apr 1;14(4):667-74. doi: 10.1016/j.spinee.2013.06.105. Epub 2013 Sep 20.

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    2014-08-14 mgqwxj
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    2014-04-25 cnxcy

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