左右差のある上肢症状を呈した頚椎症における動的因子の関与について

抄録

  Introduction : In order to determine the onset mechanisms responsible for upper extremities unilateral or asymmetrical neurological symptoms in cervical spondylosis, we performed 3 Dimensional Computed Tomography (3D-CT) in the neutral and extending positions. Then we examined the association between cervical vertebra dynamic factors and the onset of neurological symptoms.

  Materials and Methods : We selected 12 patients with unilateral or asymmetrical neurological symptoms in their upper extremities from 48 patients who underwent anterior decompression and fusion or posterior decompression to treat cervical spondylosis between January 2007 and September 2009. Subjects comprised 11 males and 1 female between the age of 28 and 78 (average 49.9). They induded 5 cases of mono-segmental fusion and 7 cases of bi-segmental fusion, and surgery was performed for 2 cases at C4-5 level, 10 cases at C5-6 level, and 7 cases at C6-7 level. Aquilion 16 TSX-101A/GB (Toshiba Medical Systems) was used for the 3D-CT imaging. CT was performed at a 0.5 mm slice thickness for neutral and retroflexed positions, after which we performed volume rendering. The degree of affection of every particular in intervertebral level was assessed according to clinical symptoms and MRI results. The inclination between vertebral bodies was measured and compared (unilateral spondylolisthesis) by drawing a line perpendicular to the line which connected the transverse processes of each vertebral body on the 3D-CT frontal view. We also examined instabilities such as misalignment or gaps of facet joints in the neutral and extending positions.

  Results : Of a total of 19 facet joints, instabilities or unilateral facet joints spondylolisthesis were observed in 11 facet joints in the extending position.

  Conclusions :

1. We investigated the mechanisms involved in the onset of unilateral or asymmetrical neurological symptoms in upper extremities in patients with cervical disk diseases using 3D-CT in the neutral and extending positions.

2. We conclude that instabilities or unilateral spondylolisthesis in unilateral facet joints in the extending position can influence the onset of neurological symptoms.