2013年8月21日 星期三

Cervical Myelopathy 頸椎脊髓病變

頸椎有問題的病患,愈來愈常見。提早從生活上預防才是重要。
Cervical myelopathy refers to compression on the cervical spinal cord from either a disc herniation or cervical spinal stenosis. 
Generally, it is more common in the elderly population and is a slow process. Symptoms include incoordination in the hands, a heavy feeling in the legs, or numbness and tingling in the legs. It is generally a slowly progressive condition. It is usually not painful as compression of the spinal cord does not cause pain.

A clinical syndrome characterized by  (手腳都受影響,但不是以痛為主要表現)
  • clumsiness in hands
  • gait imbalance
  • caused by compression of the spinal cord


寫得很好的英文資料: Cervical Myelopathy - Spine - Orthobullets.com http://goo.gl/2cVj9h
簡單中文摘要:
Cervical Spondylotic Myelopathy 的症狀和體徵 | Medisato 繁体中文 http://goo.gl/USCVyz
下肢痙攣性無力(spastic weakness of lower limbs)
治療方面:

  • Nonoperative
    • observation, NSAIDs, therapy, and lifestyle modifications
      • indications
        • may be indicated in patient with no function impairment (but some physical exam finding consistent of myelopathy) 
        • patients who are not candidates for surgery
      • modalities
        • medications (NSAIDS, gabapentin)
        • immobilization (hard collar in slight flexion)
        • physical therapy for neck strengthening, balance, and gait training
        • traction and chiropractic modalities are not likely to benefit and do have some risks
        • be sure to watch patients carefully for progression
      • outcomes
        • improved nonoperative outcomes associated with patients with larger transverse area of the spinal cord (>70mm2) 
        • some studies have shown improvement with immobilization in patients with very mild symptoms
  • Operative
    • surgical decompression and stabilization
      • indications
        • functional impairment due to myelopathy
        • asymptomatic patients with cord signal changes and radiographic compression is controversial
      • outcomes
        • prospective studies show improvement in overall pain, function, and neurologic symptoms with operative treatment
        • early recognition and treatment prior to spinal cord damage is critical for good clinical outcomes