无症状颈椎后凸与脊髓型颈椎病患者颈椎后凸的影像学形态差异分析

Analysis of differences in imaging morphology between asymptomatic cervical kyphosis and cervical kyphosis associated with cervical spondylotic myelopathy

中文关键词:  颈椎后凸  无症状  脊髓型颈椎病  颈椎矢状位参数  影像学评估

英文关键词:Cervical kyphosis  Asymptomatic  Cervical spondylotic myelopathy  Cervical sagittal parameters  Imaging assessment

中文摘要:

  【摘要】 目的：比较无症状颈椎后凸与脊髓型颈椎病（cervical spondylotic myelopathy，CSM）患者颈椎后凸在颈椎矢状面排列及形态学特征上的差异，探讨区分两种后凸类型的潜在指标。方法：纳入2022年10月~2024年10月因CSM在复旦大学附属华山医院骨科接受手术治疗且影像学上存在颈椎后凸的62例患者，男40例，女22例；年龄34~76岁（51.9±11.3岁）；从我院体检中心招募年龄和性别匹配的无症状个体作为对照组（男40例，女22例；年龄36~73岁，51.9±11.2岁），比较两组颈椎后凸相关参数（后凸节段Cobb角、C4-C7与C2-C4 Cobb角的差值等）、颈椎矢状位总体参数[C0-C2 Cobb角、颈倾角（neck tilt，NT）等]、各椎间隙角度与椎体角度，以及各椎体上下终板倾斜角（包括C0倾斜度、C4下终板倾斜角等）的差异。结果：无症状组的后凸节段Cobb角（-10.08°±6.72°）显著性小于CSM组（-17.81°±5.28°）（P<0.01）；C4-C7 Cobb角与C2-C4 Cobb角的差值（0.36°±7.04°）显著性大于CSM组 （-7.83°±13.21°）（P<0.01）；C0-C2 Cobb角及NT均显著性小于CSM组（P<0.01）；C4/5、C5/6和C6/7节段的后凸角度显著性小于CSM组（P<0.01、P=0.02、P=0.04），说明CSM组的后凸主要源于椎间隙前部高度的丢失；C3、C5和C7的后凸角度显著性大于CSM组（P值分别为0.03、0.04、0.03），说明无症状组的后凸主要源于椎体楔形变；C0倾斜度值显著性大于CSM组（P<0.01），NT显著性小于CSM组（P<0.01），C4下终板倾斜角显著性小于CSM组（P=0.03）。结论：CSM患者后凸集中于C4~C7节段，且局部角度更大；无症状颈椎后凸多见于C2~C4节段，后凸主要源于椎体楔形变。C0倾斜度、NT、C4下终板倾斜角可作为潜在的鉴别参数。

英文摘要:

  【Abstract】 Objectives: To compare the differences in cervical sagittal alignment and morphological characteristics between asymptomatic cervical kyphosis and cervical kyphosis in patients with cervical spondylotic myelopathy(CSM), and to explore potential indicators for distinguishing the two types of kyphosis. Methods: A total of 62 patients(40 males, 22 females; aged 34-76 years, mean 51.9±11.3 years) who exhibited radiological cervical kyphosis and underwent surgical treatment for CSM in the Department of Orthopedics, Huashan Hospital, Fudan University from October 2022 to October 2024 were included. Age- and sex-matched asymptomatic individuals recruited from the physical examination center of our hospital served as the control group(40 males, 22 females; aged 36-73 years, mean 51.9±11.2 years). The differences between the two groups were compared in terms of cervical kyphosis-related parameters(kyphotic segment Cobb angle, the difference between C4-C7 and C2-C4 Cobb angles), overall cervical sagittal parameters[C0-C2 Cobb angle, neck tilt(NT), etc.], intervertebral space angles, vertebral body angles, and the tilt angles of the upper and lower endplates of each vertebra(including C0 slope, C4 lower endplate tilt angle). Results: The Cobb angle of the kyphotic segment in the asymptomatic group(-10.08°±6.72°) was significantly smaller than that in the CSM group(-17.81°±5.28°)(P<0.01). The difference between the C4-C7 and C2-C4 Cobb angles in the asymptomatic group(0.36°±7.04°) was significantly greater than that in the CSM group(-7.83°±13.21°)(P<0.01). The C0-C2 Cobb angle and NT in the asymptomatic group were both significantly smaller than those in the CSM group(P<0.01). The kyphotic angles of the C4/5, C5/6, and C6/7 segments in the asymptomatic group were significantly smaller than those in the CSM group(P<0.01, P=0.02, P=0.04), indicating that the kyphosis in the CSM group primarily originated from the loss of anterior intervertebral disc height. The kyphotic angles of C3, C5, and C7 were significantly greater in the asymptomatic group than those in the CSM group(P=0.03, 0.04, and 0.03, respectively), indicating that the kyphosis in the asymptomatic group was mainly attributed to vertebral wedging. In the asymptomatic group, the C0 slope was significantly greater than that in the CSM group(P<0.01), while the NT value(P<0.01) and the C4 lower endplate tilt angle(P=0.03) were significantly smaller than those in the CSM group. Conclusions: The kyphosis in CSM patients is concentrated in the C4-C7 segments and is characterized by a larger local angle. Conversely, asymptomatic cervical kyphosis is more commonly observed in the C2-C4 segments and primarily originates from vertebral wedging. C0 slope, NT, and C4 lower endplate tilt angle can serve as potential differential parameters.