Clinical Application Of Dynamic MRI Of Cervical Intervertebral, Spinal Canal And Spinal Cord

Part one Clinical application of dynamic MRI of normal human cervicalintervertebral,spinal canal and spinal cordObjective:MRI scans of normal green, middle-aged volunteers cervicalDynamic postural (three),measuring the height of the middle of theintervertebral space,spinal canal and spinal cord sagittal diameter, analysis themiddle of the intervertebral height,spinal canal and spinal sagittaldiameterchanges for cervical spine motion process and its clinicalsignificance.Methods:Collecting35volunteers in2012.5-2013.1, male17, female18,mean age29.83±0.12years. Inclusion criteria: healthy, no neck and shoulderdiscomfort and neurological symptoms, neck surgery and a history of trauma,spinal lesions and spinal cord disease, routine MRI examination was negative.Application of GE3.0T superconducting MRI scanner, subjects supine scanstandard cervical posture as a neutral position; pillow after pillow, jaw flexionrecycle as much as possible in order to achieve the sternum; The bottom of theshoulder pad pillows,neck backwards as far as possible as a hyperextended.Routine fast spin-echo FSE-T2WI sagittal scanning. Measuring the middle ofthe intervertebral space height, spinal canal and spinal cord sagittal diameter.The application of statistical software SPSS13.0software package forstatistical analysis.Results:1Measurement Results1.1The height of the intervertebral space in the middle for flexion atC3-4/C4-5/C5-6/C6-7level:5.89±0.14mm,5.96±0.13mm,6.17±0.14mm,6.44±0.13mm, neutral position are6.39±0.10mm,6.32±0.13mm,6.69±0.11mm,7.03±0.12mm, hyperextension are6.30±0.15mm,6.33±0.11mm, 6.40±0.16mm,6.99±0.10mm.1.2The sagittal diameter of the flexion at C3-4/C4-5/C5-6/C6-7level are11.68±0.13mm,11.60±0.60mm,11.82±0.95mm,12.36±0.10mm, neutralposition11.06±0.13mm,11.00±0.11mm,11.18±0.11mm,11.83±0.11mm,hyperextension10.60±0.18mm,10.48±0.16mm,10.67±0.15mm,11.35±0.15.1.3The spinal cord sagittal diameter of flexor at C3-4/C4-5/C5-6/C6-7levelare5.60±0.73mm,5.42±0.55mm,5.20±0.56mm,4.98±0.07mm, neutralposition are6.67±0.07mm,6.36±0.06mm,6.21±0.07mm,5.90±0.08mm,hyperextension are6.84±0.68,6.56±0.06mm,6.43±0.06mm,6.10±0.09mm.2Statistical analysis of the results2.1The height of the intervertebral space in the minddle ofC3-4/C4-5/C5-6/C6-7is statistically significant with the positionchange,flexion and neutral position, flexion and hyperextended significantdifference(P<0.05), hyperextended and neutral position without the significantdifference (P>0.05). Description that the height the middle of intervertebralwith hyperextended and neutral position is not significant changes,but it ischanged at flexion position.2.2The sagittal diameter at C3-4/C4-5/C5-6/C6-7level has statisticallysignificant difference with the position change,there are significant differencesbetween the twenty-two postural,sagittal diameter,flexion> neutral position>hyperextension.2.3The spinal sagittal diameter at C3-4/C4-5/C5-6/C6-7level has statisticallysignificant difference with the changes in posture,flexion and neutralposition,flexion and hyperextended have significant difference(P<0.05),hyperextended and neutral position without the significant difference(P>0.05). The spinal cord in flexion thickening, the hyperextended thinning.Conclision：1We get the height of intervertebral space in the middle, variation and normalrange in the flexion, neutral position and hyperextended at C3-4/C4-5/C5-6/C6-7level for the first time by3.0T MR scanner.2The nucleus pulposus is located in the middle of the disc space anteriorly,themiddle of the disc space height changed to a certain extent reflect the size ofthe intervertebral disc pressure,so,it measurement has significance of theintervertebral disc pressure studies3By flexion intervertebral disc height among research,for cervical anteflexionintervertebral disc pressure theory, provides a numerical basis.Hyperextension disc pressure compared with neutral position,still needfurther research.4Through study further verified the vertebral canal and spinal sagittaldiameter change rule along with the position.The vertebral canal sagittaldiameter:flexion>neutral position>hyperextended. Spinal cord sagittaldiameter:flexion <neutral position <hyperextended. Part two Dynamic MRI clinical application of Green middle-agedcervical spondylosisObjective:Dynamic MRI scans of cervical for normal green,middle-aged volunteers, analysis of the regularity of changes for intervertebralheight in the middle,spinal canal and spinal cord sagittal diameter,for furtherstudies of disc herniation, dural sac and spinal cord compression.Methods:Selected65green,middle-aged patients with cervicalspondylopathy,30men,35women,average age46.27±1.35years.MRIdynamic position in sagittal and transverse scan,position with the firstpart.According to intervertebral disc degeneration classification (see text)evidence grading,measuring the height of intervertebral space in middle forⅡ, Ⅲ, Ⅳgrade intervertebral disc.Results:1II grade disc:The height of the intervertebral space in the middle at C3-4/C4-5/C5-6/C6-7level,flexion:6.10±0.12mm,6.11±0.18mm,6.07±0.18mm,6.57±0.20mm;neutral-position:6.22±0.15mm,6.18±0.14mm,6.22±0.23mm,6.68±0.12mm;hyperextended:6.31±0.11mm,6.29±0.10mm,6.35±0.15mm,6.79±0.15mm; Ⅲg rade-disc:flexion:6.08±0.13mm,6.06±0.12mm,6.04±0.15mm,6.54±0.11mm;neutral-position:6.31±0.12mm,6.21±0.12mm,6.19±0.12mm,6.74±0.12mm;hyperextended:6.30±0.12mm,6.37±0.11mm,6.36±0.14mm,6.87±0.09mm;Ⅳ gradedisc:flexion:5.89±0.19mm,5.81±0.11mm,5.11±0.17mm,6.47±0.11mm;neutral-position:6.12±0.11mm,6.00±0.10,5.00±0.12mm,6.56±0.14;hyperextended:6.23±0.14mm,5.91±0.13mm,5.49±0.18mm,6.38±0.11mm.2Disc herniation patients, number of disc segment, number of segments of thedural sac and spinal cord compression, flexion:27cases,47segments,45segments,20segments; neutral-position:50cases,96segments,96segments,27segments;hyperextended:60cases,123segments,120segments,69segments.3According to the intervertebral disc segment classification, patients withone-disc-segmenthig-hlights:flexion:14cases,neutral-position:17cases,hyperextended:18cases;two-disc-segment-highlights:flexion:7cases,neutral-position:13cases,hyperextended:18cases,three-disc-segment-highlights:flexion:5cases,neutral-position:13cases,hyperextended:17cases;four-disc-segment-highlights:flexion:1cases,neutral-position:7cases,hyperextended:7cases.Conclusion：1Ⅱ, Ⅲ, Ⅳ grade-disc degeneration lead to the height of the intervertebralspace in the middle do not meet the normal(Ⅰgrade intervertebral disc). Ⅱ, Ⅲintervertebral disc degeneration caused by the height of the intervertebralspace in the middle is reduced at flexion and hyperextended,prompt thatcervical spine alignment in tend to instability. Ⅳgrade intervertebral discdegeneration caused by the height of the intervertebral space in the middlewas no significant change with the position,Tip:when caused by cervicalintervertebral disc degeneration of cervical vertebra narrow middle heightsignificantly,Cervical spine motor unit function reconstruction.2C5-6Ⅲ-grade-disc degeneration more due to intervertebral disc heightreduced in the neutral position;C4-5,C5-6Ⅳ disc degeneration than C3-4, C6-7disc,due to the middle of the disc space height were significantly lowerin the three postural.3The hyperextended improve the detection rate of disc herniation,dural sacand spinal cord compression,flexion and vice versa.Neutral position to checkthe negative associated with clinical symptoms,hyperextension posture canimprove the detection rate of the disc.4For grade Ⅲdisc degeneration caused by spinal cord compression, dynamicMRI examination more meaningful;Ⅳ level disc degeneration of spinal cordcompression caused by flexion and neutral position,flexion can not reduce thedetection rate,hyperextended compared with the neutral position, thehyperextended unable to improve the detection rate,dynamic MRI,gradeⅣi ntervertebral spinal cord compression due to smaller significance,and easyto raise the risk of spinal cord injury.