Functional Magnetic Resonance Imaging Application and Its Clinical Significance in the Spondylotic Myelopathy

作者: 齐 勇 , 刘燕芳 , 林冠文 :广东省第二人民医院,广东 广州;

关键词: 脊髓型颈椎病功能磁共振成像大脑皮质Myelopathic Type Cervical Vertebra Disease Functional Magnetic Resonance Imaging The Cerebral Cortex

目的:探究功能性核磁成像技术在脊髓型颈椎病患者中应用及其临床意义。方法:选择2014年1月至2014年6月我院骨科收治的脊髓型颈椎病患者为观察对象,选择同期10例健康志愿者为对照组对象。在术前、术后6周、3月及其6月分别进行一次fMRI脑功能成像并根据日本骨科学会评分系统(JOA scores)对术后恢复情况进行评估。对照组对象同期行脑fMRI功能成像。比较两组不同时间点脑fMRI功能成像、JOA 评分和术后恢复(步长,动作完成时间)。结果:对照组健康对象在完成指定动作时,在对侧脑部主要运动区都有局部有限的皮质激活区域。脊髓型颈椎病患者fMRI图像表明激活的皮质映射区域与健康对照组相比有所扩大。脊髓减压术后皮质激活映射区有所缩小并接近健康组激活区域范围。与对照组比较,枕叶、额叶及其边缘系统是观察组患者ReHo显著降低的脑区;小脑及其边缘叶是观察组ReHo显著升高的脑区。JOA评分和术后恢复观察组患者明显(P < 0.05)。结论:fMRI可作为脊髓型颈椎病患者术前和术后皮质投射区变化的有效评定方法,通过此FMRI的评估可以有效的进行患者术后评估和术后恢复指导。

Abstract: Objective: To explore the functional magnetic resonance imaging application and its clinical significance in the spondylotic myelopathy. Methods: 10 cases spondylotic myelopathy patients treated in the orthopaedic department of our hospital from January 2014 to June 2014 were selected as the observation objects, and 10 cases healthy volunteers were selected as the control objects in the same period. Functional magnetic resonance imaging and the Japanese orthopaedic society of scoring system (JOA scores) evaluating the postoperative recovery were measured in the preoperative and postoperative 6 weeks, 3 months and 6 months, respectively. The control objects in the same period were measured by functional magnetic resonance imaging. Functional magnetic resonance imaging and JOA score and postoperative recovery (time step, action) were compared between two groups at different time points. Results: The limited areas of the cortex were activated at main motor areas on the side of the brain after completing the action in the control objects. Activation of cortical map area in functional magnetic resonance imaging of the spondylotic myelopathy patients widened compared with the healthy controls. Cortical activation mapping area reduced activation area and close to the healthy group after the spinal cord decompression. Compared with the control group, the occipital lobe, the frontal lobe and the limbic system were the areas of the brain that ReHo of the observation group patients significantly reduced. The cerebellum and the edge of leaf were the areas of the brain that ReHo of the observation group patients significantly increased. The JOA score and post-operation of the observation group are more significant than those of the control group (P < 0.05). Conclusion: Functional magnetic resonance imaging can be effective evaluation methods for the preoperative and postoperative cortical projection area changes in the spondylotic myelopathy patients’ cerebral cortex. We can evaluate the postoperative recovery and give positive postoperative rehabilitation guidance effectively with the functional magnetic resonance imaging assessment.

文章引用: 齐 勇 , 刘燕芳 , 林冠文 (2016) 功能性核磁成像技术在脊髓型颈椎病患者中应用及其临床意义。 外科, 5, 45-52. doi: 10.12677/HJS.2016.53007


[1] 王国华, 黄象望, 刘斌, 等. Mobi-C人工颈椎间盘置换与颈前路减压植骨融合术治疗脊髓型颈椎病的疗效比较[J]. 医学临床研究, 2013, 30(7): 1307-1310.

[2] 吴广忠, 陈静, 段丽莎, 等. 脊髓型颈椎病术前MRI信号变化与手术预后的相关性研究[J]. 医学临床研究, 2013, 30(7): 1254-1257.

[3] 邓化龙, 向铁城, 黄象望, 等. 颈椎后路侧块内固定与椎弓根内固定治疗脊髓型颈椎病的临床疗效比较[J]. 医学临床研究, 2014, 31(10): 2032-2035.

[4] 王雷, 周震, 王遵来, 等. 针灸治疗颈椎病的临床研究进展[J]. 针灸临床杂志, 2010, 26(5): 69-73.

[5] Konomi, T., Fujiyoshi, K., Hikishima, K., et al. (2012) Conditions for Quantitative Evaluation of Injured Spinal Cord by in Vivo Diffusion Tensor Imaging and Tractography: Preclinical Longitudinal Study in Common Marmosets. Neuroimage, 63, 1841-1853. http://dx.doi.org/10.1016/j.neuroimage.2012.08.040

[6] Baron, E.M. and Young, W.F. (2007) Cervical Spondylotic Myelopathy: A Brief Review of Its Pathophysiology, Clinical Course, and Diagnosis. Neurosurgery, 60, S35-S41. http://dx.doi.org/10.1227/01.neu.0000215383.64386.82

[7] Freund, P., Weiskopf, N., Ward, N.S., et al. (2011) Disability, Atrophy and Cortical Reorganization Following Spinal Cord Injury. Brain, 134, 1610-1622. http://dx.doi.org/10.1093/brain/awr093

[8] Burkhardt, J.K., Mannion, A.F., Marbacher, S., et al. (2013) A Comparative Effectiveness Study of Patient-Rated and Radiographic Outcome after 2 Types of Decompression with Fusion for Spondylotic Myelopathy: Anterior Cervical Discectomy versus Corpectomy. Neurosurgical Focus, 35, E4. http://dx.doi.org/10.3171/2013.3.FOCUS1396

[9] Kalsi-Ryan, S., Karadimas, S.K. and Fehlings, M.G. (2013) Cervical Spondylotic Myelopathy: The Clinical Phenomenon and the Current Pathobiology of an Increasingly Prevalent and Devastating Disorder. Neuroscientist, 19, 409- 421. http://dx.doi.org/10.1177/1073858412467377

[10] Burkhardt, J.K., Mannion, A.F., Marbacher, S., et al. (2015) The Influence of Cervical Plate Fixation with Either Autologous Bone or Cage Insertion on Radiographic and Patient-Rated Outcomes after Two-Level Anterior Cervical Discectomy and Fusion. European Spine Journal, 24, 113-119. http://dx.doi.org/10.1007/s00586-014-3456-y

[11] Kennerley, A.J., Mayhew, J.E., Boorman, L., et al. (2012) Is Optical Imaging Spectroscopy a Viable Measurement Technique for the Investigation of the Negative BOLD Phenomenon? A Concurrent Optical Imaging Spectroscopy and fMRI Study at High Field (7 T). Neuroimage, 61, 10-20. http://dx.doi.org/10.1016/j.neuroimage.2012.03.015

[12] Smith, A.C., Rymer, W.Z. and Knikou, M. (2015) Locomotor Training Modifies Soleus Monosynaptic Motoneuron Responses in Human Spinal Cord Injury. Experimental Brain Research, 233, 89-103. http://dx.doi.org/10.1007/s00221-014-4094-7

[13] Gee, D.G., McEwen, S.C., Forsyth, J.K., et al. (2015) Reliability of an fMRI Paradigm for Emotional Processing in a Multisite Longitudinal Study. Human Brain Mapping, 36, 2558-2579. http://dx.doi.org/10.1002/hbm.22791

[14] 周炜, 唐健, 陈琦, 等. 脊髓信号改变对颈后路减压内固定术治疗多节段脊髓型颈椎病疗效的影响[J]. 江苏医药, 2014, 40(23): 2868-2869.

[15] Chase, H.W., Fournier, J.C., Greenberg, T., et al. (2015) Accounting for Dynamic Fluctuations across Time When Examining fMRI Test-Retest Reliability: Analysis of a Reward Paradigm in the EMBARC Study. PLoS ONE, 10, e0126326. http://dx.doi.org/10.1371/journal.pone.0126326

[16] 周诚, 王嘉洲, 陈敏, 等. 针刺穴位与大脑皮层之间关系的脑功能MRI表现[J]. 中华放射学杂志, 2005, 29(3): 252-255.

[17] Negishi, M., Martuzzi, R., Novotny, E.J., Spencer, D.D. and Constable, R.T. (2011) Functional MRI Connectivity as a Predictor of the Surgical Outcome of Epilepsy. Epilepsia, 52, 1733-1740. http://dx.doi.org/10.1111/j.1528-1167.2011.03191.x

[18] Tsunoda, K., Sekimoto, S. and Baer, T. (2012) Brain Activity in Aphonia after a Coughing Episode: Different Brain Activity in Healthy Whispering and Pathological Aphonic Conditions. Journal of Voice, 26, 668.e11-668.e13. http://dx.doi.org/10.1016/j.jvoice.2011.11.004

[19] Zoccatelli, G., Beltramello, A., Alessandrini, F., Pizzini, F.B. and Tassinari, G. (2010) Word and Position Interference in Stroop Tasks: A Behavioral and fMRI Study. Experimental Brain Research, 207, 139-147. http://dx.doi.org/10.1007/s00221-010-2433-x

[20] 王伟东, 孔抗美, 吴仁华. 脊髓神经功能的功能磁共振成像研究[J]. 汕头大学医学院学报, 2006, 19(2): 126-128.

[21] Cadotte, D.W., Bosma, R., Mikulis, D., et al. (2012) Plasticity of the Injured Human Spinal Cord: Insights Revealed by Spinal Cord Functional MRI. PLoS ONE, 7, e45560. http://dx.doi.org/10.1371/journal.pone.0045560

[22] Kim, W. and Kim, S.K. (2016) Neural Circuit Remodeling and Structural Plasticity in the Cortex during Chronic Pain. The Korean Journal of Physiology and Pharmacology, 20, 1-8. http://dx.doi.org/10.4196/kjpp.2016.20.1.1

[23] Jantzen, K.J. (2010) Functional Magnetic Resonance Imaging of Mild Traumatic Brain Injury. The Journal of Head Trauma Rehabilitation, 25, 256-266. http://dx.doi.org/10.1097/HTR.0b013e3181e5477c

[24] Ipek, M., Hilal, H., Nese, T., Aynur, M. and Gazanfer, E. (2011) Neuronal Plasticity in a Case with Total Hemispheric Lesion. Journal of Medicine and Life, 4, 291-294.

[25] 陈业晞, 沈智威, 李志扬, 等. 电针刺激脊髓损伤患者穴位的脊髓磁共振功能成像激活区特征[J]. 中国组织工程研究与临床康复, 2010, 14(43): 8049-8052.