Anatomy 結構
Structurally cervical spine was from the base of the head to chest. It comprises of 7 cervical vertebrae with a intervertebral disc in between each of them.
These bones have a bony tunnel, called spinal canal, where the spinal cord passing through. The size is 12mm and up to 15mm, with a technical measurement of Torg-Pavlov ratio of at least 0.9.
This is an important measurement. Because the spinal cord, a central nervous system, an extension of the brain, pass through this tunnel. If the size is not spacious enough, coupled with some degeneration, the spinal cord will be compressed, leading to neurological dysfunction, called myelopathy, radiculopathy or in combination myeloradiculopathy.
從結構上來說，頸椎是從頭顱底到胸部。 它由7塊頸椎組成，每個椎骨之間都有一個椎間盤。
這些骨頭有一條稱為椎管的骨質通道，脊髓從這裡穿過，並往旁散到四肢。椎管的尺寸為12mm至15mm，以Torg-Pavlov比的技術測量，其值至少為0.9。
這是一項重要的測量。因為脊髓屬中樞神經系統，實際是大腦的延伸。如果椎管本來已經不夠寬敞，再加上一些退化性問題，脊髓就會受壓，導致神經功能障礙，稱為脊髓病變，神經根病變或合併脊髓神經根病變。
Pathology 毛病
Disease 病變
The followings are common pathologies in spine
以下是常見脊椎病變
- Myelopathy 脊髓病變
- Radiculopathy 神經根病變
- RadiculoMyelopathy 合併脊髓神經根病變
- Spinal stenosis 椎管狹窄
- Discogenic neck pain 椎間盤頸痛
- Collapse Fracture 壓縮性骨塌
- Facet Joint Dislocation 頸椎脫位
- Infection 感染
- Cervicogenic headache 頸椎源頭痛
Investigation 評估
MRI is usually required and dynamic X-ray might be indicated. Occasionally, nerve conduction study would be needed.
通常需要拍磁力共震片，並且可能需要作動態X光檢查。某些情況需安排神經功能測試。
Management 治療
Conservative treatments are indicated for majority of cases. They included,
- Physiotherapy
- Chiropractor
- TCM practitioner
- Prescribed Exercise
- Medication
For cases failed conservative treatments, intervention would be indicated.
For patients with neurological deficit lasting more than 6 weeks or witnessed deterioration, surgical intervention might be advocated.
絕大多數病人只需採取保守治療。他們包括
- 物理治療
- 脊醫
- 中醫
- 處方運動
- 藥物（口服及外敷）
對於保守治療無效的病例，會改為介入治療，例如打針。
對於持續超過6週或惡化的神經受損的患者，醫生往往會建議手術，以保神經功能。
Common Interventions include
- Steroid injection
- Radiofrequency Ablation
- Artificial Cervical Disc (Total Disc Replacement) (TDR)
- Anterior Cervical Spinal Fusion (ACDF)
- Laminoplasty
- Posterior Spinal Fusion (PSF)
- Corpectomy and fusion
Reference
- Masaaki Chazono,Takaaki Tanaka, Yoshio Kumagae, Tomoaki Sai, and Keishi Marumo. Ethnic differences in pedicle and bony spinal canal dimensions calculated from computed tomography of the cervical spine: a review of the English-language literature. Eur Spine J. 2012 Aug; 21(8): 1451–1458.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3535254/ - Yue WM, Tan SB, Tan MH et al (2001) The Torg-Pavlov-ratio in cervical spondylotic myelopathy: a comparative study between patients with cervical spondylotic myelopathy and a nonspondylotic, nonmyelopathic population. Spine 26(16):1760–1764. https://pubmed.ncbi.nlm.nih.gov/11493847/