轴向颈部疼痛是常见的，并且经常使人衰弱。诊断特定的疼痛源可能是一个挑战，这混淆了有效的治疗。在许多这些病例中都涉及颈椎小关节病变。在常规的横截面成像模式下很容易做出诊断，尤其是CT成像。然而,这种方式不足以确定骨关节炎小关节是否真正是症状的来源。放射性核苷酸成像在可疑的面部源性疼痛患者的检查中提供了常规横断面成像的非侵入性放射学辅助手段。在这里，作者介绍了连续病例系列诊断为颈椎小关节病变和放射性核苷酸示踪剂摄取一致阳性的患者在颈椎轴下脊柱后路器械性关节固定术后的结果(PRO).
回顾了2014年9月至2018年4月在一家三级医疗机构接受高级作者治疗的患者的临床病例系列。如果患者的主要症状是无神经功能缺损的轴性颈部疼痛，并且CT成像显示颈椎小关节病变，则选择患者入选。这些患者以平面99mTc亚甲基二膦酸盐（99mTcMDP）骨闪烁显像研究的形式进行了放射性核苷酸成像。那些在与小关节病变一致的位置发现放射性核苷酸示踪剂摄取的人被选择接受受影响水平的颈椎后路器械关节固定术。在手术会诊时记录PRO(即，非手术治疗后)和6周，3个月,6个月,手术后一年。这些包括颈部和手臂疼痛，颈部残疾指数(NDI)和12项简短形式健康调查答复。
本回顾性病例系列共纳入11例患者。基线时平均报告的颈部疼痛和NDI评分较高;分别为7.6±2.3和37.1±13.9。手术干预后12个月，观察到报告的颈部疼痛显著降低-4.5(95%CI-6.9,-2.1;p=0.015),NDI显著降低-20.0(95%CI-29.4,-10.6;p=0.014).
本病例系列代表了迄今为止最大的接受外科关节固定术的患者，在一项一致的阳性放射性同位素图像研究中发现了关节突关节病。这些观察结果为越来越多的证据提供了支持，这些证据表明，放射性同位素成像可用于鉴定原发性轴性颈部疼痛和颈椎关节突关节病的患者的致面部疼痛发生器。这些初步数据应有助于促进未来的前瞻性，关于将放射性核苷酸成像纳入疑似颈椎面部源性疼痛患者的检查中的对照研究。
Axial neck pain is common and often debilitating. Diagnosis of the specific pain source can be a challenge, and this confounds effective treatment. Cervical facet arthropathy is implicated in many of these cases. The diagnosis is readily made on conventional cross-sectional imaging modalities, particularly CT imaging. However, this modality falls short in determining if an osteoarthritic facet joint is truly the source of symptoms. Radionucleotide imaging presents a noninvasive radiological adjunct to conventional cross-sectional imaging in the workup of patients with suspected facetogenic pain. Herein, the authors present the patient-reported outcomes (PROs) following posterior instrumented arthrodesis of the subaxial cervical spine from a consecutive case series of patients with a diagnosis of cervical facet joint arthropathy and a concordant positive radionucleotide tracer uptake.
The clinical case series of patients treated by the senior author at a single tertiary care institution between September 2014 and April 2018 was reviewed. Patients were selected for inclusion if their primary symptom at presentation was axial neck pain without neurological deficits and if CT imaging revealed facet arthropathy of the cervical spine. These patients underwent radionucleotide imaging in the form of a planar 99mTc methylene diphosphonate (99mTc MDP) bone scintigraphy study. Those with a finding of radionucleotide tracer uptake at a location concordant with the facet arthropathy were selected to undergo posterior cervical instrumented arthrodesis of the affected levels. PROs were recorded at the time of surgical consultation (i.e., after nonoperative treatment) and at 6 weeks, 3 months, 6 months, and 1 year following surgery. These included neck and arm pain, the Neck Disability Index (NDI) and the 12-Item Short Form Health Survey responses.
A total of 11 patients were included in this retrospective case series. The average reported neck pain and NDI scores were high at baseline; 7.6 ± 2.3 and 37.1 ± 13.9 respectively. Twelve months after surgical intervention, a significant decrease in reported neck pain of -4.5 (95% CI -6.9, -2.1; p = 0.015) and a significant decrease in NDI of -20.0 (95% CI -29.4, -10.6; p = 0.014) was observed.
This case series represents the largest to date of patients undergoing surgical arthrodesis following a finding of facet arthropathy with a concordant positive radioisotope image study. These observations add support to a growing body of evidence that suggests the utility of radioisotope imaging for identification of a facetogenic pain generator in patients with primary axial neck pain and a finding of cervical facet arthropathy. These preliminary data should serve to promote future prospective, controlled studies on the incorporation of radionucleotide imaging into the workup of patients with suspected facetogenic pain of the cervical spine.
