流行病学
颈椎病的发病率随年龄不同而有所差异。基于人群的磁共振成像(magnetic resonance imaging, MRI)研究显示,接近 100% 年龄 >40 岁的成年人,至少有一个颈椎水平(通常是 C5/6)发生严重的退行性变。[1]Matsumoto M, Fujimura Y, Suzuki N, et al. MRI of cervical intervertebral discs in asymptomatic subjects. J Bone Joint Surg Br. 1998 Jan;80(1):19-24.https://online.boneandjoint.org.uk/doi/pdf/10.1302/0301-620X.80B1.0800019http://www.ncbi.nlm.nih.gov/pubmed/9460946?tool=bestpractice.com[2]Guzman J, Haldeman S, Carroll LJ, et al. Clinical practice implications of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders: from concepts and findings to recommendations. J Manipulative Physiol Ther. 2009 Feb;32(2 suppl):S227-43.http://www.ncbi.nlm.nih.gov/pubmed/19251069?tool=bestpractice.com[3]Braga-Baiak A, Shah A, Pietrobon R, et al. Intra- and inter-observer reliability of MRI examination of intervertebral disc abnormalities in patients with cervical myelopathy. Eur J Radiol. 2008 Jan;65(1):91-8.http://www.ncbi.nlm.nih.gov/pubmed/17532165?tool=bestpractice.com[4]Siivola SM, Levoska S, Tervonen O, et al. MRI changes of cervical spine in asymptomatic and symptomatic young adults. Eur Spine J. 2002 Aug;11(4):358-63.http://www.ncbi.nlm.nih.gov/pubmed/12193998?tool=bestpractice.com[5]American College of Radiology. ACR appropriateness criteria: cervical neck pain or cervical radiculopathy. 2018 [internet publication].https://acsearch.acr.org/docs/69426/Narrative/[6]Binder AI. Neck pain. BMJ Clin Evid. 2008 [internet publication].https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907992/http://www.ncbi.nlm.nih.gov/pubmed/19445809?tool=bestpractice.com 然而,仅有一小部分患者表现为轴性颈椎痛,即使颈部放射影像学检查和 MRI 可能显示严重的自发性退行性病变,患者通常也可能无症状。[4]Siivola SM, Levoska S, Tervonen O, et al. MRI changes of cervical spine in asymptomatic and symptomatic young adults. Eur Spine J. 2002 Aug;11(4):358-63.http://www.ncbi.nlm.nih.gov/pubmed/12193998?tool=bestpractice.com[7]Binder AI. Cervical spondylosis and neck pain. BMJ. 2007 Mar 10;334(7592):527-31.http://www.ncbi.nlm.nih.gov/pubmed/17347239?tool=bestpractice.com[8]Kovalova I, Kerkovsky M, Kadanka Z, et al. Prevalence and imaging characteristics of nonmyelopathic and myelopathic spondylotic cervical cord compression. Spine (Phila Pa 1976). 2016 Dec 15;41(24):1908-16.http://www.ncbi.nlm.nih.gov/pubmed/27509189?tool=bestpractice.com
据估计,在北美,退行性脊髓型颈椎病的发病率至少为每一百万人 41 例。[9]Nouri A, Tetreault L, Singh A, et al. Degenerative cervical myelopathy: epidemiology, genetics, and pathogenesis. Spine (Phila Pa 1976). 2015 Jun 15;40(12):E675-93.http://www.ncbi.nlm.nih.gov/pubmed/25839387?tool=bestpractice.com 在一项研究中,59% 年龄 >40 岁者的 MRI 显示颈髓受压迹象。[8]Kovalova I, Kerkovsky M, Kadanka Z, et al. Prevalence and imaging characteristics of nonmyelopathic and myelopathic spondylotic cervical cord compression. Spine (Phila Pa 1976). 2016 Dec 15;41(24):1908-16.http://www.ncbi.nlm.nih.gov/pubmed/27509189?tool=bestpractice.com由于对大多数患者来说,非手术治疗是有效的,故仅有 1%-2% 的颈椎病患者需要行手术干预治疗。[10]Matz PG. Does nonoperative management play a role in the treatment of cervical spondylotic myelopathy? Spine J. 2006 Nov-Dec;6(6 suppl):175S-81S.http://www.ncbi.nlm.nih.gov/pubmed/17097536?tool=bestpractice.com[11]Mazanec D, Reddy A. Medical management of cervical spondylosis. Neurosurgery. 2007 Jan;60(1 suppl 1):S43-50.http://www.ncbi.nlm.nih.gov/pubmed/17204885?tool=bestpractice.com[12]Patil PG, Turner DA, Pietrobon R. National trends in surgical procedures for degenerative cervical spine disease: 1990-2000. Neurosurgery. 2005 Oct;57(4):753-8.http://www.ncbi.nlm.nih.gov/pubmed/16239888?tool=bestpractice.com[13]Rao RD, Gourab K, David KS. Operative treatment of cervical spondylotic myelopathy. J Bone Surg Am. 2006 Jul;88(7):1619-40.http://www.ncbi.nlm.nih.gov/pubmed/16818991?tool=bestpractice.com[14]Salt E, Wright C, Kelly S, Dean A. A systematic literature review on the effectiveness of non-invasive therapy for cervicobrachial pain. Man Ther. 2011 Feb;16(1):53-65.http://www.ncbi.nlm.nih.gov/pubmed/21075037?tool=bestpractice.com
在一项系统评价中,颈椎神经根病的发病率为 0.832‰-1.79‰。[15]Mansfield M, Smith T, Spahr N, et al. Cervical spine radiculopathy epidemiology: a systematic review. Musculoskeletal Care. 2020 Dec;18(4):555-67.http://www.ncbi.nlm.nih.gov/pubmed/32710604?tool=bestpractice.com
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