頸椎椎間盤突出症及其職業因素之探討

Clinical Manifestations of Cervical Disc Herniation and Its RelatedOccupational Factors

黃善凱(Shan-Kai Huang) ； 王建楠(Jian-Nan Wang) ； 蘇世斌(Shih-Bin Su)

《中華職業醫學雜誌》 14卷4期 (2007/10) Pp. 237-246

https://doi.org/10.30027/CJOM.200710.0003

摘要

頸椎椎間盤突出症常見於四十至五十歲的人，大多數是因為年齡老化、頭部長期負重或承受垂直震動外力所引起，整體而言，頸椎椎間盤突出之所以較腰椎椎間盤突出少見，可能是因為構成頸椎椎間盤的物質較少，及頸椎所承受的力量較輕。不過頸椎椎間盤突出症的主要三大臨床症狀：頸部疼痛、神經根病變及脊髓病變，確實帶給人們生活上不少的困擾和疑惑，由於許多疾病的症狀及徵象可能與頸椎椎間盤突出症狀類似，因此初步的鑑別診斷便有其必要性。
頸椎椎間盤突出，不只是一個簡單的機械物理變化，同時形成過程中還包括椎間盤的發炎反應，而導致發炎物質如MMP-3，IL-6，及PGE-2的增加。另外藉由觀察頸部椎間盤突出的過程型態，可提供我們對於頸椎椎間盤突出的分類及手術的考慮範圍，有更為詳盡的參考或計劃。至於頸椎椎間盤突出的診斷，首先需要仔細的病史詢問、理學檢查及神經學檢查，之後才利用脊髓造影、磁振造影、電腦斷層或電腦斷層脊髓造影幫忙做進一步的確定，其鑑別診斷需要先排除急性且嚴重的問題，如脊髓感染或腫瘤等。針對頸椎椎間盤突出的治療，第一線常使用非類固醇類消炎藥來減緩疼痛及消炎，若神經學症狀無改善而繼續惡化時，則建議接受磁振造影的檢查。如果內科保守性治療六至十二週仍無效時，則考慮手術治療。
頸椎椎間盤突出的職業流行病學研究發現，頸椎椎間盤的退化或突出與使用頭部負重的程度及時間、承受全身垂直震動及年齡老化有關，而駕駛、工作所持姿勢或電腦工作與此疾病相關的證據尚不充足。

關鍵字

頸椎椎間盤突出 ； 神經根病變 ； 脊髓病變 ； 脊髓造影

並列摘要

Cervical disc herniation (CDH) is common for people between ages 40 and 50, and its main cause is old age, long-term head loading, or suffering vertical vibrating force. Generally speaking, CDH is less common than lumbar disc herniation, because of less disc material in the cervical spine and substantially less force across the cervical spine. There are three main clinical manifestations of CDH, cervical pain, radiculopathy, and myelopathy, which do disturb people. The symptoms and signs of many other diseases are much similar to CDH's; therefore, the initial differential diagnosis is necessary.
CDH is not only a simple physical change of mechanical process, but also an inflammatory process of the cervical interverterbral discs, leading to increased inflammatory substances such as MMP-3, IL-6 and PGE-2. Additionally, with the CDH forming process observed, CDH categorization and surgery specific location determination can be planned more completely. Diagnosis of CDH preliminarily needs history detailedly-taking, physical checkup, and neurological examination before the diagnosis is confirmed manipulating myelography, MRI, CT or CT myelography. The differential diagnosis primarily needs ruling out acute and serious problems such as spinal infection and tumors. After the said ruled out, the first line treatment for CDH is to use NSAIDs to reduce pain and inflammation status. If the neurological symptoms show no improvement and get exacerbated, MRI is suggested. Finally, if the conservative treatment of 6-12 weeks fails, surgical treatment is considered.
Moreover, cervical disc degeneration-or herniation-related factors found by the occupational epidemiology are the head loading and loading time, whole body vertical vibration, and old age, instead of the insufficiently proved factors-driving, posture or computer related job.

並列關鍵字

cervical disc herniation ； radiculopathy ； myelopathy ； myelography