AbstractTo explore whether the potential instability of the cervical spine and cervical muscle degeneration in patients with cervical spondylotic radiculopathy (CSR) affect the efficacy of cervical traction, and whether cervical traction can aggravate the potential instability of the cervical spine.

目的探讨神经根型颈椎病（CSR）患者颈椎潜在不稳定和颈椎肌肉退变是否影响颈椎牵引的疗效，以及颈椎牵引是否会加重颈椎潜在不稳定。

We divided the 113 recruited CRS patients into three groups based on the differences in horizontal displacement and abnormal angle, and measured the degree of cervical muscle degeneration in the patients through MRI. Considering functional scores, VAS, NDI and PCS scores of the three groups post-treatment were significantly improved.

我们根据水平位移和异常角度的差异将113例CRS患者分为三组，并通过MRI测量患者的颈部肌肉变性程度。考虑到功能评分，三组患者治疗后的VAS，NDI和PCS评分均显着改善。

Through the intergroup analysis, we found that the improvement in functional scores in the mild and moderate instability trend groups was better than that in the severe group. Through MRI measurements, we found that the degree of cervical muscle degeneration was significantly increased in the severe instability trend group.

通过组间分析，我们发现轻度和中度不稳定趋势组的功能评分改善优于重度组。通过MRI测量，我们发现严重不稳定趋势组的颈部肌肉变性程度显着增加。

Regarding the changes in X-Ray imaging parameters pre- and post-treatment, no significant differences were observed pre- and post-treatment. For patients with CSR, the more serious their predisposition for cervical instability was, the more severe the degree of cervical muscle degeneration was, which means the worse the curative effect was, but cervical traction did not aggravate the potential degree of cervical instability..

关于治疗前后X射线成像参数的变化，治疗前后没有观察到显着差异。对于CSR患者，他们的颈椎不稳倾向越严重，宫颈肌肉变性程度越严重，这意味着疗效越差，但颈椎牵引并未加重颈椎不稳的潜在程度。。

IntroductionCervical spondylotic radiculopathy (CSR) primarily results from the lateral protrusion of the intervertebral disc or the narrowing of the intervertebral foramen. This condition is characterized by degenerative cervical disease, manifesting as radiating pain and numbness in the neck, shoulders, and upper limbs.

引言神经根型颈椎病（CSR）主要由椎间盘外侧突出或椎间孔狭窄引起。这种情况的特征是退行性宫颈疾病，表现为颈部，肩部和上肢放射状疼痛和麻木。

As the population ages and lifestyles evolve, there is a growing prevalence of cervical spondylosis, with CSR constituting 60–70% of reported cases1. It has been reported that the annual incidence rate of CSR is approximately 1.79/10002. In recent years, the number of patients has increased year by year, with the onset of CSR gradually impacting younger populations, which has attracted extensive attention3.CSR is presently managed using a gradual approach, and it is advised to pursue conservative treatment initially.

随着人口年龄和生活方式的发展，颈椎病的患病率越来越高，CSR占报告病例的60-70%。据报道，CSR的年发病率约为1.79/10002。近年来，患者人数逐年增加，CSR的发作逐渐影响到年轻人群，这引起了广泛的关注3.CSR目前采用渐进的方法进行管理，建议最初采用保守治疗。

Surgical intervention is recommended for patients who do not respond to nonsurgical treatments or those experiencing severe clinical symptoms1. Lately, a guideline addressing cervical spondylotic radiculopathy highlighted that improvements in patient-reported pain have been linked to cervical halter traction, as well as combinations of medications, physical therapy, injections, and traction, as observed in uncontrolled case series4.The main content of diagnosing spinal instability is the loss of stability of functional spinal units (vertebrae, ligaments, and muscle complexes), which may lead to decreased elasticity, increased mobility, and abnormal movement5,6,7.

建议对非手术治疗无反应或出现严重临床症状的患者进行手术干预1。最近，一项针对神经根型颈椎病的指南强调，患者报告的疼痛改善与颈椎笼头牵引以及药物，物理治疗，注射和牵引的组合有关，如在不受控制的病例系列中所观察到的4。诊断脊柱不稳的主要内容是功能性脊柱单位（椎骨，韧带和肌肉复合体）的稳定性丧失，这可能导致弹性降低，活动性增加和异常运动5,6,7。

Since White et al.5 first reported the X-ray measurement method of cervical instability: (1) More than 3.5 mm horizontal displacement of one vertebra in relation to an adjacent vertebra, anteriorly or posteriorly, measured on resting lateral or flexion–extension roentgenograms of .

由于White等[5]首次报道了颈椎不稳的X射线测量方法：（1）在静息侧位或屈伸位X线片上测量，一个椎骨相对于相邻椎骨的前后水平位移超过3.5 mm。

1.

1.

Basic data: Age, sex, BMI, smoking history, alcohol consumption history, VAS scores, NDI scores, SF-36 scores and therapeutic efficacy rate;

基本数据：年龄，性别，BMI，吸烟史，饮酒史，VAS评分，NDI评分，SF-36评分和治疗有效率；

Smoking background: Individuals who have smoked more than one cigarette daily for over six months or those who have consumed more than 100 cigarettes in total. Alcohol usage history: Individuals who engage in drinking at least once a week for over half a year.The Visual Analog Score (VAS) was documented using an 11-point numeric rating scale ranging from zero (indicating no pain) to ten (representing the worst imaginable pain).

吸烟背景：六个月以上每天吸烟超过一支的人或总共吸烟超过100支的人。饮酒史：半年以上每周至少饮酒一次的人。视觉模拟评分（VAS）使用11分数字评分量表记录，范围从零（表示无疼痛）到十（表示可想象的最严重疼痛）。

Neck function was assessed using the Neck Disability Index (NDI). Patient evaluations encompassed pain intensity, self-care proficiency, weightlifting capability, reading aptitude, presence of headaches, concentration, work performance, sleep quality, driving, and engagement in recreational activities.

使用颈部残疾指数（NDI）评估颈部功能。患者评估包括疼痛强度，自我护理能力，举重能力，阅读能力，头痛，注意力，工作表现，睡眠质量，驾驶和参与娱乐活动。

The total NDI score was capped at 100, with higher scores indicative of poorer neck function.The Medical Outcomes Study Short-Form 36 (SF-36) comprises eight scales (vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning, and mental health), along with two summary measures: the Physical Component Summary (PCS) and the Mental Component Summary (MCS).Therapeutic effectiveness rate: Our study defines the therapeutic efficacy rate as a 20% decrease in the Neck Disability Index (NDI) following conservative treatment, considering that the minimal clinically important difference (MCID) in NDI has been previously documented to range between 15 and 17%, with a standard deviation of 17%.16,17..

NDI总分上限为100分，分数越高表示颈部功能越差。医学成果研究简表36（SF-36）包括八个量表（活力，身体机能，身体疼痛，一般健康感知，身体角色功能，情绪角色功能，社会角色功能和心理健康），以及两个总结指标：身体成分总结（PCS）和心理成分总结（MCS）。治疗有效率：我们的研究将治疗有效率定义为保守治疗后颈部残疾指数（NDI）下降20%，考虑到NDI的最小临床重要差异（MCID）先前已被记录在15%至17%之间，标准差为17%[16,17]。。

2.

2.

Cervical spinal parameters in X-rays: C2-C7 Cobb angle (CL), T1 slope (T1S), C2-7 sagittal vertical axis (SVA), CL (Flexion, F), CL (Extension, E), CL (Range of motion, ROM), horizontal displacement and abnormal angle. Meanwhile, the relevant parameters of the cervical vertebrae and spinal canal with the most obvious unstable trend were measured: Anteroposterior diameter of the vertebral body (AP), Sagittal developmental diameter of the cervical canal (SDD) and Pavlov ratio (SDD/AP)..

颈椎X线参数：C2-C7 Cobb角（CL），T1斜率（T1S），C2-7矢状纵轴（SVA），CL（屈曲，F），CL（伸展，E），CL（活动范围，ROM），水平位移和异常角度。同时测量不稳定趋势最明显的颈椎和椎管的相关参数：椎体前后径（AP）、颈椎管矢状径（SDD）和巴甫洛夫比（SDD/AP）。。

Standard radiographic techniques were employed for capturing lateral cervical radiographs. The tube-to-subject distance was set at 72 inches, and the radiographic tube was precisely centered at the C4–C5 intervertebral disc space, without any magnification. The lateral radiographs of the cervical spine were acquired with the patient in a comfortable standing position.

采用标准射线照相技术拍摄颈椎侧位X线片。管与受试者的距离设置为72英寸，射线管精确地位于C4-C5椎间盘空间的中心，没有任何放大。患者以舒适的站立姿势获得颈椎的侧位X线片。

During the procedure, the upper extremities were positioned naturally at the sides of the trunk, and the patient maintained a straight-ahead gaze.Cervical radiographs in flexion or extension were obtained with the patient positioned laterally in front of the camera frame. During the procedure, the patient maximally flexed or extended the head and neck, aligning the long axis of the neck parallel to the film's long axis.

在手术过程中，上肢自然位于躯干两侧，患者保持直视。患者横向放置在相机框架前面，获得了屈曲或伸展的颈椎X线照片。在手术过程中，患者最大程度地弯曲或伸展头部和颈部，使颈部长轴与胶片长轴平行。

Additionally, the shoulders were allowed to droop as much as possible. The imaging technician consistently captured all images, maintaining the same requirements as those for lateral films. Range of motion (ROM) was determined by calculating the difference between extension and flexion.Table 1 and Fig. 2 provide detailed explanations of the methods employed to measure cervical sagittal parameters in the radiographs.Table 1 The measuring methods of cervical sagittal parameters in the radiographs and MSCC, MCC, TA, TAR, CR, CCR in MRI.Full size tableFig.

此外，肩膀尽可能下垂。成像技术人员始终如一地拍摄所有图像，保持与侧面胶片相同的要求。通过计算伸展和屈曲之间的差异来确定运动范围（ROM）。表1和图2提供了用于测量射线照片中宫颈矢状面参数的方法的详细解释。表1 X线片中颈椎矢状面参数和MRI中MSCC，MCC，TA，TAR，CR，CCR的测量方法。全尺寸表图。

2Cervical spinal parameters with representative measurements in X-rays. (A) C2-C7 Cobb angle (CL), T1 slope (T1S), Anteroposterior diameter of the vertebral body (AP), Sagittal developmental diameter of the cervical canal (SDD). (B) C2-7SVA. (C) Horizontal displacement. (D) Abnormal angle.Full size imageFor assessing corresponding segmental paravertebral muscle degeneration on MRI, the following categories were considered: up(low)-fat/muscle,.

2在X射线中具有代表性测量的颈椎参数。（A） C2-C7 Cobb角（CL），T1斜率（T1S），椎体前后径（AP），颈椎管矢状发育直径（SDD）。（B） C2-7SVA。（C） 水平位移。（D） 异常角度。全尺寸图像为了评估MRI上相应的节段性椎旁肌变性，考虑了以下类别：上（低）-脂肪/肌肉，。

Data availability

数据可用性

The data that support the findings of this study are available from the corresponding author upon reasonable request.

根据合理的要求，通讯作者可以提供支持本研究结果的数据。

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Download referencesAuthor informationAuthor notesThese authors contributed equally: Taotao Lin, Zhitao Shangguan and Zhehao Xiao.Authors and AffiliationsDepartment of Orthopedics, Fujian Medical University Union Hospital, Fuzhou, ChinaTaotao Lin, Zhitao Shangguan, Rongcan Wu, Yujie Zhao, Dehui Chen, Linquan Zhou, Zhenyu Wang & Wenge LiuDepartment of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, ChinaZhehao XiaoAuthorsTaotao LinView author publicationsYou can also search for this author in.

下载参考文献作者信息作者注意到这些作者做出了同样的贡献：林涛，上官志涛和肖哲浩。作者和附属机构福建医科大学附属福州协和医院骨科林涛，上官志涛，吴荣灿，赵玉洁，陈德惠，周林泉，王振宇，刘文阁福建医科大学附属福州协和医院神经外科肖哲浩作者林涛观点作者出版物您也可以在中搜索作者。

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PubMed Google ScholarContributionsTL：Lead the writing of the original draft of the project and responsible for overall project management, including resource allocation and progress tracking. ZS: Offer innovative suggestions and strategic guidance during the conceptualization phase and contribute to the initial drafting of project content.

PubMed Google ScholarContributionsTL：领导项目初稿的撰写，负责项目的整体管理，包括资源分配和进度跟踪。ZS：在概念化阶段提供创新建议和战略指导，并为项目内容的初步起草做出贡献。

ZX: Responsible for collecting and organizing relevant data to provide reliable research support. RW, YZ and DC: Assist in developing formal analysis methods and standards to ensure accuracy and completeness. LZ and ZW: Lead the investigation phase, ensuring the project is based on thorough facts and information and responsible for reviewing and editing written content.

ZX：负责收集和组织相关数据，提供可靠的研究支持。RW、YZ和DC：协助制定正式的分析方法和标准，以确保准确性和完整性。LZ和ZW：领导调查阶段，确保项目基于彻底的事实和信息，并负责审查和编辑书面内容。

WL: Lead the overall conceptualization of the project, defining its core ideas and goals, provide professional guidance and support in methodology to ensure the team works according to specified methods and participate in the review and editing process, ensuring the quality and coherence of the final written material.

WL：领导项目的整体概念化，确定其核心思想和目标，在方法论上提供专业指导和支持，以确保团队按照指定的方法工作，并参与审查和编辑过程，确保最终书面材料的质量和一致性。

All authors read and approved the final manuscript.Corresponding authorCorrespondence to.

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Wenge Liu.Ethics declarations

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Reprints and permissionsAbout this articleCite this articleLin, T., Shangguan, Z., Xiao, Z. et al. Whether the potential degree of cervical instability and cervical muscle degeneration in patients with cervical spondylosis radicular affect the efficacy of cervical traction.

转载和许可本文引用本文Lin，T.，Shangguan，Z.，Xiao，Z。等人。神经根型颈椎病患者潜在的颈椎不稳定程度和颈椎肌肉变性是否会影响颈椎牵引的疗效。

Sci Rep 14, 20467 (2024). https://doi.org/10.1038/s41598-024-71429-9Download citationReceived: 31 March 2024Accepted: 28 August 2024Published: 03 September 2024DOI: https://doi.org/10.1038/s41598-024-71429-9Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

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KeywordsCervical spondylotic radiculopathyCervical tractionCervical instability tendencyCervical muscle degenerationCervical imaging parameters

关键词颈椎病神经根病颈椎牵引颈椎不稳倾向颈椎肌肉退行性病变颈椎成像参数

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