退变性脊柱侧凸的研究进展

<正>退变性脊柱侧凸(degenerative scoliosis,DS)是指在骨骼发育成熟之后,因一个或多个椎间盘以及相应关节突出现不对称退行性变而导致的脊柱结构性侧凸,伴有非对称性的椎间隙塌陷、椎体旋转性半脱位或侧方滑移,在冠状面上形成侧凸,在矢状面表现为腰椎前凸消失及节段性后凸~([1])。患者既往没有脊柱畸形病史,因椎间盘等退变发病,不仅影响外观,更引起腰痛、下肢放射痛以及间歇性跛     

腰椎退变性侧凸患者椎间盘退行性变的影像学观测

目的:评价退变性腰椎侧凸患者椎间盘退变程度与腰椎侧凸角度、腰椎前凸角度的相关性.方法:本组共包括84例退变性腰椎侧凸患者(平均年龄为64.1±5.3岁),在X线片上测量其顶椎间盘(如顶椎为椎体则取该椎体下位椎间盘)及其相邻上下椎间盘(共252个椎间盘)的不对称指数,MRI T2加权像上测量椎问盘内髓核与脑脊液的平均相对信号强度.应用Spearmann相关性分析研究椎间盘不对称指数与腰椎侧凸角的相关性、平均相对信号强度与腰椎前凸角的相关性.结果:84例退变性腰椎侧凸患者中,凸侧三个椎间盘的高度平均为40.1±1.8mm:凹侧平均为38.3±1.1mm.凸凹侧椎同盘高度比较差异有显著性(P<.05).椎间盘不对称指数的平均值为0.042±0.018,经Spearman相关分析椎间盘不对称指数与侧凸Cobb角之间有明显正相关性(P<.05);T2加权像上退变性腰椎侧凸髓核平均相对信号强度Ⅰ级8例,Ⅱ级27例,Ⅲ级32例,Ⅳ级17例;经Spearman相关分析该平均相对信号强度与腰椎前凸Cobb角之间有相关性(P<.05).结论:退变性腰椎侧凸的侧凸角与椎间盘退变的不对称性程度存在正相关,腰椎前凸角减少与椎间盘退变程度有相关性.     

腰椎退变性疾病（续）

3 退变性腰椎滑脱 退变性腰椎滑脱是指因腰椎退变引起损害节段的上位椎 体向前或向后滑动;若伴有神经根压迫症状,称为退变性腰椎 滑脱症。 3.1 病理 由于腰椎椎间盘和两个小关节突关节软骨进行性退变, 关节囊及棘上、棘间韧带松弛,腰椎不稳,导致小关节突的相 互制约能力逐步减弱,损害节段的上位椎体向前或向后滑动, 但与峡部崩裂导致的椎体滑脱不同,退变性滑脱通常不超过 椎体前后径的30％,Ⅰ°为主,占90.5％,Ⅱ°仅占9.5％;后 者是椎节间丧失了制约关系,随着剪应力的加大,上位椎体前 滑脱可达Ⅱ°、Ⅲ °,甚至位移至下位椎体的前面。 发生退变性滑脱的椎节通常有节段性椎管狭窄,当两侧 关节突退变破坏不对称时,上位脊椎相对下位脊椎发生旋转, 导致侧隐窝和椎管变形和狭窄,引起相应的神经根压迫。     

退变性腰椎侧凸两侧椎间高度及关节突矢状角参数特点及其对侧凸的影响

目的:分析退变性腰椎侧凸骨性结构参数的特点及其与椎间盘-终板退变的相关性,探讨骨性结构参数对腰椎侧凸发生、发展的影响及意义。方法:选取120例原发性退变性腰椎侧凸患者的影像学资料作为病例组,同时期、同年龄段及同性别比例诊断为腰椎退变性疾病(除外腰椎侧凸)的89例患者的影像学资料作为对照组。分别测量两组患者椎体和椎间两侧高度及两侧关节突矢状角,计算椎体和两侧椎间平均高度及两侧关节突平均矢状角作为骨性结构参数。测量病例组患者的腰椎侧凸角及前凸角。采用pffirman及Modic分级评分法对各个椎间盘及邻近终板退变程度进行量化。比较两组的骨性结构参数,分析骨性结构参数与椎间盘-终板退变、腰椎侧凸角及前凸角的关系。结果:病例组凸凹侧骨性结构参数有显著性差异(P<0.05),呈不对称分布;对照组两侧骨性结构参数无显著性差异(P>0.05);两组间椎间盘-终板退变评分有显著性差异(P<0.05)。相关性分析显示,骨性结构参数不对称度与椎间盘-终板退变评分有相关性(P<0.05),与腰椎侧凸角呈正相关(0相似文献   

退变性脊柱侧凸长节段固定融合端椎选择的研究进展

正退变性腰椎侧凸(degenerative lumbar scoliosis,DLS)是指成年后由于椎间盘与小关节等不对称性退变引起的椎体侧方滑移、旋转以及半脱位,形成冠状面Cobb角10°的脊柱畸形,顶椎常为L2/3、L3/4椎间隙~([1])。随着老年人口的增长,DLS的发病率有明显上升趋势,并成为引起中老年人腰腿疼痛的重要原因之一。典型的临床表现为腰背部     

退变性脊柱侧凸症治疗所面临的几个问题

<正>退变性脊柱侧凸是由于椎间盘与小关节等退变引起的椎间隙塌陷、椎体旋转半脱位或侧方滑移在冠状面上形成的侧凸,Cobb角10°。主要发病于50岁以上,女性较常见。常有腰痛、神经根压迫或椎管狭窄引起的下肢痛和间歇性跛行等症状,影像学表现除冠状面上的脊柱侧凸外还伴有腰椎前凸消失、胸腰椎后凸等矢状面失衡[1]。矢状面平衡因与生存质量密切相关,手术恢复脊柱-骨盆矢状面平衡成为近年研究热点之一[2]。成人退变性脊柱侧凸的外科治疗重点在于彻底解除神经压迫、重建脊柱稳定与平     

退变性腰椎侧凸的影像学和临床特点的相关性研究

目的通过观察退变性腰椎侧凸的影像学和临床特点,探讨二者的相关性及密切程度,为退变性腰椎侧凸的预防和治疗提供理论依据。方法将退变性腰椎侧凸(degenerative lumbar scoliosis,DLS)腰腿痛视觉模拟评分(visual analogue scale,VAS)和国际脊柱侧凸社会生活质量调查表(scoliosis research society-22,SRS-22)与影像学参数采用多元线性回归分析。结果 a)腰痛与相邻椎体的最大侧方位移、腰椎稳定性、椎间孔的面积、腰椎前凸角有显著相关性;下肢痛与腰椎间孔的面积、顶椎的椎体旋转度、椎管的面积有显著相关性;生活质量SRS-22评分与腰椎间孔的面积、腰椎的稳定性、椎管的面积、腰椎前凸角、椎体的侧方位移、顶椎的旋转度有显著相关性。b)在经充分减压,稳定脊柱的基础上,腰痛的改善率与腰椎最大的侧方位移和腰椎前凸角的矫正率有显著相关性,下肢痛的改善率与顶椎的旋转度和椎体的侧方位移的矫正率有显著相关性,生活质量SRS-22评分与腰椎前凸角、顶椎的旋转度和椎体的侧方位移的矫正率有显著相关性。结论 a)腰椎间孔的面积、腰椎的稳定性、顶椎的旋转度、椎管的面积、腰椎前凸角与临床症状有显著相关性。b)手术充分减压、稳定脊柱、恢复腰椎的前凸角、改善顶椎的旋转度和最大侧方位移是获得良好疗效的有力保障。     

退变性脊柱侧凸椎间盘-终板退变与骨性结构参数的相关性研究及意义

目的 分析退变性脊柱侧凸椎间盘-终板退变与骨性结构参数的关系,探讨其在退变性脊柱侧凸发病机制中的作用及意义.方法 回顾分析2005年3月至2010年3月诊治的79例退变性脊柱侧凸患者(病例组)的影像学资料,选取41例诊断为特发性脊柱侧凸患者(对照组)的影像学资料做为对照.所有患者以主弯内的椎体及附件为观测对象,分别测量椎体和椎间两侧高度及两侧关节突关节面矢状角角度,分别计算椎体和椎间两侧平均高度及两侧关节突关节面平均矢状角作为骨性结构参数.采用分级评分法对各个椎间盘及邻近终板退变程度进行量化,其分值代表椎间盘-终板退变的程度.组内比较各骨性结构参数,分析骨性结构参数的特点及其与椎间盘-终板退变和侧凸Cobb角的关系.结果 经配对t检验比较,病例组的椎间高度、椎体高度及关节面矢状角凸凹侧差异有统计学意义(t=3.411,2.623和2.085,P＜0.05);对照组的椎间高度凸凹侧差异有统计学意义(t =3.276,P＜0.01),椎体高度及关节面矢状角差异无统计学意义(t=1.572和1.493,P＞0.05).直线相关和多元回归分析显示,各骨性结构参数不对称度与椎间盘-终板退变有显著相关性(-1 ＜r＜1,P ＜0.05),与腰椎侧凸Cobb角呈正相关(0＜r＜1,P＜0.05),且存在直线回归关系(F=427.342,P＜0.01),其回归方程为Cobb角=-8.904+8.136×椎间不对称度+3.274×椎体不对称度-0.713×关节突不对称度.结论 退变性脊柱侧凸两侧骨性结构呈不对称改变,其不对称性与椎间盘-终板退变和脊柱侧凸相互关联;不对称骨性结构改变可能是侧凸渐进性发展的生物力学动力因素,而椎间盘-终板不对称退变可能有病因学意义.     

退变性腰椎侧凸椎体终板Modic改变的分布情况及其影响因素

目的:观察退变性腰椎侧凸患者终板Modic改变的分布情况,分析其相关影响因素及与腰痛的关系。方法:回顾分析2000年3月～2009年3月我院收治的126例退变性腰椎侧凸患者的影像学资料,采用VAS对患者腰痛程度进行评估。观察患者终板Modic改变的发生率、类型及分布特点;比较存在Modic改变与不存在Modic改变患者的VAS评分;分析Modic改变与椎间盘退变、终板倾斜度、腰椎侧凸角及体重指数间的相关性。结果:126例患者756个腰椎间盘中,69例(54.8%)124(18.2%)个椎间盘邻近终板存在Modic改变。存在Modic改变患者VAS评分5.5±2.0,不存在Modic改变患者VAS评分3.0±1.5,两者比较差异有显著性(P<0.01)。Modic分型:Ⅰ型有15例患者(11.9%)19个椎间盘退变(2.5%),Ⅱ型48例(38.1%)97个椎间盘退变(12.8%),Ⅲ型6例(4.8%)8个椎间盘退变(1.1%)。退变终板节段:L5/S1椎间盘32个(25.8%),L4/5椎间盘26个(21.0%),L3/4椎间盘9个(7.3%),L2/3椎间盘47个(37.9%),L1/2椎间盘6个(4.8%),T12/L1椎间盘4个(3.2%)。Modic改变发生于终板凹侧99(13.1%)个,发生于终板凸侧25(3.3%)个;凹侧与凸侧发生率比较差异有显著性(P<0.01)。Modic改变与椎间盘退变、终板倾斜度、腰椎侧凸角及体重指数存在显著相关性(P<0.05)。结论:Modic改变与椎间盘退变、终板倾斜度、腰椎侧凸角及体重指数之间存在相关关系;Modic改变以Ⅱ型多见,多发生于终板的凹侧,以L2/3、L5/S1和L4/5节段多发。     

退行性脊柱侧凸矢状位失衡评估与矫正策略的研究进展

<正>退行性脊柱侧凸(degenerative scoliosis,DS)是指人体骨骼发育成熟后,除外脊柱本身的疾病,例如创伤、肿瘤、感染等以及原有侧凸进展,因椎间盘、双侧的椎间小关节严重退变引发椎间隙非对称性塌陷、椎体旋转性半脱位或是侧方滑移,冠状面上形成大于10°的侧凸,矢状面上则表现为腰椎前凸消失及节段性后凸~([1])。目前,DS在老年人群的发生率已高达68%~([2~4]),对于保守治疗后仍存在腰痛、下肢放射痛的患者应行手术治疗。手术的主要目的是通过     

退行性腰椎侧凸生物力学的研究进展

退行性腰椎侧凸（DLS）的发生、发展与腰椎生物力学性能的改变关系密切。椎间盘、小关节以及腰椎肌肉群不同程度的退变均可能引起腰椎节段受力不平衡,形成腰椎侧凸,进而进一步增加腰椎承受的负重,并改变其受力方向,二者形成恶性循环,加重病情。该文就腰椎整体、椎间盘、小关节以及腰椎肌肉群的生物力学性能改变及其与DLS之间的关系加以综述,为DLS的临床治疗提供理论基础。     

Are intravertebral vacuum phenomena benign lesions?

We retrospectively reviewed plain radiographs from patients with four different diseases that can cause vertebral collapse: osteoporotic vertebral collapse, spinal infection, spinal metastasis, and multiple myeloma. The objective of the study was to find the percentages of intravertebral vacuum phenomena and vertebral collapse rates in the four groups. The vacuum phenomenon is often observed in osteoporotic compression fractures. However, these phenomena are rarely seen in spinal infection and malignant lesions. Whether the vacuum phenomenon is a benign indicator is not known. We retrospectively reviewed plain radiographs from four groups of patients, including 328 osteoporotic vertebral collapse patients, 317 spinal infection patients, 302 spinal metastasis patients, and 325 multiple myeloma patients. The pattern and occurrence rates of intravertebral vacuum phenomena and vertebral body collapse were analyzed. The occurrence rate of intravertebral vacuum phenomena in patients with osteoporotic vertebral collapse was approximately 18.9%. Only one case of intravertebral vacuum phenomena was observed in patients with spinal infection. Vacuum phenomena were not observed in patients with spinal metastasis. The occurrence rate of intravertebral vacuum phenomena in patients with multiple myeloma was 6.4%. The patterns of intravertebral vacuum phenomena were also analyzed. Intravertebral vacuum phenomena are common in patients with osteoporotic vertebral collapse. Most cases of intravertebral vacuum phenomena are of a benign nature. Moreover, intravertebral vacuum phenomena occur extremely rarely in patients with spinal infection. Such phenomena are also found in patients with multiple myeloma.     

锁定式颈椎融合器治疗单节段颈椎间盘突出症

目的探讨应用颈椎前路减压结合锁定式颈椎融合器治疗单节段颈椎间盘突出症的临床疗效。方法 21例单节段颈椎间盘突出症应用颈椎前路减压加锁定式颈椎融合器植骨融合术治疗,并对其疗效进行评价。结果所有病例随访12~24个月,平均17.6个月。6个月后椎体间均达到骨性融合,无并发症出现,脊髓功能状态评分术后1个月及术后6个月优良率分别达66.67%、85.71%。结论应用颈椎前路减压结合锁定式颈椎融合器治疗单节段颈椎间盘突出症疗效肯定。     

Segmental vertebral rotation in early scoliosis

Summary In order to investigate the development of the vertebral axial rotation in patients with early scoliosis, the vertebral rotation angle (VRA) was quantified on the basis of 132 anteroposterior radiographs obtained from patients with diagnosed or suspected scoliosis. The rotation was measured in the apical vertebra and in the two suprajacent and two subjacent vertebrae. The radiographic material was divided into a control reference group and three scoliotic groups with varying Cobb angle from 4° up to 30°. In the reference group a slight vertebral rotation was significantly more often seen to the right. In the scoliotic groups, the rotation was most pronounced in the apical segments. The mean VRA toward the convex side was significantly increased in the vertebrae just suprajacent to the apex in curves with a Cobb angle of 8°–15° and in the cranial four vetebrae in curves with a Cobb angle of 16°–30°. Atypical vertebral rotation to the opposite side of the major curve was observed in 12.8% of the cases. There was a significant positive correlation between the VRA and the Cobb angle. These results show that a slight VRA to the right is a common feature in the normal spine, and that the VRA increases with progressive lateral deviation of the spine. It is concluded that the coronal plane deformity in early idiopathic scoliosis is accompanied and probably coupled to vertebral rotation in the horizontal plane.     

Differential diagnosis of early scoliosis in Scheuermann's disease and idiopathic scoliosis (author's transl)

In order to avoid overtreatment or undertreatment of a beginning scoliosis early differentiation of the clinically unimportant concomitant scoliosis of Scheuermann's disease is essential as against early idiopathic scoliosis, spondyloepiphyseal dysplasia and the fixed round back deformity of adolescents. Scheuermann's scoliosis as opposed to idiopathic scoliosis is characterised by the almost complete lack of vertebral rotation (as with spondyloepiphyseal dysplasia), by a localized unilateral narrowing of the intervertebral space in the a.p. x-ray, as well as by a slight Z- or E-pattern, and a relative shortness of the curves. Simultaneous dorsal kyphosis may be absent. Indispensable is furthermore, the familiarity with the early x-ray signs of Scheuermann's disease in the lateral view as compared with the X-ray of the fixed roundback.     

Analysis of vertebral morphology in idiopathic scoliosis with use of magnetic resonance imaging and multiplanar reconstruction

BACKGROUND: Several studies have provided data on the vertebral morphology of normal spines, but there is a paucity of data on the vertebral morphology in patients with idiopathic scoliosis. METHODS: The morphology of the pedicles and bodies of 307 vertebrae as well as the distance between the pedicles and the dural sac (the epidural space) in twenty-six patients with right-sided thoracic idiopathic scoliosis were analyzed with use of magnetic resonance imaging and multiplanar reconstruction. RESULTS: A distinct vertebral asymmetry was found at the apical region of the thoracic curves, with significantly thinner pedicles on the concave side than on the convex side (p < 0.05). The degree of intravertebral deformity diminished farther away from the apex, with vertebral symmetry restored at the neutral level. In the thoracic spine, the transverse endosteal width of the apical pedicles measured between 2.3 mm and 3.2 mm on the concave side and between 3.9 mm and 4.4 mm on the convex side (p < 0.05). In the lumbar spine, the pedicle width measured between 4.6 mm at the cephalad part of the curve and 7.9 mm at the caudad part of the curve. The chord length and the pedicle length gradually increased from 34 mm and 18 mm, respectively, at the fourth thoracic vertebra to 51 mm and 25 mm, respectively, at the third lumbar vertebra. The transverse pedicle angle measured 15 in the cephalad aspect of the thoracic spine, decreased to 7 at the twelfth thoracic vertebra, and increased again to 16 at the fourth lumbar vertebra. The width of the epidural space was <1 mm at the thoracic apical vertebral levels and averaged 1 mm at the lumbar apical vertebral levels on the concave side, whereas it was between 3 mm and 5 mm on the convex side (p < 0.05). CONCLUSION: Idiopathic scoliosis is associated with distinctive intravertebral deformity, with smaller pedicles on the concave side and a shift of the dural sac toward the concavity.     

Kümmell病的影像学诊断分析

目的 :探讨骨质疏松性Kümmell病的影像学特征对其诊断价值。方法 :2010年5月至2014年5月共收治经病理证实的Kümmell病患者16例,男4例,女12例;年龄67~83岁,平均73.4岁;腰背部疼痛病史2个月~3年,平均4.7个月。回顾性分析所有病椎X线片,CT横断位、矢状位和冠状位重建与MRI矢状位T1WI、T2WI及STIR影像学资料。结果:正侧位X线片病椎可见线形透亮线样"椎体裂缝征",CT可见椎体内伴有气体和(或)液体的空壳样改变,MRI提示椎体出现边界完整的液体信号区域。结论:骨质疏松性Kümmell病影像学表现具有一定特异性,结合临床发病特点,为早期明确诊断提供依据。     

The impact of degenerative disc disease on regional volumetric bone mineral density (vBMD) measured by quantitative computed tomography

BACKGROUND CONTEXTIt has been reported that degenerative disc disease (DDD) is associated with higher spinal bone mineral density (BMD) based on previous studies that used dual X-ray absorptiometry (DXA). However, DDD is often associated with proliferative bone changes and can lead to an overestimation of BMD measured with DXA. Trabecular volumetric BMD (vBMD) in the vertebral body measured with quantitative computed tomography (QCT) is less affected by those changes and can be a favorable alternative to DXA for patients with degenerative spinal changes.PURPOSEThe purpose of this study is to investigate the effect of DDD on regional trabecular vBMDs in the vertebral body measured by QCT.STUDY DESIGN/SETTINGCross-sectional observational study at a single academic institution.PATIENTS SAMPLEConsecutive patients undergoing posterior lumbar spinal fusion between 2014 and 2017 who had a routine preoperative CT scan and magnetic resonance imaging (MRI) within a 90-day interval.OUTCOME MEASURESRegional trabecular vBMDs in the vertebral body by QCT.METHODSQCT measurements were conducted in L1–S1 vertebral trabecular bone. Any apparent sclerotic lesions that might affect vBMD values were excluded from the region of interest. The vBMDs of each level were defined as the average vBMD of the upper and lower vertebrae. To evaluate DDD, Pfirrmann grade, Modic grade, total end plate score, and vacuum phenomenon were documented. Univariate regression analysis and multivariate analyses with a linear mixed model adjusted with individual variability of segmental vBMDs were conducted with vBMD as the response variable.RESULTSOf 143 patients and 715 disc levels, 125 patients and 596 discs met our inclusion criteria. Mean vBMD (±standard deviation [SD]) of all levels was 119.0±39.6 mg/cm³. After adjusting for all covariates, Pfirrmann grade was not an independent contributor to vBMD, but the presence of any Modic change (type 1, β=6.8, p≤.001; type 2, β=6.7, p<.001; type 3, β=43.6, p<.001), high TEPS (score 10–12, β=14.2, p<.001), or vacuum phenomenon (β=9.0, p<.001) was shown to be independent contributors to vBMD.CONCLUSIONSOur results showed that the presence of certain end plate lesions (Modic changes and high TEPS) on MRI was significantly associated with increased regional QCT-vBMDs in the vertebral body, but no significant association was observed with disc nucleus pathology, unless it was associated with a vacuum phenomenon. When end plate lesions with Modic changes and high TEPS are present at the measuring level, care must be taken to interpret vBMD values, which might be overestimations even if the trabecular area appears normal.     

Can a short spinal cord produce scoliosis?

Some patients with scoliosis have a relatively short vertebral canal. This poses the question of whether a short spinal cord may sometimes cause scoliosis. The present paper presents two observations that may support this concept. It presents a scoliosis model demonstrating what effect a short, unforgiving spinal cord might have on the spinal column. The model uses two flexible parallel tubes with the facility to tighten one. It demonstrates that a short, unforgiving spinal cord could produce the abnormal rotatory anatomy observed at the apex in scoliosis, with first lordosis, then lateral deviation and finally a rotation of the vertebral column, with the rotation occurring between the canal and the vertebral body, around the axis of the cord. The anatomy of the apical vertebra is described from two museum specimens, a computed tomography (CT) myelogram and seven magnetic resonance imaging (MRI) studies. The study confirms that the vertebral canal and the intervertebral foraminae retain their original orientation. The spinal cord is eccentric in the canal towards the concavity of the curve; the major component of rotation occurs anterior to the vertebral canal and the axis of this rotation seems to be at the site of the spinal cord. These observations do not establish that a short spinal cord will result in scoliosis, but the results are compatible with this hypothesis, and that impairment of spinal cord growth factors may sometimes be responsible for scoliosis.