腰椎间盘突出症患者腰骶部多裂肌肌电的比较研究

目的:比较腰椎间盘突出症患者腰骶部多裂肌退变的情况。方法:2015年12月至2017年9月招募健康志愿者和单侧L_(4,5)腰椎间盘突出患者各35例,每组男20例,女15例,年龄25～55岁,其中健康志愿者组年龄(35.66±8.73)岁,BMI(21.85±1.94) kg/m~2;腰椎间盘突出症组年龄(36.09±7.70)岁,BMI(21.50±1.78) kg/m~2,VAS评分(4.40±0.88)分,病程(11.20±7.14)个月,对两组的多裂肌进行表面肌电图测定分析,通过分析平均肌电振幅数值,比较两组多裂肌观察指标的差异。结果:健康志愿者多裂肌平均肌电振幅左侧为(48.84±7.77)μV,右侧为(49.13±7.86)μV,两侧差异无统计学意义(P0.05);腰椎间盘突出症患者多裂肌平均肌电振幅健侧为(48.82±8.14)μV,患侧为(42.81±7.00)μV,两侧差异有统计学意义(P0.05)。腰椎间盘突出症健侧与健康志愿者左侧多裂肌的平均肌电振幅,腰椎间盘突出症健侧与健康志愿者右侧多裂肌的平均肌电振幅,差异均无统计学意义(P0.05);腰椎间盘突出症患者患侧与健康志愿者左侧多裂肌的平均肌电振幅,腰椎间盘突出症患者患侧与健康者愿者右侧多裂肌的平均肌电振幅,差异均有统计学意义(P0.05)。结论:慢性期腰椎间盘突出症患者存在肌电活动失衡,患侧多裂肌肌力较明显下降。     

椎旁肌群变化与腰椎间盘突出程度的相关性分析

目的探讨椎旁肌群变化与腰椎间盘突出程度的相关性,为腰椎间盘突出症的预防和早期干预提供依据。方法自2017年10月-2018年10月,随机纳入60例于我科就诊的腰腿痛或坐骨神经痛患者,均予以腰椎MRI检查,获取腰椎各节段的T2加权像横截面图像,测量多裂肌、最长肌和腰大肌的相对横截面积(Relative cross-sectional area,RCSA)和脂肪浸润程度(Degree of fat infiltration,DFF),椎间盘突出程度采用Pfirrmann标准进行分级。统计相关测量数据,并采用Spearman系数进行椎旁肌群RCSA和DFF值与椎间盘Pfirrmann分级的相关性分析。结果①腰椎间盘的Pfirrmann分级越高,多裂肌、最长肌和腰大肌的RCSA值越低、DFF值越高,差异有显著统计学意义(P0.01)。②经Spearman相关系数分析,多裂肌、最长肌和腰大肌的RCSA值均与椎间盘突出程度呈较强的相关性(P0.01),DFF值则与之呈中等程度的相关性(P0.05)。结论椎旁肌群的退变与腰椎间盘突出程度密切相关。其中,多裂肌、腰大肌和最长肌的相对横截面积与其呈较强的相关性,而脂肪浸润程度则与之呈中等程度相关性。     

腰椎间盘突出症患者腰骶部多裂肌脂肪变化的影像学研究

目的：比较腰椎间盘突出症患者腰骶部多裂肌退变情况。方法：招募健康志愿者和单侧L_4,5腰椎间盘突出患者各35例,每组男20例,女15例,年龄25~55岁。健康志愿者组年龄（35.66±8.73）岁,BMI指数（21.85±1.94）kg/m²;腰椎间盘突出症患者组年龄（36.09±7.70）岁,BMI指数（21.50±1.78）kg/m²,VAS评分（4.40±0.88）分,病程（11.2±7.14）个月,采用核磁共振波谱成像分析,观察L_4,5间隙腰骶部多裂肌脂肪比例、去脂肪化横截面积比例。结果：健康志愿者左侧多裂肌脂肪比例（0.169±0.035）%、去脂肪化横截面积比例（0.699±0.070）%和右侧多裂肌脂肪比例（0.168±0.031）%、去脂肪化横截面积比例（0.712±0.056）%比较,差异无统计学意义（P>0.05）。腰椎间盘突出症患者健侧多裂肌脂肪比例（0.173±0.021）%、去脂肪化横截面积比例（0.695±0.054）%和患侧多裂肌脂肪比例（0.228±0.027）%、去脂肪化横截面积比例（0.629±0.048）%比较,差异有统计学意义（P<0.05）。患者患侧与志愿者左右两侧多裂肌脂肪比例、去脂肪化横截面积比例比较,差异均有统计学意义（P<0.05）;患者健侧与健康志愿者左右侧多裂肌脂肪比例、去脂肪化横截面积比例比较,差异均无统计学意义（P>0.05）。结论：单侧L_4,5腰椎间盘突出症患侧腰骶部多裂肌存在退变,表现为多裂肌面积萎缩、脂肪浸润。     

腰椎间盘突出症影像学分析

[目的]探讨腰椎间盘突出症影像学的基本特征。[方法]结合临床，利用腰椎间盘突出症在影像学诊断中的基本表现加以分析，对58例患者影像检查的特征性改变，归类统计。[结果]腰椎间盘突出症是在椎间盘变性基础上的髓核疝出，其X线表现及CT／MRI表现有其基本特性。X线片以腰椎间隙不均匀变窄，椎体边缘骨质增生以及Schmorls结节有其特征：CT表现更具有特征，以其椎间盘后缘局限性突起，突出的CT值高于硬膜囊CT值和硬膜外脂肪移位为其特点改变。其MRI表现T1加权象信号强度与高信号强度的硬膜外脂肪及低信号强度的硬膜囊形成鲜明对比，诊断意义可以成为最佳影像手段。[结论]腰椎间盘突出症是腰椎常见的在椎间盘变性基础上的髓核疝出，其X线表现及CT／MRI表现有其定性诊断意义。     

临床症状与髓核突出左右不一致的腰椎间盘突出症的诊治

目的探讨腰椎间盘突出症导致非对称性下肢放射痛的可能原因及术式的选择。方法25例经SCT、MRI检查证实为突出侧与临床症状侧别左右不一致的腰椎间盘突出症患者，均行手术治疗，其中14例行双侧开窗减压探查髓核摘除术，11例仅行突出侧开窗术。结果影像学上髓核突出侧别与术中所见相吻合，但该侧神经根未见到明显压迫或炎性水肿等病理表现；而症状侧无髓核突出，5例神经根未发现异常表现，9例存在不同程度的炎性水肿，其中6例探查发现神经根与对侧髓核不同程度粘连。术后所有患者症状均得到缓解，经过1～5年（平均2．4年）的随访，均无复发。结论SCT结合MRI检查有助于此类腰椎间盘突出症的明确诊断。纤维环无破裂的突出型腰椎间盘突出症，单纯突出侧减压可以获得较好的治疗效果；纤维环破裂的游离型及脱出型腰椎间盘突出症，宜同时行对侧开窗探查。     

骨化性肌炎压迫胫神经致腰椎间盘术后残留小腿疼痛1例报告

腰椎间盘突出症术后遗留腰腿痛,很多是术前即有其它原因所致,因其椎间盘突出症状典型又有影象学佐证,其他原因为突出症状所掩盖,报道1例小腿骨化性肌炎压迫患侧胫神经所致腰椎间盘摘除后残留的小腿痛,经再次手术治愈.     

硬膜内腰椎间盘突出症

目的 探讨硬膜内腰椎间盘突出症的诊断与手术治疗方式,并对其发病机制进行讨论.方法 对5例硬膜内腰椎间盘突出症患者进行了手术治疗,男3例,女2例,年龄28～52岁,平均42岁,并经CT、MRI和手术证实,手术中采用半椎板切除或全椎板切除术,切开硬脊膜和蛛网膜,显露突出的椎间盘髓核组织,并仔细予以摘除,缝合硬脊膜切口,用脂肪、肌肉、或纤维蛋白凝胶覆盖.结果 尽管患者术前都有明显的神经症状,术后患者都取得了良好的效果,对病人进行了1～5年的随访,术前腰痛、下肢痛均缓解,明显改善了工作和生活质量.3例患者效果良好,恢复了原工作,其他2例患者术前出现了马尾综合征,仍残留一些神经症状,尿频尿急,会阴部感觉丧失,肌肉萎缩.结论 硬脊膜腹侧与后纵韧带粘连是造成硬膜内腰椎间盘突出的主要因素,硬膜内腰椎间盘突出术前很难诊断,通常诊断是在术中确定的,术前诊断应强调MRI的重要性,患者多需要紧急手术,因为神经预后与神经症状出现的时间有关,早期诊断和适当的手术治疗对于取得良好的效果是非常重要的.     

腰骶部多裂肌与腰椎间盘突出症关系的研究进展

腰椎间盘突出症是临床常见疾病,既往对腰椎间盘突出症的治疗多关注对椎间盘局部的治疗,如手术疗法及其他介入治疗等,但术后并发症及高复发率一直是相关专业领域内的难点问题。随着脊柱生物力学及解剖学的发展,对腰突症的研究也日益增多。研究者们发现腰椎间盘突出症的发病和转归与局部肌肉等软组织密不可分。而作为脊旁深层肌肉,多裂肌对腰椎椎体节段间的稳定性起到重要作用,其功能的异常可使腰椎的稳定性降低,而腰椎的慢性疾病也可导致多裂肌的萎缩。     

腰椎间盘突出症中医保守治疗的MRI观察

目的 :观察腰椎间盘突出症 (lumbardiscprotrusion ,LDP)中医保守治疗后突出椎间盘及其周围结构的形态变化。方法 :4 5例LDP病例经MRI确诊后进行中医保守治疗 (推拿、牵引、针灸、中药治疗 ) ,疗程结束后行腰椎MRI复查 ,评估治疗效果及治疗前后突出椎间盘及其周围结构的形态变化。结果 :中医治疗LDP的优良率为 82 2 2 % ;治疗前、后的腰椎间盘MRI信号强度、厚度、突出的程度、椎管前后径与横径、侧隐窝宽度、椎体终板疝的形态等均无明显差异。结论 :中医保守疗法不能对腰椎间盘突出症的形态改变产生明显影响 ,但可有效缓解LDP患者的临床症状。     

腰椎间盘突出症与X线片测量指标的相关性研究

目的探讨单节段腰椎间盘突出症患者腰椎侧位X线片测量指标与腰椎间盘突出程度的相关性。方法回顾性分析自2016-01-2018-12诊治的60例单节段腰椎间盘突出症患者资料,通过腰椎矢状位MRI进行椎间盘退行性改变Pfirrmann分级,在腰椎侧位X线片上测量腰椎曲线指数、腰椎Cobb角、骶骨倾斜角、椎体后缘切线角及椎间隙高度,采用多元线性回归分析Pfirrmann分级与X线片测量指标之间的相关性。结果随着Pfirrmann分级增加,患者腰椎曲线指数、腰椎Cobb角、椎间隙高度逐渐减小,差异有统计学意义(P 0.05)。不同Pfirrmann分级患者的骶骨倾斜角、椎体后缘切线角比较差异无统计学意义(P0.05)。腰椎曲线指数、腰椎Cobb角、椎间隙高度与Pfirrmann分级呈负相关。多元线性回归分析结果显示,腰椎曲线指数(P=0.002)、腰椎Cobb角(P=0.001)、椎间隙高度(P=0.001)是椎间盘退行性改变Pfirrmann分级的独立影响因素。结论临床上测量单节段腰椎间盘突出症患者侧位X线片上腰椎曲线指数、腰椎Cobb角、椎间隙高度对于腰椎间盘突出症诊断具有重要意义。     

Is level- and side-specific multifidus asymmetry a marker for lumbar disc pathology?

Background context

Several reports suggest that level- and side-specific multifidus atrophy or fat infiltration may be related to localized spinal pathology and symptoms. In particular, a study using a porcine model reported rapid level- and side-specific multifidus atrophy and adipocyte enlargement resulting from anterolateral disc or nerve root lesions.

Purpose

To investigate asymmetry in cross-sectional area (CSA) and fat infiltration in multifidus and other paraspinal muscles in patients with acute or subacute unilateral symptoms of radiculopathy and concordant posterolateral disc herniation. If multifidus asymmetry is indeed related to local pathology, this may serve as a marker for helping to target the search for less clearly identifiable pathology responsible for low back–related symptoms, which currently remains elusive in approximately 85% of those seeking care.

Study design

Cross-sectional observational study.

Patient sample

Subjects were patients referred to magnetic resonance imaging (MRI) with unilateral leg symptoms of less than 6 weeks onset suggestive of radiculopathy, with a consistent posterolateral lumbar disc herniation verified on imaging.

Methods

Using T2-weighted axial MRI, measurements were obtained for total muscle CSA and signal intensity, functional (fat-free) CSA, and the ratio of functional CSA to total CSA.

Results

Forty-three subjects met the inclusion criteria. The ratio of functional CSA to total muscle CSA was smaller on the side of the herniation than on the unaffected side, both below (mean 0.69 vs. 0.72, p=.007) and at the level of herniation (mean 0.78 vs. 0.80, p=.031). Multifidus signal intensity (fat infiltration) was greater on the side of the herniation at the level below the herniation (p=.014). Contrary to expectation, greater total multifidus CSA was found ipsilateral to the pathology at the level of herniation (p=.033). No asymmetries were found at the level above the herniation or in any other paraspinal muscles, with the exception of higher signal in the erector spinae at the level and side of herniation.

Conclusions

Multifidus may be particularly responsive to, or indicative of, localized lumbar disc or nerve root pathology within the first 6 weeks of symptoms as expressed through fat infiltration, but not through CSA asymmetry on MRI. However, such measurements are not reliable markers of lumbar pathology on an individual basis for use in clinical or research settings.     

Paraspinal muscle asymmetry and fat infiltration in patients with symptomatic disc herniation

Purpose

To investigate asymmetry in size and composition of the multifidus and erector spinae in patients with posterolateral disc herniation and concordant radicular symptoms, and determine whether symptom duration is associated with degree of asymmetry.

Methods

Thirty-three patients diagnosed with posterolateral disc herniation at L4–L5 verified on imaging and concordant leg pain were included. Multifidus and erector spinae cross-sectional area (CSA), functional cross-sectional area (FCSA, fat-free area), signal intensity and ratio of FCSA to total CSA were measured bilaterally from T ₂-weighted axial magnetic resonance imaging (MRI) at L3–L4, L4–L5, L5–S1 and S1 levels.

Results

No side-to-side differences in multifidus CSA, FCSA, and ratio of FCSA/CSA reached statistical significance at any spinal level. The multifidus signal intensity at L5–S1 was significantly greater (more fatty infiltration) on the side of the disc herniation. The erector spinae FCSA (lean muscle mass) at L5–S1 was found to be significantly smaller on the side of the herniation and the ratio of FCSA/CSA was smaller (more fatty infiltration) on the side of the herniation at L4–L5 and L5–S1. The degree of muscle asymmetry was not associated with symptoms duration.

Conclusions

There was no significant asymmetry of the multifidus at spinal level above, same or level below the disc herniation. Instead, variations in muscle composition were observed, with greater fat infiltration on the side and at spinal levels adjacent to the disc herniation. Muscle asymmetry was not correlated with symptom duration.

     

Histochemistry and morphology of the multifidus muscle in lumbar disc herniation: comparative study between diseased and normal sides

STUDY DESIGN: This comparative study was conducted on 19 patients (13 men and 6 women) with lumbar disc herniation (LDH). The histologic and histochemical differences and changes in the back muscles of the diseased and normal sides were evaluated. OBJECTIVES: To determine the histologic differences in the back muscles between the diseased and normal sides in lumbar disc herniation. SUMMARY OF BACKGROUND DATA: The morphologic changes of back muscles between the diseased and normal sides in lumbar disc herniation were examined using histologic and histochemical methods. Few studies have reported the difference in these changes based on quantitative analyses. METHODS: All samples were harvested bilaterally from the multifidus muscle at the level of L4-L5 or L5-S1 in patients with lumbar disc herniation and then were examined by histologic and histochemical methods (hematoxylin-eosin, Gomori trichrome, NADH-TR, and ATPase stains). The percentage, cross-sectional area (CSA), and lesser diameter (LD) of muscle fibers were measured using computerized image analysis. The Wilcoxon, paired t, Kruskal Wallis, and Fisher tests were used for statistical analysis. RESULTS: Both Type I and II fibers in the diseased side were significantly smaller than those from the normal side. In the diseased side, the potential strength of Type II fibers was weakened. Some pathologic changes (fiber type grouping, small angulated fibers, group atrophy, moth-eaten appearance, and internal nuclei, etc.) in the diseased side were more obvious than those in the normal side. When the straight leg raising test results were abnormal, both Type I and II fibers in the diseased side were smaller than those in the normal side. The Type I fibers of the diseased side were significantly smaller when the patients had symptoms of central low back pain. The size of the Type I fibers as well as of the Type II fibers did not differ between the diseased and normal sides in patients with unilateral and bilateral low back pain. CONCLUSIONS: The present study indicated that there were differences in the characteristics of the multifidus muscle between the diseased and normal sides in patients with lumbar disc herniation. The changes in muscle characteristics primarily were related to the disc protrusion. In addition, different locations of the low back pain seemed to cause different secondary effects on the muscle characteristics.     

Histochemical changes in the multifidus muscle in patients with lumbar intervertebral disc herniation

STUDY DESIGN: The histochemical changes in the multifidus muscle in 29 patients with L4-L5 lumbar intervertebral disc herniation were studied. OBJECTIVES: To clarify how nerve root impairment affects the histochemical properties of the lumbar multifidus muscle in patients with lumbar intervertebral disk herniation. SUMMARY OF BACKGROUND DATA: There have been several studies on histochemical changes in lumbar muscles in patients with nerve root impairment, but the findings concerning changes in muscle fiber sizes vary among investigators. METHODS: Biopsy specimens were obtained intraoperatively from the L4 and L5 bands of the multifidus muscle on the affected and nonaffected sides. The specimens were stained with ATPase to evaluate the size of the fibers and structural changes. RESULTS: In the L5 muscle band, the mean sizes of Type 1 and Type 2 fibers on the affected side were significantly smaller than those on the nonaffected side (Type 1: P < 0.01, Type 2: P < 0.001). The decrease in size was 6.4% for Type 1 and 9.8% for Type 2. Increased percentages of Type 1 fibers and a high incidence of small angular fibers and fiber type grouping were also shown on the affected side. In contrast, in the L4 muscle band, no side-to-side differences in the histologic findings were observed. There was no significant level-to-level difference in the mean size of Type 1 or Type 2 fibers on either the affected or the nonaffected side. CONCLUSIONS: These results suggest that nerve root impairment leads to atrophy of Type 1 and Type 2 fibers, with structural changes in the multifidus muscle only at the involved level.     

腰椎间盘突出症根性征的影像学表现分析

目的:探讨使用MRM诊断腰椎间盘突出症神经根性受压症状体征的价值及技术方法.方法:选择根性征阳性及阴性共2组腰椎间盘突出症患者,进行常规CT或MRI及MRM扫描,资料进行分析.结果:神经根受压症状体征对MRM图像上神经根鞘袖内脑脊液截断征象有显著影响(P<0.01),对硬膜囊有无压迹无显著影响(P>0.05),对神经根鞘袖走行正常与改变无显著影响(P>0.05),MRM图像上神经根鞘袖受压、不受压患者MRI显示椎间盘突出大小无显著差异(P>0.05).结论:MRM较MRI或CT能更真实的反映腰椎间盘突出症患者神经根受压状态,与临床症状体征较一致,是CT或MRI的重要补充.     

Magnetic resonance imaging and histologic evidence of postoperative back muscle injury in rats

STUDY DESIGN: Postoperative back muscle injury was evaluated in rats by magnetic resonance imaging and histologic analyses. OBJECTIVE: To compare the magnetic resonance imaging manifestation of back muscle injury with the histologic findings in rats and to subsequently clarify the histopathologic appearance of the high intensity regions on T2-weighted images in human postoperative back muscles. SUMMARY OF BACKGROUND DATA: In a previous study, it was found that the signal intensity on T2-weighted images of the postoperative back muscles was increased in patients who had postsurgical lumbar muscle impairment, especially in those with a prolonged surgery duration. However, the specific histopathologic changes that cause the high signal intensity on T2-weighted images remain unclear. METHODS: Rats were divided into three groups: sham operation group, 1-hour retraction group, and 2-hour retraction group. Magnetic resonance imaging and histology of the multifidus muscles were examined before surgery and at 2, 7, and 21 days after surgery. RESULTS: T2-weighted imaging was more useful than T1-weighted imaging to estimate back muscle injury. The high signal intensity of the multifidus muscles on T2-weighted images remained 21 days after surgery only in the 2-hour retraction group. Histologically, the regeneration of the multifidus muscles was complete at 21 days after surgery in the 1-hour retraction group, but the regenerated muscle fibers in the 2-hour retraction group had a small diameter, and the extracellular fluid space remained large. CONCLUSION: The high signal intensity on T2-weighted images of the postoperative multifidus muscles in the regenerative phase may be due to an increased extracellular space and incomplete muscle fiber regeneration.     

Biomechanical changes in the lumbar spine following spaceflight and factors associated with postspaceflight disc herniation

Background ContextFor chronic low back pain, the causal mechanisms between pathological features from imaging and patient symptoms are unclear. For instance, disc herniations can often be present without symptoms. There remains a need for improved knowledge of the pathophysiological mechanisms that explore spinal tissue damage and clinical manifestations of pain and disability. Spaceflight and astronaut health provides a rare opportunity to study potential low back pain mechanisms longitudinally. Spaceflight disrupts diurnal loading on the spine and several lines of evidence indicate that astronauts are at a heightened risk for low back pain and disc herniation following spaceflight.PurposeTo examine the relationship between prolonged exposure to microgravity and the elevated incidence of postflight disc herniation, we conducted a longitudinal study to track the spinal health of twelve NASA astronauts before and after approximately 6 months in space. We hypothesize that the incidence of postflight disc herniation and low back complaints associates with spaceflight-included muscle atrophy and pre-existing spinal pathology.Study DesignThis is a prospective longitudinal study.Patient SampleOur sample included a cohort of twelve astronaut crewmembers.Outcome MeasuresFrom 3T MRI, we quantified disc water content (ms), disc degeneration (Pfirrmann grade), vertebral endplate irregularities, facet arthropathy and/ fluid, high intensity zones, disc herniation, multifidus total cross-sectional area (cm²), multifidus lean muscle cross-sectional area (cm²), and muscle quality/composition (%). From quantitative fluoroscopy we quantified, maximum flexion-extension ROM (°), maximum lateral bending ROM (°), and maximum translation (%). Lastly, patient outcomes and clinical notes were used for identifying postflight symptoms associated with disc herniations from 3T MRI.MethodsAdvanced imaging data from 3T MRI were collected at three separate time points in relation to spending six months in space: (1) within a year before launch (“pre-flight”), (2) within a week after return to Earth (“post-flight”), and (3) between 1 and 2 months after return to Earth (“recovery”). Fluoroscopy of segmental kinematics was collected at preflight and postflight timepoints. We assessed the effect of spaceflight and postflight recovery on longitudinal changes in spinal structure and function, as well as differences between crew members who did and did not present a symptomatic disc herniation following spaceflight.ResultsHalf of our astronauts (n=6) experienced new symptoms associated with a new or previously asymptomatic lumbar disc protrusion or extrusion following spaceflight. We observed decreased multifidus muscle quality following spaceflight in the lower lumbar spine, with a reduced percentage of lean muscle at L4L5 (-6.2%, p=.009) and L5S1 (-7.0%, p=.006) associated with the incidence of new disc herniation. Additionally, we observed reduced lumbar segment flexion-extension ROM for L2L3 (-17.2%, p=.006) and L3L4 (-20.5%, p=.02) following spaceflight, and furthermore that reduced ROM among the upper three lumbar segments (-24.1%, p=.01) associated with the incidence of disc herniation. Existing endplate pathology was most prevalent in the upper lumbar spine and associated with reduced segmental ROM (-20.5%, p=.02).ConclusionsIn conclusion from a 10-year study investigating the effects of spaceflight on the lumbar spine and risk for disc herniation, we found the incidence of lumbar disc herniation following spaceflight associates with compromised multifidus muscle quality and spinal segment kinematics, as well as pre-existing spinal endplate irregularities. These findings suggest differential effects of spinal stiffness and muscle loss in the upper versus lower lumbar spine regions that may specifically provoke risk for symptomatic disc herniation in the lower lumbar spine following spaceflight. Results from this study provide a unique longitudinal assessment of mechanisms and possible risk factors for developing disc herniations and related low back pain. Furthermore, these findings will help inform physiologic countermeasures to maintain spinal health in astronauts during long-duration missions in space.