成人腰椎峡部裂性滑脱症与退变性滑脱症患者脊柱骨盆矢状面形态学研究

【摘要】 目的：研究成人腰椎峡部裂性滑脱症与退变性滑脱症患者的脊柱骨盆矢状面形态。方法：选择2009年3月~2012年3月就诊且有完整影像学资料的腰椎峡部裂性滑脱症与退变性滑脱症患者共58例,其中峡部裂性滑脱（峡部裂组）29例,男9例,女20例,年龄23~67岁,Ⅰ度滑脱22例、Ⅱ度7例,L4滑脱16例、L5滑脱13例;退变性滑脱（退变组）29例,男5例,女24例,年龄45~85岁,Ⅰ度滑脱22例、Ⅱ度7例,L3滑脱3例、L4滑脱23例、L5滑脱3例。峡部裂组和退变组患者ODI评分分别为25.5分和22.0分,两组间无统计学差异（P＞0.05）。测量两组脊柱骨盆矢状面形态学指标,包括骨盆入射角（pelvic incidence,PI）、骨盆倾斜角（pelvic tilt,PT）、骶骨倾斜角（sacral slope,SS）、腰椎前凸角（lumber lordosis,LL）、胸椎后凸角（thoracic kyphosis,TK）、矢状面轴向垂直距离（sagittal vertical axis,SVA）。同时测量两组病例的腰椎滑脱角、滑脱率以及滑脱距离。采用独立样本t检验对两组患者的上述指标进行比较。结果：峡部裂组患者LL、TK和滑脱角分别为52.2°±10.9°、25.3°±11.1°、9.9°±6.4°,明显高于退变组的44.2°±15.4°、23.4°±12.6°、6.0°±3.9°（P＜0.05）;退变组患者SVA为30.6±40.6mm,明显高于峡部裂组的4.6±24.9mm（P＜0.01）。两组患者的骨盆形态学参数PI（峡部裂组53.9°±11.5°,退变组55.8°±10.8°）、PT（17.0°±8.3°,22.9°±7.2°）、SS（36.9°±8.7°,33.4°±9.9°）以及腰椎滑脱率[（21.8±9.8）%,（19.7±7.8）%]、滑脱距离（6.2±2.7mm,5.6±1.9mm）均无统计学差异（P＞0.05）。结论：成人腰椎峡部裂性滑脱症与退变性滑脱症患者具有相似的骨盆形态,但峡部裂性滑脱症患者较退变性滑脱症患者表现为更大的胸椎后凸、腰椎前凸以及滑脱角。     

关节面方向和终板倾斜角度对退变性腰椎滑脱的影响

目的：探讨退变性L4-5滑脱的生物力学机制。方法：测量L4-5关节面与椎体冠状面角度和L5终板倾斜的角度，并与同年龄组没有退变性腰椎滑脱的腰痛患者作对照。对有退变性滑脱病人的L4-5关节面与椎体冠状面角度和L5终板倾斜的角度与椎间隙的高度，腰椎的生理曲度进行相关性分析。结果：有L4-5退变性腰椎滑脱的患者L4关节面较对照组更偏向于矢状位，L5终板倾斜度的增大，L4-5关节面的角度变大与椎间盘高度的降低及L5终板倾斜角度增大与腰椎曲度的减小有相关。结论：在有L4-5退变性滑脱的病人中，L4-5关节面的方向更接近矢状位，L5椎体终板的倾斜度更大。     

腰椎人工椎间盘置换术治疗腰椎间盘退变性疾病的中长期疗效分析

【摘要】 目的：评定腰椎人工椎间盘置换术（TDR）治疗腰椎间盘退变性疾病的中长期疗效。方法： 1999年12月~2006年12月应用Charite SB Ⅲ假体进行腰椎人工椎间盘置换术治疗腰椎间盘退变性疾病患者65例,其中随访时间≥5年的患者48例,共52个假体。均在术前和末次随访时进行疼痛VAS评分和Oswestry功能障碍指数（ODI）评定,测量术前及末次随访时手术节段的活动度和椎间隙高度。对上述数据进行统计学分析。结果: 随访时间≥5年但＜10年患者（A组）33例,≥10年者（B组）15例。术前、末次随访时疼痛VAS评分,A组分别为94.0±6.3分、23.0±3.1分,B组分别为92.0±5.8分、21.0±2.2分,每组末次随访时与术前比较均有统计学差异（P＜0.05）。术前、末次随访时ODI,A组分别为（66.0±4.2）%、（12.0±2.9）%,B组分别为（65.0±7.8）%、（9.0±2.8）%,每组末次随访时与术前比较均有统计学差异（P＜0.05）。术前、末次随访时手术节段活动度,A组分别为5.0°±2.3°、6.0°±1.1°,B组分别为4.0°±3.8°、6.0°±2.2°,每组末次随访时与术前比较均无统计学差异（P＞0.05）;末次随访时3例患者手术节段基本丧失活动度（平均为1.2°±0.4°,术后5年1例,术后7年2例）,其余患者保留了2°~10°的活动度,平均为6.5°。48例患者中,出现相邻节段退变4例,其中1例患者术后8年出现腰痛,影像学检查发现手术相邻上位节段椎间盘退变并膨出,行手术治疗;1例患者术后7年手术相邻上位节段椎间隙高度较术前降低＞2mm,2例（术后5年、8年各1例）患者手术相邻上位节段椎体前缘骨赘高度＞3mm。2例出现假体移位（分别于术后5年和6.5年）,3例出现异位骨化（分别于术后6年、7年和9年）,均未出现临床症状。结论：腰椎人工椎间盘置换术治疗腰椎间盘退变性疾病的中长期疗效较为满意。     

关节面方向和终板倾斜角度对退变性腰椎滑脱的影响

目的探讨退变性L4-5滑脱的生物力学机制.方法测量L4～5关节面与椎体冠状面角度和L5终板倾斜的角度,并与同年龄组没有退变性腰椎滑脱的腰痛患者作对照,对有退变性滑脱病人的L4～5关节面与椎体冠状面角度和L5终板倾斜的角度与椎间隙的高度,腰椎的生理曲度进行相关性分析.结果有L4～5退变性腰椎滑脱的患者L4关节面较对照组更偏向于矢状位,L5终板倾斜度的增大,L4～5关节面的角度变大与椎间盘高度的降低及L5终板倾斜角度增大与腰椎曲度的减小有相关.结论在有L4～5退变性滑脱的病人中,L4～5关节面的方向更接近矢状位,L5椎体终板的倾斜度更大.     

腰椎间盘退变性疾患下腰椎终板形态的MRI观察

【摘要】　目的：在MRI片上观察腰椎间盘退变患者下腰椎终板形态的分布规律,分析终板形态和椎间盘退变的关系。方法：回顾分析两组腰椎间盘退变性疾病患者的术前腰椎MRI,A组110例为单节段腰椎间盘突出症患者,B组35例为椎间盘源性腰痛患者。根据正中矢状面MRI T1像,将终板形态分为凹面、平坦、不规则三型;根据Pfirrmann法评定椎间盘退变程度并将Ⅰ～Ⅴ级分别计为1～5分;按Modic改变分级标准判定各节段终板有无Modic改变。分析下腰椎终板的形态特点及三种分型与椎间盘退变程度、Modic改变等的关系。结果：①435个下腰椎节段中,凹面型终板最多（215/435）,A组中占50.6％（167/330）,B组中占45.7％（48/105）,且主要分布于L3/4（108/215）、L4/5（83/215）节段;平坦型终板占29.0％（126/435）,并主要位于L5/S1节段（76/126）;不规则型终板最少（94/435）,A组中占23.0％（76/330）,B组中占17.1％（18/105）,也主要位于L5/S1节段（45/94）。②A组患者中,凹面型终板退变程度平均为3.31±0.81分,平坦型为3.66±0.64分,不规则型为4.16±0.67分,两两比较有显著差异（P＜0.05）;椎间盘突出节段以平坦型（37/110）和不规则型（43/110）终板占多数,无突出节段则以凹面型（137/220）终板占多数,差异有显著性（P＜0.05）;不规则型终板比凹面型和平坦型更容易伴发Modic改变,差异有显著性（P＜0.05）,凹面型和平坦型间无显著性差异（P＞0.05）。③B组患者中,凹面型终板的椎间盘退变程度平均为3.23±0.86分,平坦型为3.54±0.85分,不规则型为3.94±0.54分,仅凹面型和不规则型间差异有显著性（P＜0.05）。④相同终板形态时A组和B组椎间盘退变程度相比均无显著性差异（P＞0.05）。结论：终板形态与椎间盘退变、Modic改变之间有相关性。终板形态由凹面型到平坦型再到不规则型,腰椎间盘退变程度逐渐加重。影像学上终板形态改变在一定程度上反映了椎间盘退变的程度。     

L_5轻度峡部裂型滑脱患者脊柱-骨盆矢状面参数与椎间盘退变的关系

[目的]探讨L5轻度峡部裂型滑脱患者中脊柱-骨盆矢状面参数与其椎间盘退变之间的关系。[方法]回顾性分析2011年7月~2014年5月间79例L5轻度峡部裂型滑脱患者的临床资料。在站立位脊柱侧位X线片上进行矢状面参数的测量(包括LSA、LL、PI、PT、SS、L5I及SVA等),在腰椎MRI的矢状位T2WI图像中观察L4/L5及L5/S1节段椎间盘退变的等级。分别按滑脱程度的不同、PI的大小以及L5/S1椎间盘退变的等级不同进行分组对比。[结果]与L5滑脱程度<25%组相比,滑脱>25%组的L5/S1椎间盘退变程度更重;两组L4/L5椎间盘退变程度的差异无统计学意义。按PI大小进行分组,大PI组的L5/S1椎间盘退变等级与小PI组或正常PI组相比均更重。按L5/S1椎间盘退变不同等级进行分组,中重度退变组的LSA明显小于无退变组,而PI、PT、SS和L5I值均明显大于无退变组。三组的LL及SVA对比差异无统计学意义(P>0.05)。[结论]在L5轻度峡部裂型滑脱患者中,L5/S1椎间盘退变的等级与脊柱-骨盆矢状面参数之间存在密切关系。     

双侧小关节切除制作大鼠颈椎间盘退变模型的可行性

【摘要】 目的：探讨双侧小关节切除建立大鼠颈椎间盘退变模型的可行性。方法：16只3月龄雌性SD大鼠随机均分为实验组和对照组。实验组大鼠C4/5和C5/6双侧上、下关节突采用磨钻切除。术后12周时获取大鼠C4~C6标本。显微CT扫描C5/6节段,测量椎间高度及软骨终板的缺损率,并观测C5椎体微结构的变化;番红O快绿染色后观察髓核和纤维环的形态,并对椎间盘退变程度评分。采用RT-PCR法检测C4/5椎间盘组织中蛋白聚糖、Ⅱ型胶原以及基质金属蛋白酶（MMP）3和13的mRNA表达水平。组间定量指标行独立样本t检验,显著性水平为P<0.05。结果：术后12周,实验组椎间高度为0.51±0.04mm,显著低于对照组（0.55±0.02mm）（P<0.05）。实验组软骨终板出现明显的缺损,下终板缺损主要出现在腹侧,而上终板四周及中央均出现缺损;实验组的缺损率为（11.5±2.0）%,显著大于对照组的（6.9±1.0）%（P<0.05）。在椎体微结构中,实验组骨体积分数和骨小梁间隙分别为（53.0±6.0）%和170±2μm,而对照组分别为（46.4±3.0）%和195±1μm,两组间的差异均有统计学意义。实验组的骨小梁数目和厚度与对照组无统计学差异。组织学观察到实验组椎间盘的软骨终板形态不规则、出现缺损及少许钙化,髓核细胞出现聚集、数量减少,纤维环排列紊乱。实验组椎间盘退变评分为8.6±0.8分,显著高于对照组的5.8±0.5分。在实验组椎间盘组织中,蛋白聚糖和Ⅱ型胶原的mRNA表达水平明显低于对照组,MMP-13的mRNA表达水平显著高于对照组,MMP-3则呈现上升趋势。结论：大鼠颈椎双侧小关节切除可导致切除节段椎间盘在形态学、组织学和分子生物学上的退变,是建立椎间盘退变模型的一种可行方法。     

经皮椎弓根螺钉内固定联合骶前间隙轴向椎间融合治疗L5椎体滑脱症

【摘要】 目的：探讨采用经皮椎弓根钉内固定联合骶前间隙轴向椎间融合术（axial lumbar interbody fusion,AxiaLIF）治疗L5椎体滑脱症的临床效果。方法：2010年6月~2013年3月我院收治17例L5椎体滑脱症患者,均采用经皮椎弓根钉内固定联合骶前间隙轴向椎间融合术治疗。其中男8例,女9例;年龄33～58岁,平均43.7岁。退变性腰椎滑脱5例,峡部裂性腰椎滑脱11例,创伤性腰椎滑脱1例;17例均为Ⅱ度以内L5椎体滑脱。观察手术时间、术中出血量及并发症发生情况,影像学观察Taillard指数、滑脱角、椎间隙高度及植骨融合情况,以视觉疼痛模拟评分（VAS）评估临床效果。结果：17例手术时间110～190min,平均140min;术中出血60～150ml,平均70ml;全部病例随访9～27个月,平均14.5个月。Taillard指数由术前0.1632±0.0325改善至术后1周0.0716±0.007,末次随访为0.0732±0.008。滑脱角由术前5.32°±1.37°改善至术后1周2.14°±0.60°,末次随访为2.33°±0.50°。椎间隙高度由术前平均（4.78±1.43）mm改善至术后1周（9.72±1.69）mm,末次随访为（9.68±1.18）mm。Taillard指数、滑脱角及椎间隙高度术前与术后1周时比较差异均有统计学意义（P<0．05）,术后1周与末次随访比较差异均无统计学意义（P>0．05）。所有病例术后6个月薄层螺旋CT扫描三维重建可见完全的骨小梁连接,达到骨性融合。术前及末次随访腰痛VAS评分分别为7.34±1.56分、0.73±0.68分,末次随访时较术前明显改善（P<0．05）。术后出现单侧的下肢疼痛2例,感染2例,经对症处理后痊愈。余无内固定等相关并发症发生。结论：经皮椎弓根钉内固定联合骶前间隙轴向椎间融合术对腰椎结构破坏小,出血少,近期手术效果好,是一种治疗Ⅱ度以内L5椎体滑脱症的有效组合微创方法。     

Dynesys动态固定与经椎间孔椎间融合术治疗退变性L5/S1椎间盘突出症的疗效比较

目的 对比分析后路经椎弓根动态固定与经椎间孔椎间融合术（transforminal lumbar interbody fusion, TLIF）治疗退变性L₅/S₁椎间盘突出症的临床疗效。方法 回顾性分析2011年1月至2015年1月我科收治的82例退变性L₅/S₁椎间盘突出症病人,所有病例均符合纳入标准。其中38例采用Dynesys动态内固定术（Dynesys组）,44例采用经椎间孔椎间融合术（TLIF组）。比较两组术后1、3、6、12、24个月评估临床和影像学结果。结果 末次随访时,两组Oswestry功能障碍指数（the Oswestry disability index, ODI）评分和疼痛视觉模拟评分（visual analogue score, VAS）均较术前显著改善,差异均有统计学意义（P均＜0.05）。Dynesys组和TLIF组L₅/S₁的活动度（range of motion, ROM）分别从7.5°±2.6°降至5.2°±2.4°和7.2°±2.3°降至0°（P＜0.05）。L_4/5的ROM分别从8.6°±2.8°增至10.1°±2.6°和8.4°±2.5°增至12.5°±2.9°（P＜0.05）。Dynesys组和TLIF组发生L_4/5邻近节段退变（adjacent segment degenelation, ASD）的例数分别为2例（5.25%）和11例（25.00%）。末次随访时,两组ROM和ASD比较,差异均有统计学意义（P均＜0.05）。结论 Dynesys与TLIF治疗退变性L₅/S₁椎间盘突出症均能获得满意的临床疗效。与TLIF比较,Dynesys有利于保持ROM和减少ASD的发生,可作为退变性L5/S1椎间盘突出症的优选术式。     

微创经椎间孔腰椎体间融合术与传统开放手术对退变性腰椎滑脱症腰椎-骨盆矢状位参数的不同影响

【摘要】 目的：比较微创经椎间孔腰椎体间融合术（transforaminal lumbar interbody fusion,TLIF）与传统开放后路腰椎体间融合术（posterior lumbar interbody fusion,PLIF）治疗退变性腰椎滑脱症对腰椎-骨盆矢状位参数的不同影响。方法：回顾性分析比较2010年6月~2013年6月符合纳入标准的L4单节段退变性腰椎滑脱症48例患者的临床资料,其中23例采用传统开放PLIF治疗（开放组）,25例采用微创Quadrant系统下TLIF治疗（微创组）。在包含双侧股骨头的站立位腰椎侧位X线片上,测量微创组与开放组术前及末次随访的滑脱度（SP）、腰椎前凸角（LL）、骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS）、腰骶角（LSA）、滑脱角（SA）及L1铅垂线与S1距离（LASD）参数变化,采用相关分析分析各参数间的相关性。结果：开放组的滑脱复位率（ΔSP）为（67.42±33.80）%,明显高于微创组的（36.59±50.68）%（P<0.05）。微创组末次随访时的LL为43.03°±14.07°、SA为3.12°±4.02°,均明显低于术前的46.53°±15.72°、6.10°±5.64°（P<0.05）。开放组的ΔSA为2.53°±6.63°,明显高于微创组的-2.98°±5.42°（P<0.05）。开放组的ΔLASD为-4.10±14.53mm,明显低于微创组的3.48±9.01mm（P<0.05）。术前SP与LASD、ΔSA与ΔLL具有正相关关系,ΔLL与ΔPT具有负相关关系。结论：对于退变性腰椎滑脱,微创TLIF和开放PLIF都能明显地使滑脱椎体复位,但开放PLIF的滑脱复位率较高。微创TLIF可明显减小LL、SA,导致融合节段相对后凸。开放PLIF可明显减小LASD,更有助于改善脊柱-骨盆矢状位力线平衡。     

解剖学因素在退变性腰椎滑脱发生中的意义

目的:探讨退变性腰椎滑脱(degenerative lumbar spondylolisthesis,DLS)的解剖学危险因素。方法:以2009年7月~2010年9月在我院确诊的60例DLS患者为观察对象(滑脱组),男20例,女40例,年龄51~75岁,平均65.3±7.8岁,L4滑脱42例,L5滑脱18例。以性别和年龄匹配无DLS的60例健康志愿者为对照(对照组)。在腰椎侧位X线片上测量腰椎前凸角(lumbar lordosis angle,LLA)、骶骨水平角(sacral horizontalangle,SHA)及滑脱节段(对照组取相应节段)的椎体指数(lumbar index,LI)、椎间盘角度(disc angle,DA)、椎间盘高度(disc height,DH),在腰椎正位X线片上测量L5横突的长度(the length of transverse process of L5,TPL)和宽度(the width of transverse process of L5,TPW)。采用t检验比较两组间各指标的差异,应用Logistic逐步回归分析影响退变性腰椎滑脱的解剖学危险因素。结果:滑脱组患者LLA、SHA、LI、DA、DH分别45.83°±10.42°、28.35°±11.16°、0.85±0.13、7.24°±3.83°、9.12±2.73mm;对照组分别为47.48°±10.75°、23.16°±10.68°、0.96±0.10、9.68°±5.54°、10.54±2.48mm,两组间SHA、LI、DA、DH有显著性差异(P<0.05),LLA无显著性差异(P>0.05)。滑脱组TPL、TPW分别为2.15±0.43cm、1.64±0.41cm,对照组为2.06±0.39cm、1.57±0.32cm,两组间比较无显著性差异(P>0.05)。Logistic回归分析结果显示DLS与LI、DA有显著性相关关系,回归系数分别为-1.693、-1.406。结论:DLS患者的LI下降,DA减小,其可能是DLS的危险因素。     

Orientation and tropism of lumbar facet joints in degenerative spondylolisthesis

The orientation and tropism of the lumbar facet joints at L4-5 level was assessed by magnetic resonance imaging (MRI) in 53 patients with degenerative L4-5 spondylolisthesis and 53 age- and sex-matched normal control subjects. The degree of disc degeneration at the L4-5 level and of vertebral slip on lateral radiographs was also evaluated. Patients with degenerative spondylolisthesis had more sagittally orientated facet joints (P < 0.01) and more significant facet joint tropism (P < 0.05) than normal control subjects. For patients with degenerative spondylolisthesis, the facet joint tropism was significantly correlated with the degree of disc degeneration (P < 0.05). The results suggest that morphological abnormalities of the lumbar facet joints are a predisposing factor in the development of degenerative spondylolisthesis.     

Magnetic resonance assessment of the distribution of lumbar spine disc degenerative changes

The lumbar spine magnetic resonance (MR) studies in 246 consecutive patients who suffered from persistent back and leg pain were evaluated for the degree of degenerative disc disease and the presence of disc bulging, prolapse, or herniation. No patient had a history of previous back surgery. In those patients, degenerative disc changes increased with age until the fifth decade of life, after which a relatively similar proportion of patients had degenerative disc disease. Significant dehydration and degeneration occurred in less than 5% of the upper two disc spaces while L4/5 and L5/S1 had marked changes in greater than 20%. Prolapse and herniation progressively increased with each lower interspace, where at L5/S1 it was present in nearly one-third of the patients. Although a few patients had disc prolapse or herniation with a nondegenerated disc, there was a relationship between the presence of disc degeneration and prolapse or herniation.     

Clinical outcome of condoliase injection treatment for lumbar disc herniation: Indications for condoliase therapy

BackgroundCondoliase is a novel, potent chemonucleolytic drug available for clinical use for lumbar disc herniation (LDH) in Japan. The aim of this study was to assess the clinical outcome of condoliase therapy in patients with LDH, as well as factors affecting the clinical outcome.MethodsWe enrolled patients with LDH who were receiving condoliase injection. The following baseline data were collected: symptom duration; herniation level and type; T2 signal intensity of herniation; adverse events; rates of spondylolisthesis, posterior intervertebral angle of ≥5°, and vertebral body translation of ≥3 mm. Change in disc height, disc degeneration, herniation size, visual analog scale (VAS) for leg and back pain, and Oswestry Disability Index (ODI) were evaluated at the baseline, and 3-month follow-up. These data were compared between patients with efficacious (VAS improvement of ≥20 mm; group E) and inefficacious (VAS improvement <20 mm or required operation; group I) for condoliase treatment.ResultsForty-seven patients (20 women, 27 men; mean age 48 years) were included. The herniation level was L2/3 in one patient, L3/4 in two, L4/5 in 23, and L5/S1 in 21. Median symptom duration was 8 months. The mean VAS and ODI improved significantly from the baseline to 3-month follow-up (p < 0.01). Group E included 33 patients (70.2%) and group I included 14, three of whom had a history of discectomy. The rates of spondylolisthesis and posterior intervertebral angle ≥5° were significantly higher in group I than in group E. However, the rates of trans-ligamentous type and herniation with high signal intensity on T2-weighted images (highT2) were significantly higher in group E. Reduction of disc herniation was more frequently observed in group E.ConclusionsCondoliase injection resulted in significantly improved symptoms in patients with LDH. Condoliase therapy was less effective for patients with a history of discectomy, spondylolisthesis, or those with a posterior intervertebral angle ≥5°, while trans-ligamentous type and high T2 herniation were associated with increased efficacy.     

腰椎不稳定与腰椎间盘退变程度的相关性分析

目的：探讨腰椎不稳定与腰椎间盘退变程度的相关性。方法：随机选择100例腰腿痛病人,根据第一病人的腰椎功能位X线片和腰椎MRI图片,确定椎间盘的退变程度及有无节段不稳,并分析二者间关系。结果：L3－S1共有36个节段不稳,占12％;腰椎不稳29例,占病人总数的29％,L4／5、L3／4、L5／S1的不稳定发生率分别为22％、10％和4％;腰椎不稳与病人年龄分组呈现密切正相关,腰椎不稳与单节段退变及总退变度密切正相关,结论：腰椎不稳与椎间盘退变和蔼密切相关,但并非严重退变一定会发生节段不稳。     

复发性腰椎间盘突出症的影像学分析及临床意义

目的:探讨复发性腰椎间盘突出症的影像学特点及其临床意义。方法:回顾52例复发性腰椎间盘突出症患者的临床资料,分析其站立位腰椎正、侧位及过伸、过屈动力位X线片和腰椎MRI等影像学资料及其临床特点。结果:同节段突出36例,相邻节段突出6例,同节段突出合并相邻节段突出10例。20例存在腰椎失稳,2例合并腰椎滑脱,腰椎失稳主要发生在L4/5节段,与手术方式及椎间隙狭窄程度相关。结论:复发性腰椎间盘突出多伴有椎间隙狭窄和节段性失稳,对复发性腰椎间盘突出症的治疗要兼顾减压和稳定两个方面。     

退变性腰椎滑脱中腰椎-骨盆结构参数的特点分析

目的:分析退变性腰椎滑脱(degenerative lumbar spondylolisthesis,DLS)中腰椎-骨盆结构特点及其在退变性腰椎滑脱症中的意义。方法:对2015年4月至2017年1月收治的45例单纯退行性L_4,5节段腰椎滑脱患者(滑脱组)的临床资料进行回顾性分析,并与同期50例(对照组)体检资料齐全的健康者进行比较。通过影像学资料对受试者的腰椎-骨盆结构参数进行统计分析,分析DLS患者的脊柱-骨盆特点。观察退变性腰椎滑脱患者椎间盘及关节突关节退变特点。利用Spearson分析各观察项目之间的相关性。结果:滑脱组L_4,5关节突关节角、腰椎前凸角、骨盆入射角、骨盆倾斜角、骶骨倾斜角为(36.5±11.2)°、(44.2±7.3)°、(66.5±11.6)°、(22.2±10.0)°、(33.4±11.3)°。对照组L_4,5关节突关节角、腰椎前凸角、骨盆入射角、骨盆倾斜角、骶骨倾斜角为(44.4±8.2)°、(36.7±8.5)°、(55.4±13.2)°、(14.4±7.0)°、(42.3±13.1)°,滑...     

Grade three disc degeneration is a critical stage for anterior spondylolisthesis in lumbar spine

Introduction

Little is known about when and how progressive spondylolisthesis occurs. In this report segmental motion related to age and disc degeneration at L4/5 disc was investigated.

Materials and methods

637 patients with low back and/or leg pain underwent radiologic and MRI examinations simultaneously. Because 190 patients with conditions which might impede accurate measurement were excluded, 447 patients, comprising 268 men and 179 women, were included; age range, was 10–86 (mean: 53) years. Three radiologic parameters slip in neutral position (mm), sagittal translation (mm), and segmental angulation (degrees) were examined at the L4/5 segment. On T2-weighted MRI, severity of disc degeneration at L4/5 was classified by Pfirrmann’s criteria, grade 1-5.

Results

Results showed stage of disc degeneration that progressed according to aging with significant differences except for between grades 4 and 5. Amount of anterior slip was small among grades 1 to 3; however, it greatly increased between grades 3 and 4 and between grades 4 and 5, suggesting that grade 3 disc degeneration has a potential risk of future progression of anterior slip. This finding may also suggest that once significant slip occurs, it will progress to the final grade. Furthermore, the grade 3 degeneration group exhibited large amounts of motion in both angulation and translation, suggesting it was the most unstable group.

Conclusion

Our results with radiography and MRI indicate that grade 3 disc degeneration is a critical stage for the progression of lumbar spondylolisthesis at L4/5 segment.     

Disc degeneration of cervical spine on MRI in patients with lumbar disc herniation: comparison study with asymptomatic volunteers

An association between progression of cervical disc degeneration and that of lumbar disc degeneration has been considered to exist. To date, however, this association has not yet been adequately studied. Age-related changes in the cervical intervertebral discs were evaluated by magnetic resonance imaging (MRI) in patients with lumbar disc herniation, and compared with the MRI findings of healthy volunteers without lower back pain. The purpose of this study was to clarify whether the prevalence of asymptomatic cervical disc degeneration is higher in patients with lumbar disc herniation than in healthy volunteers. The study was conducted on 51 patients who were diagnosed as having lumbar disc herniation and underwent cervical spine MRI. The patients consisted of 34 males and 17 females ranging in age from 21–83 years (mean 46.9 ± 14.5 years) at the time of the study. The control group was composed of 113 healthy volunteers (70 males and 43 females) aged 24–77 years (mean 48.9 ± 14.7 years), without neck pain or low back pain. The percentage of subjects with degenerative changes in the cervical discs was 98.0% in the lumbar disc herniation group and 88.5% in the control group (p = 0.034). The presence of lumbar disc herniation was associated significantly with decrease in signal intensity of intervertebral disc and posterior disc protrusion in the cervical spine. None of the MRI findings was significantly associated with the gender, smoking, sports activities, or BMI. As compared to healthy volunteers, patients with lumbar disc herniation showed a higher prevalence of decrease in signal intensity of intervertebral disc and posterior disc protrusion on MRI of the cervical spine. The result of this study suggests that disc degeneration appears to be a systemic phenomenon.