Lumbar spondylosis: clinical presentation and treatment approaches

Low back pain (LBP) affects approximately 60–85% of adults during some point in their lives. Fortunately, for the large majority of individuals, symptoms are mild and transient, with 90% subsiding within 6 weeks. Chronic low back pain, defined as pain symptoms persisting beyond 3 months, affects an estimated 15–45% of the population. For the minority with intractable symptoms, the impact on quality of life and economic implications are considerable. Despite the high prevalence of low back pain within the general population, the diagnostic approach and therapeutic options are diverse and often inconsistent, resulting in rising costs and variability in management throughout the country. In part, this is due to the difficulty establishing a clear etiology for most patients, with known nociceptive pain generators identified throughout the axial spine. Back pain has been termed as “an illness in search of a disease.” Indeed, once “red flag” diagnoses such as cancer and fracture have been ruled out, the differential sources of low back pain remain broad, including the extensive realm of degenerative changes within the axial spine for which radiological evaluation is nonspecific and causal relationships are tentative. We will elaborate on these degenerative processes and their clinical implications. We will further discuss diagnostic approaches and the efficacy of existing treatment options.     

颈椎软骨终板钙化与颈椎间盘退变和椎体骨赘形成的关系

目的：研究颈椎软骨终板钙化与颈椎间盘退变和颈椎椎体骨赘形成的关系。方法：应用组织学方法观察颈前路环锯手术切下的18例脊髓型颈椎病和4例颈椎过伸性损伤致颈椎间盘突出患者的颈椎间盘及相邻的上下椎体标本,研究不同退变程度颈椎间盘软骨终板和椎间盘的形态学变化及椎体骨赘形成过程。结果：退变程度较轻或基本正常的颈椎间盘软骨终板结构良好,潮标清晰,退变程度较重的颈椎间盘软骨终板发生明显纤维化,潮标前移,钙化软骨和软骨下骨板增厚,退变颈椎间盘周边软骨终板潮标明显前移,钙化和骨化层增厚,形成突向外侧的椎体边缘的骨赘。结论：颈椎软骨终板的不断钙化和骨化导致颈椎间盘营养发生障碍可能是启动颈椎间盘退变的关键因素,退变椎体周边软骨终板的不断钙化和骨化是椎体骨赘形成的根本原因。     

Ruptured Triceps Tendon Diagnosed Radiographically

The authors present two cases involving rupture of the triceps tendon that was initially diagnosed on radiographs. Tendon ruptures have been radiographically diagnosed before but only once by a fractured osteophyte of the triceps tendon, to our knowledge. The first case demonstrated this while the other showed an avulsion fracture at the tendon's insertions which has been described previously (seven times) on radiographs.     

超声观察英夫利西单抗治疗强直性脊柱炎患者骨质改变的研究

目的 应用超声观察英夫利西单抗治疗前、后强直性脊柱炎患者骨质改变的情况,并探讨其临床意义。方法 48例活动性AS患者均满足1984年改良的纽约分类标准,并签署知情同意书,所有患者均接受6次infliximab 5 mg/kg 静脉输注。用高分辨率B超和能量型多普勒超声观察英夫利西单抗治疗前、后下肢关节及肌腱附着点的骨质形态学及血流供应的变化。并分别在0和30w记录背痛VAS评分,关节肿痛及CRP、ESR和BASDAI、BASFI、BASMI等指标。结果 48例AS患者完成试验,其中31例复查了超声检查。治疗前48例患者超声检查发现骨侵蚀有37处,骨赘有2处,肌腱增厚有17处,滑囊炎有15处,肌腱钙化1处,异常血流数有22处,关节积液11处,滑膜增生1处。英夫利西单抗治疗后30w,31例患者复查超声发现骨侵蚀8处,多普勒异常血流1处,与治疗前比较统计学有显著差异（P<0.01）,滑囊炎3处,与治疗前比较统计学有差异（P<0.05）。骨侵蚀中以股骨大转子肌腱点最多,有13处,治疗后只有2处;膝关节内侧副韧带有7处,治疗后为2处,与治疗前相比有统计学差异（P<0.05）。骨赘治疗前有2处,治疗后无进展,仍为2处,与治疗前相比无统计学差异（P>0.05）。治疗前后各临床指标均有明显好转,统计学有显著差异（P<0.01）。结论 超声可清晰显示肌腱附着点及关节的骨侵蚀、骨赘形成,并可发现肌腱增厚、滑囊炎、关节滑膜增生及异常血流等情况,能更实时反映AS患者骨质改变的过程及监测疗效。     

Limitations of minimally invasive posterior cervical foraminotomy—a decompression method of posteriorly shifting the nerve root—in cases of large anterior osteophytes in cervical radiculopathy: A retrospective multicenter cohort study

BackgroundPosterior cervical foraminotomy against anterior osteophyte is an indirect decompression procedure but less invasive compared to anterior cervical discectomy and fusion. Residual compression to the nerve root may lead to poor surgical outcomes. Although clinical results of posterior cervical foraminotomy for osteophytes are not considered better than those of disk herniation, osteophyte size and the association of the decompression area with poor surgical outcomes remain unclear. This study aimed to identify the limitations of minimally invasive posterior cervical foraminotomy for cervical radiculopathy and discuss the methods to improve surgical outcomes.MethodsWe analyzed 55 consecutive patients with degenerative cervical radiculopathy who underwent minimally invasive posterior cervical foraminotomy. Minimum postoperative follow-up duration was 1 year. We divided the patients into nonimproved and improved groups. The cutoff value between preoperative and postoperative Neck Disability Index scores was 30% improvement. Preoperative imaging data comprised disk height, local kyphosis, spinal cord compression, anterior osteophytes in the foramen, and anterior osteophytes of >50% of the intervertebral foramen diameter. Postoperative imaging data comprised craniocaudal length and lateral width of decompressed lamina, preserved superior facet width, and area of decompressed lamina.ResultsFifty-five patients were divided into two groups: nonimproved (n = 19) and improved (n = 36). The presence of osteophytes itself was not significant; however, the presence of osteophytes of >50% of the foramen diameter increased in the nonimproved group (P = 0.004). Mean lateral width and mean area of decompressed lamina after surgery significantly increased in the improved group (P = 0.001, P = 0.03).ConclusionThe presence of anterior osteophytes >50% of the diameter of the foramen led to poor improvement of clinical outcomes in minimally invasive posterior cervical foraminotomy. However, the larger the lateral width and area of the decompressed lamina, the better the surgical outcome.