spondylolisthesis
Introduction
Introduction to the spine isthmus Spinal canal isthmus is a common condition that can occur on one or both sides of the vertebral body. The isthmus is located between the superior and inferior articular processes, where it is not connected or broken, called the vertebral isthmus or spine disintegration, or may be combined with other deformities such as spine. It is a potential internal cause of low back pain, a small number of asymptomatic or spondylolisthesis, most of which can cause spinal instability and varying degrees of lumbar spinal stenosis. basic knowledge The proportion of illness: 0.0003% Susceptible people: good for infants and young children Mode of infection: non-infectious Complications: muscle spasm
Cause
Spine spondylolysis
The spine begins to appear in the seventh week of the embryo with four cartilage nucleus (two vertebral bodies, one for each side of the vertebral arch). The four cartilage nucleus continue to grow and form a cartilage-like spine, about ten weeks after the embryo. Three primary nucleus nucleus began to appear, contained in the primary cartilage nucleus, and grew chronically. It is still separated at birth. About 1 to 2 years after birth, the vertebral arch begins to unite and occurs. After ~6 years old, the vertebral body and the vertebral arch bone nucleus fuse.
The fully grown spine can be divided into vertebral body, vertebral arch, lamina, superior and inferior articular processes, transverse process and spinous process, and there is a narrow area between the superior and inferior articular processes, which is the pedicle isthmus, such as ossification of this part. Or potential cartilage defects, that is, the formation of congenital isthmus nonunion, the defect area is located between the superior and inferior articular processes, the vertebral body and the posterior lamina without bone connection, and the adjacent vertebral body only by soft tissue, such as The weakness of the development, coupled with some degree of trauma or strain, can also lead to fractures in the weak isthmus, the mechanism is similar to fatigue fractures.
Prevention
Spinal canal isthmus crack prevention
This disease is mostly caused by congenital factors, so there is no effective preventive measures. For some lesions caused by fatigue, it is the key to pay attention to work and rest when working normally. Secondly, early diagnosis and early treatment is another key to the prevention and treatment of this disease.
Complication
Spinal canal isthmus complication Complications
The patient has a prominent lumbar vertebrae, the trunk is slightly forward, the ribs are close to the humerus, the hips are posterior, the abdomen is drooping, the lumbosacral sag is depressed, and the fifth lumbar spinous process is prominently protruding, inconvenient to walk, and has a swinging step. State, waist muscle spasm, limited function, especially in the past, the fifth lumbar spinous process is markedly tender, women with obvious anterior spine detachment, the distance from the lumbar vertebrae to the pubic symphysis is reduced, like a flat pelvis, during production Affect children into the pelvis.
Symptom
Spinal vertebral isthmus rupture symptoms common symptoms neuralgia diffuse lower back pain paralysis feeling separation
The clinical manifestations of this disease can be divided into the following situations:
(1) True spondylolisthesis is the most common cause of spondylolisthesis due to non-continuity of the pedicle isthmus.
(B) pseudo spondylolisthesis without isthmus nonunion, only due to spinal or disc degeneration, or other reasons caused by mild anterior displacement of the vertebral body, more common.
(3) After slipping is less common.
The common symptoms of the above three types of spondylolisthesis are chronic low back pain. There is no obvious clinical symptoms in simple schizophrenia. However, due to poor stability of the lumbosacral region, local soft tissue is prone to strain, and the symptoms of spondylolisthesis are obvious in adulthood. Symptoms are low back pain, painful parts and nature, and can be continuous or intermittent. There are also those who start to feel pain only when they are overworked. The pain can be limited to the lumbosacral region, or to the hip, the appendix or Radiation of the lower extremities, such as sciatica, spinal canal stenosis, etc., which produce cauda equina numbness, the pain is mild after bed rest, the pain is aggravated when getting up from the lying position, and there is occasional movement inside the waist.
Examine
Examination of the spine isthmus
Film degree exam
For spinal disintegration and mild spondylolisthesis, clinical diagnosis is difficult, X-ray examination is required, and the commonly used projection positions are anteroposterior, lateral and oblique.
(1) The anterior and posterior vertebral arch disintegration is often difficult to show in the anterior and posterior positions. If there is obvious isthmus defect, when the plane of the fissure is parallel to the X-ray, under the circular shadow, see a reduced-angle oblique shadow. If there is obvious slippage, it can be seen that the lower edge of the slippery vertebral body overlaps with the lower vertebral body, and the crescent shape density is thickened, and the fifth lumbar vertebrae transverse process overlaps with the anterior edge of the vertebral body.
(2) The lateral position is the isthmus of both sides of the vertebral arch, which can be found in the posterior and posterior vertebral pedicles, between the upper and lower joints, see a oblique bone conspiracy to reduce the shadow, and the posterior part is higher than the front, such as the defect The side is not easy to see.
If there is slippage, the vertebral body moves forward, but the weight is different. There is a complete advancement of the whole vertebral body, and there is also a slight advancement. Most of the scapula is about 1/3 to 1/4, and the disc has degenerative changes. The intervertebral space is narrowed.
1. Method for measuring slippage by positioning
(1) From the front edge of the first atlas plane, draw a vertical line that passes through the lower front edge of the fifth lumbar vertebral body, such as the fifth lumbar vertebrae, which will pass through the vertebral body (Ullman line).
(2) When the fifth lumbar vertebrae is suspected to be slipping forward, the posterior superior and inferior edges of the fifth lumbar vertebrae, and the posterior superior margin of the fourth lumbar vertebral body may be connected to the posterior superior edge of the first iliac vertebral body, and the two lines may intersect. Or parallel, the angle between the two lines at normal time is not more than 2°, and below the lower edge of the fourth lumbar vertebrae, if the distance between the two lines is not more than 3mm (Ullman line), the intersection point is at the lower edge of the fourth lumbar vertebra when there is slippage. In the above, the slippage can be divided into three degrees according to the size of the intersection angle of the two lines or the distance of the parallel line distance.
Indexing method for lumbar spondylolisthesis
Slippage degree intersecting angle Parallel distance is mild 3°10° 410mm Moderate 11°20° 1020mm Severe 21° 21mm
(3) The upper edge of the first atlas is divided into four equal parts. In normal time, the fifth lumbar vertebral body and the posterior edge of the first vertebral body form a continuous arc. When there is slippage, the fifth lumbar vertebral body moves forward and advances. One quarter is 1°, 2/4 is 2°, 3/4 is 3°, and full slip is 4°.
2. Lateral slice for the diagnosis of the lateral slice can identify true and false spondylolisthesis, the anteroposterior diameter of the former spine increases; the latter does not change, and the intervertebral space is narrowed, the adjacent vertebral body edge is hardened, or the lip Degenerative lesions such as hyperplasia.
(3) The 45° oblique image of the oblique slice is the best position for displaying the isthmus. The normal vertebral arch attachment is shaped like a hunting dog, the dog's mouth represents the ipsilateral transverse process, the dog's eye represents the pedicle, and the dog's ear is the upper articular process. The dog's neck is the isthmus, the dog body is the lamina, the front and rear dog legs represent the ipsilateral and contralateral superior articular processes, and the dog's tail is the contralateral transverse process.
If the isthmus is not connected, a band of density can be seen in the neck to reduce the shadow, just like a hunting dog with a collar, this is the vertebral arch is not connected to the bone, if there is slip, the upper articular process and transverse process with the vertebral body forward, Such as the dog's head and neck.
CT, MRI: partial vertebral bone defect, disc herniation, nerve hole, spinal canal deformation, pedicle fracture, asymmetrical spinous process of the vertebral arch to one side, CT can appear "double tube" sign.
Diagnosis
Diagnosis and diagnosis of spine isthmus
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
The disease needs to be differentiated from the vertebral arch fracture caused by mechanical violence; in addition, X-ray lateral radiograph can identify true and false vertebral spondylolisthesis, the anteroposterior diameter of the former spine increases; the latter has no change, and the intervertebral space can be seen Narrowing, osteoporosis of adjacent vertebral body margins, or degenerative lesions such as lip-like hyperplasia.
