脊柱退行性疾病-英文课件

脊柱退行性疾病Spinaldegenerativediseases

长治医学院附属和平医院骨科裴卫卫脊柱退行性疾病长治医学院附属和平医院骨科裴卫卫Whatiscalleddegeneration?

Whatiscalleddegeneration?Wealsofoundotherphenomenon.SomePeopleareonly40yearsold,butlookslike60yearsofageortheopposite。Wealsofoundotherphenomenon影响因素influencefactors过度负荷overload不良体位poorposture慢性劳损chronicstrain外伤injury慢性炎症chronicinflammation先天因素congenitalfactors影响因素influencefactorsAnatomyoftheSpineSagittalViewAP-viewLordosisKyphosisLordosisAnatomyoftheSpineSagittalVDevelopmentofDiscandSpinalCurvature

Newborn25years4years-nosignificantcurvature-DiscHeight=VertebralBodyHeight-Double-Scurvature-DiscHeight=40%ofVBH-biconcave-biconvexshapeofintervertebralspace-DiscHeight=25%ofVBHDevelopmentofDiscandSpinalIntervertebraldiscAnulusfibrosusNucleusPulposusIntervertebraldiscAnulusfibrNewborn65yearsNovascularisationofdiscNewborn65yearsNovascularisat7years70years30yearsWatercontentinthenucleuspulposusdecreasedwithage

7years70years30yearsWatercFacetJoints

Cervicalvertebrae——sloping

Thoracicvertebrae——coronal

Lumbarvertebrae——sagittalFacetJoints

CervicalvertebraLigamentsAnteriorlongitudinalligamentPosteriorlongitudinalligament

LigamentsAnteriorlongitudinalBloodSupplyBloodSupplyLoadTransfer80%20%TheFUNCTIONALUNITofthespineComprisedof:TwoadjacentvertebraeIntervertebraldiscConnectingligamentsTwofacetjointsandcapsulesLoadTransfer80%20%TheFUNCTIOIntradiscalPressureBiomechanics18,31,24,62,75,011,011,023,017,0IntradiscalPressureBiomechani颈椎退行性疾病

cervicaldegenerativedisease包括：一、颈椎病二、颈椎管狭窄症三、颈椎间盘突出症四、颈椎后纵韧带骨化

including一、Cervicalspondylosis二、Cervicalcanal

stenosis三、Cervicaldischerniation四、Ossificationofcervicalposteriorlongitudinalligament颈椎退行性疾病

cervicaldegenerative一、颈椎病Cervicalspondylosis

发病率随着年龄的增加而显著提高

40～50岁的发病率为20％，60岁以上者达50％，

70岁以上则更高。目前发病年龄趋于年轻化

一、颈椎病Cervicalspondylosis

发定义Concept颈椎间盘退变及其继发性改变，刺激或压迫相邻脊髓、神经、血管等组织，并引起相应的症状或体征者，称为颈椎病。Cervicalspondylosisisadisorderinwhichthereisabnormalwearonthecartilageandbonesoftheneck.定义Concept颈椎间盘退变及其继发性改变，刺分型Classification

脊髓型CervicalSpondyloticMyelopathyCSM

神经根型CervicalSpondyloticRadiculopathyCSR

交感神经型SympatheticCervicalSpondylosisSCS椎动脉型CervicalSpondylosisofVertebralarterytype其它（食道压迫型、颈型、混合型）

分型Classification脊髓型CSM以颈脊髓受损为主要临床表现的颈椎病。主要表现为走路不稳、四肢麻木、大小便困难等。Mainclinicalmanifestations:Cervicalspinalcordinjury，suchasunsteadywalk,numbnessoflimbs,micturitionanddefecationdifficultiesCSM以颈脊髓受损为主要临床表CSR

1.多见于30岁以上者Morecommoninpeopleover30yearsold2.起病缓慢、病程长，反复发作。Slowonset,longcourseofdisease,recurrentseizures.3.颈肩部疼痛，下颈椎病变可向前臂放射。

Neckandshoulderpain,somecanradiatetothearm

CSR1.多见于30岁以上者SCS

主要表现为头晕、眼花、耳鸣、手麻、心动过速、心前区疼痛等一系列症状。X线片有失稳或退变，椎动脉造影阴性。

Mainclinicalmanifestations:dizziness,tinnitus,numbnessofhand,heartbeattachycardia,precordialpain.X-ray:degenerationofcervicalvertebra.Vertebralarteryangiographynegative.SCS主要表现为头晕、眼花、耳鸣、手麻、心动过速、CervicalSpondylosisofVertebralarterytype以椎基底动脉供血不足为主要临床表现的颈椎病。主要表现为头痛，头晕，黑朦等症状，与颈部旋转有关。

Mainclinicalmanifestations:vertebralbasilararteryinsufficiency，suchasheadache,dizzinessandamaurosis,relatetotheneckrotation.CervicalSpondylosisofVerteb食管型颈椎病

Esophagustypecervicalspondylosis

AspecialtypeofCSThroatdiscomfort,foreignbodysensationisanearlysymptomLatemanifestationsisdysphagiaOftenaccompaniedbysymptomsofothercervicalspondylosis食管型颈椎病

Esophagustypecervical颈型

Necktypecervicalspondylosis以颈部酸、痛、麻、僵为主要临床表现或颈项部压迫感的颈椎病，症状集中在颈部，转动不灵活。Mainclinicalmanifestations:aciddistention、pain、numbnessandstiffintheneck.颈型

NecktypecervicalspondyloMixedtypeofcervicalspondylosis

具备以上两种或两种以上的表现者，即可确诊。

Withtwoormorethantwokindsofperformanceabove.MixedtypeofcervicalspondylDiagnosisMustbehavethreeconditions:

CervicaldegenerativechangesRelevantclinicalmanifestationsRelevantclinicalmanifestationsareconsistentwithimagingfindingsDiagnosisMustbehavethreecoTreatmentIndicatioMildsymptomsCannottolerateoperationMethodsCorrectbadpostureTractionMassage—cautiouslyusePhysiotherapyMedicationsexpectanttreatmentTreatmentIndicatioMethodssurgicaltherapy

IndicatioFormalexpectanttreatmentfor3~6monthsisinvalidSymptomofCSMaggravateprogressivelyorsuddenlyorMRIshowedthatthecervicalspinalcordsignalchangesSymptomofCSRimpactqualityoflifesurgicaltherapyIndicatio手术方式手术目的surgicalpurpose

彻底减压Completedecompression重建脊柱稳定性Reconstructionofspinalstability

开放式：Openoperation

前路—直接减压Anteriorcervicaloperation—Directdecompression

后路—间接减压Posteriorcervicaloperation—Indirectdecompression

微创式：Microinvasiveoperation手手术目的surgicalpurpose开放式Case1颈前路椎间盘摘除、取自体髂骨椎间植骨融合、内固定术Case1颈前路椎间盘摘除、Case2颈前路椎间盘摘除、椎间融合器植骨融合、内固定术Case2颈前路椎间盘摘除、Case3颈前路椎体次全切除、椎间钛笼植骨融合、内固定术Case3颈前路椎体次全切除、Case4颈后路单开门椎管扩大成形术Case4颈后路单开门椎管扩大成形术Case5颈后路单开门椎管扩大成形后路支撑钢板内固定术Case5颈后路单开门椎管扩大成形Case5颈椎人工间盘置换术Case5颈椎管狭窄症

CervicalcanalstenosisEtiologyandpathologyCongenitaldevelopmentalCCSDegenerativeoriatrogenicCCSCCScanbesingleormultisegmentalstenosis,commonintheC4,5andC6,7segments颈椎管狭窄症

CervicalcanalstenosClinicalmanifestation

SymptomsaresimilartothesymptomsofCSX-rayCTMRIA:椎管失状径A≥13mm正常A＜13mm相对狭窄A＜10MM绝对狭窄B:椎体中失状径A:B＜0.75狭窄

椎管正中失状径≥13mm正常＜13mm相对狭窄＜10mm绝对狭窄ClinicalmanifestationSymptomCervicalintervertebraldiscdegeneration

Externalforce

causeruptureofannulusfibrosus

andlongitudinalligamentNucleuspulposus

protrudeintospinalcanalThepainofnerverootandsignsofspinalcompression.颈椎间盘突出症

CervicaldischerniationCervicalintervertebraldiscdRelationshipbetweenCDHandCS颈椎间盘突出症是颈椎病发病过程的病理变化之一

CDHisoneofthepathologicalchangesinthepathogenesisofCS颈椎间盘突出症的致压物只能是突出的髓核，而颈椎病可以是髓核以外的其他组织

Inducedpressurecanonlybeprotrudingnucleuspulposus，howeveritcanbe

othertissuesexceptthenucleuspulposusRelationshipbetweenCDHandC男性，40岁，煤矿工人，既往无四肢麻木、无力病史，摔伤后出现颈部不适伴双上肢放射性麻木、行走不稳1个月，经颈围制动、脱水、激素及神经营养治疗效果不佳。男性，40岁，煤矿工人，既往无四肢麻木、无力病史，颈椎后纵韧带骨化症

Ossificationofcervicalposteriorlongitudinalligament颈椎后纵韧带异常增殖并骨化，压迫脊髓和神经根，产生感觉、运动功能障碍。Cervicalposteriorlongitudinalligamentabnormally

proliferateandossify，whichcanconstrictthespinalcordandnerveroot，andthenleadtoparalysis颈椎后纵韧带骨化症

OssificationofcerEtiologyTheexactmechanismisnotclear，butthereareseveralhypothesisTheoryofheredityMechanicaldamagetheoryDisturbanceofcarbohydratemetabolismtheoryThewholebodybonehypertrophytheoryEtiologyTheexactmechanismisEpidemiologyTheincidenceofOPLLinEastAsiaishigherJapan

1.9～4.3%(over30yearsold.）Korea

3.6%Taiwan

2.8%China

1.6~1.8%EpidemiologyTheincidenceofOClinicalcharacteristicsAchronic,progressive,spinalcordornerverootcompressionsymptomsIt‘ssymptomsareverysimilartoCCSorCSX-ray,CTandMRIcanimprovethediagnosisClinicalcharacteristicsAchroClassification-SagittalSectionTopicaltypeSegmentaltype

SuccessivetppeMixedtypeClassification-SagittalSectClassification-Coronalsection图１点状骨化图２蕈伞状骨化图３山丘状骨化图４偏一侧骨化Classification-Coronalsecti测量椎管狭窄率ImagingevaluationofOPLL测量椎管狭窄率ImagingevaluationofO减压不彻底神经功能障碍无改善或加重ImagingevaluationofOPLL减压不彻底神经功能障碍无改善或加重ImagingevaluVerydifficultHigh-riskMorecomplicationsPoorprognosisTreatment

Operationistheonlyeffectivemeans

ChallengeVerydifficultTreatmentOperatHowtoselectthereasonableoperation?successivetypeandMixedtypeossificrange>3vertebralsegmentsCervicalcanalstenosis>50%Posteriorcervicaloperation/IndirectdecompressionLaminectomyLaminoplastyLaminectomy+internalfixationHowtoselectthereasonableoTopicaltypeandSegmentaltypeossificrange＜3vertebralsegmentsCervicalcanalstenosis＜50%Anteriorcervicaloperation/Directdecompression

DiscectomyCorpectomydecompression

TopicaltypeandSegmentaltyp腰椎退行性疾病

lumbardegenerativedisease包括：一、腰椎间盘突出症二、腰椎管狭窄症三、腰椎滑脱症

including一、LumbarDiscHerniation二、lumbarspinalstenosis三、lumbarspondylolisthesis腰椎退行性疾病

lumbardegenerativedi腰椎间盘突出症

LumbarDiscHerniationLDH腰椎间盘突出症

LumbarDiscHerniatioEpidemiologySymptomaticLDHareseeninallagegroupsbuthavetheirpeakinpatientsagedbetween35and45years.Exceptsmoking,occupationalfactorsincludesedentaryworkanddriverarethemainreasonsforLDHEpidemiologySymptomaticLDHarClassification—Degeneration/BulgingMildsevereClassification—Degeneration/BuCentralPosterlateralLateralClassification—ProtrusionCentralPosterlateralLateralClassification—Extrusion

Classification—Extrusion

Classification—Sequestration

Classification—Sequestration

Classification—Schmorl's

nods

Classification—Schmorl'snods

SymptomsHowcanwerecognizeaherniateddisk?LowerbackpainSciaticaPain,weakness,numbnessortinglingin

thelegs,buttocksandfeetProblemswithbowel,bladderorerectile

function,inseverecasesSymptomsHowcanwerecognizeGeneralSignsChangesoflumbarcurvatureCompensatoryscoliosisStraightleg-raising(SLR)testSLRstrengthentestFemoralnervestretchingtest

GeneralSignsChangesoflumbarNeurologicsignsSensibilityMuscleforceDeeptendonreflexMuscleatrophyWecaninitiallylocatetheintervertebraldiscNeurologicsignsSensibilityWeProtrusionoftheL3/4discProtrusionoftheL3/4discProtrusionoftheL4/5discProtrusionoftheL4/5discProtrusionoftheL5/S1discProtrusionoftheL5/S1disc

ImagingexaminationX-rayCTMRILumbarmyelographyImagingexaminationX-rayTreatmentExpectanttreatmentSurgicaltreatmentTreatmentExpectanttreatmentExpectanttreatmentYoungFirstattackShortcourseSymptomscanberelievedbyrestNospinalstenosisNospondylolisthesisExpectanttreatmentYoungSurgicaltreatmentThestrictexpectanttreatmentisinvalidCaudaequinasyndromeSurgicaltreatmentThestricteClassical-discectomyClassical-discectomyLumbararthroscopicdiscectomyPLDPLDDLumbararthroscopicdiscectomLumbartunnelMEDdiscectomyLumbartunnelMEDdiscectomyMLDMLDAnteriorlumbardiscectomy,

interbodyfusion

Anteriorlumbardiscectomy,

iLumberartificialdiscreplacementLumberartificialdiscreplace腰椎管狭窄症

lumbarspinalstenosisLSS，causedbyvariousreasons

，canconstrictspinalcordandnerverootandleadtocorrespondingnervedysfunction，Oneofthecommondiseasesoflowerbackandlegpain腰椎管狭窄症

lumbarspinalstenosisLEtiologyandpathologyCongenitaldevelopmentalLSSDegenerativeLSSTraumaticoriatrogenic

LSSBesingleormultisegmentalstenosisCommonintheL4/5EtiologyandpatholoEpidemiologyMorecommoninelderlypatients,morethan50yearsoldItiscommoninL4/5，secondaryinL5/S1EpidemiologyMorecommonineldClinicalmanifestationChroniclowbackpainMildpainordiscomfortSlowlyaggravationAlleviationaftertheactivityCoughwithoutaggravating

ClinicalmanifestationChronicClinicalmanifestationNeurogenicIntermittentClaudicationNICLCompressionbloodcirculatorydisorderInflammatorystimulusClinicalmanifestationNeurogenSymptomsarecloselyrelatedwithlumbarpostureAlleviationinflexionAggravationinextensionUphilliseasierthandownhillCanride，hardtowalkClinicalmanifestationSymptomsarecloselyrelatedwLowerlimbneurologicalsymptomsClinicalmanifestationLowerlimbneurologicalsymptoImagingexamination

——X-ray

Transversediameter＜18mmSagittaldiameter＜13mmImagingexamination

——X-rayValuablemethodDisplaythelocationanddegreeofthediseaseImagingexamination

——Lumbarmyelography

ValuablemethodImagingexaminCoincidencerateishighTransversediameter＜18mmSagittaldiameter＜13mmNerverootcanal＜3mmImagingexamination

——CT

CoincidencerateishighImaginHighdiagnosticcoincidencerateDifferentialdiagnosissignificanceImagingexamination

——MRI

HighdiagnosticcoincidenceraTreatmentExpectantSurgicalDecompressionFusionX-StopTreatmentExpectant腰椎滑脱

Thelumbarspondylolithesis

Spondylo——椎体Lithesis——滑移腰椎滑脱

ThelumbarspondylolithesHistoryIn1782,theBelgianHerbinlaux,whoisanfirstdescribedaphenomenonofdystociacausedbyL5spondylolithesisIn1854,theGermandoctorKilianfirstproposedthespondylolisthesisandgivethedescriptionInthe1950s,domesticgraduallybegantoreportspondylolisthesis.HistoryIn1782,theBelgianHeEpidemiologyTheincidencerateisabout5%Varingfromtheage,regionandrace,occupation,gender

MorbidityrateincreasewiththegrowthofageMorewomenthanmenMoreblacksthanwhites