脊柱退行性疾病-英文

脊柱退行性疾病Spinaldegenerativediseases

长治医学院附属和平医院骨科裴卫卫Whatiscalleddegeneration?

Wealsofoundotherphenomenon.SomePeopleareonly40yearsold,butlookslike60yearsofageortheopposite。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congenitalfactorsAnatomyoftheSpineSagittalViewAP-viewLordosisKyphosisLordosisDevelopmentofDiscandSpinalCurvature

Newborn25years4years-

nosignificantcurvature-DiscHeight=VertebralBodyHeight-Double-Scurvature-DiscHeight=40%ofVBH-biconcave-biconvexshapeofintervertebralspace-DiscHeight=25%ofVBHIntervertebraldiscAnulusfibrosusNucleusPulposusNewborn65yearsNovascularisationofdisc7years70years30yearsWatercontentinthenucleuspulposusdecreasedwithage

FacetJoints

Cervicalvertebrae——sloping

Thoracicvertebrae——coronal

Lumbarvertebrae——sagittalLigamentsAnteriorlongitudinalligamentPosteriorlongitudinalligament

BloodSupplyLoadTransfer80%20%TheFUNCTIONALUNITofthespineComprisedof:TwoadjacentvertebraeIntervertebraldiscConnectingligamentsTwofacetjointsandcapsulesIntradiscalPressureBiomechanics18,31,24,62,75,011,011,023,017,0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

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.分型Classification

脊髓型CervicalSpondylotic

MyelopathyCSM

神经根型CervicalSpondylotic

RadiculopathyCSR

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

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,micturitionanddefecationdifficultiesCSR

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

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.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.食管型颈椎病

Esophagustypecervicalspondylosis

AspecialtypeofCSThroatdiscomfort,foreignbodysensationisanearlysymptomLatemanifestationsisdysphagia

Oftenaccompaniedbysymptomsofothercervicalspondylosis

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.Mixedtypeofcervicalspondylosis

具备以上两种或两种以上的表现者，即可确诊。

Withtwoormorethantwokindsofperformanceabove.DiagnosisMustbehavethreeconditions:

CervicaldegenerativechangesRelevantclinicalmanifestationsRelevantclinicalmanifestationsareconsistentwithimagingfindingsTreatmentIndicatioMildsymptomsCannottolerateoperationMethodsCorrectbadpostureTractionMassage—cautiouslyusePhysiotherapyMedicationsexpectanttreatmentsurgicaltherapy

IndicatioFormalexpectanttreatmentfor3~6monthsisinvalidSymptomofCSMaggravateprogressivelyorsuddenlyorMRIshowedthatthecervicalspinalcordsignalchangesSymptomofCSRimpactqualityoflife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：MicroinvasiveoperationCase1颈前路椎间盘摘除、取自体髂骨椎间植骨融合、内固定术Case2颈前路椎间盘摘除、椎间融合器植骨融合、内固定术Case3颈前路椎体次全切除、椎间钛笼植骨融合、内固定术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颈椎人工间盘置换术颈椎管狭窄症

CervicalcanalstenosisEtiologyandpathologyCongenitaldevelopmentalCCSDegenerativeoriatrogenicCCSCCScanbesingleormultisegmentalstenosis,commonintheC4,5andC6,7segmentsClinicalmanifestation

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Cervicalintervertebraldiscdegeneration

Externalforce

causeruptureofannulusfibrosus

andlongitudinalligamentNucleuspulposus

protrudeintospinalcanalThepainofnerverootandsignsofspinalcompression.颈椎间盘突出症

CervicaldischerniationRelationshipbetweenCDHandCS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

othertissuesexceptthenucleuspulposus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。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，andthenleadtoparalysisEtiologyTheexactmechanismisnotclear，butthereareseveralhypothesisTheoryofheredityMechanicaldamagetheoryDisturbanceofcarbohydratemetabolismtheoryThewholebodybonehypertrophytheoryEpidemiologyTheincidenceofOPLLinEastAsiaishigherJapan

1.9～4.3%(over30yearsold.）Korea

3.6%Taiwan

2.8%China

1.6~1.8%ClinicalcharacteristicsAchronic,progressive,spinalcordornerverootcompressionsymptomsIt‘ssymptomsareverysimilartoCCSorCSX-ray,CT

andMRIcanimprovethediagnosisClassification-

SagittalSectionTopicaltypeSegmentaltype

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

Operationistheonlyeffectivemeans

ChallengeHowtoselectthereasonableoperation?successivetypeandMixedtypeossificrange>3vertebralsegmentsCervical

canalstenosis

>50%Posteriorcervicaloperation/IndirectdecompressionLaminectomyLaminoplastyLaminectomy+internalfixationTopicaltypeandSegmentaltypeossificrange＜3vertebralsegmentsCervical

canalstenosis

＜50%Anteriorcervicaloperation/Directdecompression

Discectomy

Corpectomydecompression

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腰椎间盘突出症

LumbarDiscHerniationLDHEpidemiologySymptomaticLDHareseeninallagegroupsbuthavetheirpeakinpatientsagedbetween35and45years.Exceptsmoking,occupationalfactorsincludesedentaryworkanddriverarethemainreasonsforLDHClassification—Degeneration/BulgingMildsevereCentralPosterlateral

LateralClassification—ProtrusionClassification—Extrusion

Classification—Sequestration

Classification—Schmorl's

nods

SymptomsHowcanwerecognizeaherniateddisk?LowerbackpainSciaticaPain,weakness,numbnessortinglingin

thelegs,buttocksandfeetProblemswithbowel,bladderorerectile

function,inseverecasesGeneralSignsChangesoflumbarcurvatureCompensatoryscoliosisStraightleg-raising(SLR)testSLRstrengthentestFemoralnervestretchingtest

NeurologicsignsSensibilityMuscleforceDeeptendonreflexMuscleatrophyWecaninitiallylocatetheintervertebraldiscProtrusionoftheL3/4discProtrusionoftheL4/5discProtrusionoftheL5/S1disc

ImagingexaminationX-rayCTMRILumbarmyelography

TreatmentExpectanttreatmentSurgicaltreatmentExpectanttreatmentYoungFirstattackShortcourseSymptomscanberelievedbyrestNospinalstenosis

Nospondylolisthesis

SurgicaltreatmentThestrictexpectanttreatmentisinvalidCauda

equinasyndromeClassical-discectomyLumbararthroscopicdiscectomyPLDPLDDLumbartunnelMEDdiscectomyMLDAnteriorlumbardiscectomy,

interbodyfusion

Lumberartificialdiscreplacement腰椎管狭窄症

lumbarspinalstenosisLSS，causedbyvariousreasons

，canconstrictspinalcordandnerverootandleadtocorrespondingnervedysfunction，OneofthecommondiseasesoflowerbackandlegpainEtiologyandpathologyCongenitaldevelopmentalLSSDegenerativeLSSTraumaticoriatrogenic

LSSBesingleormultisegmentalstenosis

CommonintheL4/5EpidemiologyMorecommoninelderlypatients,morethan50yearsoldItiscommoninL4/5，secondaryinL5/S1ClinicalmanifestationChroniclowbackpainMildpainordiscomfortSlowlyaggravationAlleviationaftertheactivityCoughwithoutaggravating

ClinicalmanifestationNeurogenicIntermittentClaudicationNICLCompressionbloodcirculatorydisorderInflammatorystimulusSymptomsarecloselyrelatedwithlumbarpostureAlleviationinflexionAggravationinextensionUphilliseasierthandownhillCanride，hardtowalkClinicalmanifestationLowerlimbneurologicalsymptomsClinicalmanifestationImagingexamination

——X-ray

Transversediameter＜18mmSagittaldiameter＜13mmValuablemethodDisplaythelocationanddegreeofthediseaseImagingexamination

——Lumbarmyelography

CoincidencerateishighTransversediameter＜18mmSagittaldiameter＜13mmNerverootcanal＜3mmImagingexamination

——CT

HighdiagnosticcoincidencerateDifferentialdiagnosissignificanceImagingexamination

——MRI

TreatmentExpectantSurgicalDecompressionFusionX-Stop腰椎滑脱

Thelumbarspondylolithesis

Spondylo——椎体Lithesis——滑移HistoryIn1782,theBelgianHerbinlaux,whoisanfirstdescribedaphenomenonofdystociacausedbyL5spondylolithesisIn1854,theGermandoctorKilianfirstproposedthespondylolisthesisandgivethedescriptionInthe1950s,domesticgraduallybegantoreportspondylolisthesis.EpidemiologyTheincidencerateisabout5%Varingfromtheage,regionandrace,occupation,gender

MorbidityrateincreasewiththegrowthofageMorewomen