【脊柱侧弯 精】6.1 退行性脊柱侧凸临床和影像学评估
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小关节退变和椎间孔狭窄 Facet degeneration and
foraminal stenosis Nerve root entrapment
Concave radiculopathy
临床评估量表 • VAS • 腰痛 • 腿痛 • ODI • SRS-22 • SF-36
影像学评估 Imaging Study
stenosis Neurogenic claudication
椎管狭窄原因Causes of spinal stenosis
神经牵拉Nerve root stretch Convex
radiculopathy
旋转滑移Rotatory slip L2-L3 Central canal
stenosis Neurogenic claudication
退行性脊柱侧凸临床和影像学评估
Clinical and Radiographic Evaluation of ADS
成人退行性脊柱侧凸
• ADS成人退行性脊柱侧凸 • 在骨骼发育成熟后(大于20岁)出现的脊柱侧弯(Cobb角>10°) • On site after bone mature & Cobb>10°
旋转滑移Rotatory slip L2-L3 Central canal
stenosis Neurogenic claudication
椎管狭窄原因Causes of拉Nerve root stretch Convex
radiculopathy
旋转滑移Rotatory slip L2-L3 Central canal
Lee, et al. Contemporary Spine Surgery, 2010 Russo, et al. Current Orthopedic Practice, 2008
退行性脊柱侧凸
• 继发于椎间盘及椎间关节退变的成人结构性侧凸 • 不对称退变: 椎间盘disc, 小关节facet joints • 不对称畸形: 侧凸scoliosis, 后凸kyphosis • 常见于T11或T12到L5或S1 • 椎管或根管狭窄症状 • Stenosis of Spinal Canal • Root compression on the Concave • 凹侧神经根压迫 • Root Stretching on the Convex • 凸侧神经根的牵拉
2016 The Spine Journal
神经根性疼痛
• 神经根性疼痛相关因素研究 • interpedicular height (IPH) • Aassociated with side- and level-specific radicular pain
椎管狭窄原因Causes of spinal stenosis
• 目的 Goal • 评价平衡情况 • 评价退变程度 • 明确疼痛来源 • 明确神经受压情况 • X线评估 X-ray • 站立位正侧位片 • 卧位侧屈曲位摄片 • 卧位过伸过屈位摄片
腰椎正侧立位片
旋转脱位Subluxation
旋转脱位与神经症状
• The site of stenosis and different patterns or locations of lateral subluxation • 35 patients with DLS average age, 70.2 years • Subluxation level • Amount of listhesis • Subluxation angle • Axial rotation • Pattern or location of spinal stenosis
2013 Spine Deformity
旋转脱位与神经症状
旋转脱位与神经症状
• 60 subluxations in 35 patients • Open:L3/4 convex • Closed:L1/2 concave
发病率及分类 Adult Spinal Deformity
IS DS CS NMS
20%
Morbility
ASD13.3%
19%
50%
11%
LESS≠UNIMPORTANT
成人退行性脊柱侧凸
3-Dimensional
Coraonal Sagital Axial
Sagital Local Regional Global
成人退行性脊柱侧凸
• 流行病学Demographic data • 年龄越大，发病率越高Aging population is increasing • 发病年龄Age of presentation: 50-60s • 发病率Prevalence: 6% • 伴随其他系统疾病 • 骨质疏松 Poor bone quality
4th Dimension: Time Disco-ligamentous structures Bone density Muscle mass and tone Neural control mechanisms
De Novo Scoliosis
Complex Spinal Deformity
临床评估 Clinical Evaluation
疼痛评估 Pain
• 专科情况 • 疼痛来源与程度 • 局限 or 广泛 • 间歇性跛行 • 神经系统检查 • 根性痛 • 神经功能障碍 • 弯曲柔软性 • 躯干总体平衡状况 • 站立姿势
• 步态 • 胸廓形状 • 肩部、骨盆是否对称 • 膝、髋关节屈曲情况
疼痛史 压痛点 疼痛范围 神经根封闭 小关节封闭 椎管内封闭 根管造影 椎间盘造影
CTM
神经根性疼痛
• 神经根性疼痛相关因素研究 • 200 patients, 50 year-old • 60/200 presented with radicular pain • Older age • >55 years • 8 times more likely to have RP • 5 times more likely to have sensory and motor defict
foraminal stenosis Nerve root entrapment
Concave radiculopathy
临床评估量表 • VAS • 腰痛 • 腿痛 • ODI • SRS-22 • SF-36
影像学评估 Imaging Study
stenosis Neurogenic claudication
椎管狭窄原因Causes of spinal stenosis
神经牵拉Nerve root stretch Convex
radiculopathy
旋转滑移Rotatory slip L2-L3 Central canal
stenosis Neurogenic claudication
退行性脊柱侧凸临床和影像学评估
Clinical and Radiographic Evaluation of ADS
成人退行性脊柱侧凸
• ADS成人退行性脊柱侧凸 • 在骨骼发育成熟后(大于20岁)出现的脊柱侧弯(Cobb角>10°) • On site after bone mature & Cobb>10°
旋转滑移Rotatory slip L2-L3 Central canal
stenosis Neurogenic claudication
椎管狭窄原因Causes of拉Nerve root stretch Convex
radiculopathy
旋转滑移Rotatory slip L2-L3 Central canal
Lee, et al. Contemporary Spine Surgery, 2010 Russo, et al. Current Orthopedic Practice, 2008
退行性脊柱侧凸
• 继发于椎间盘及椎间关节退变的成人结构性侧凸 • 不对称退变: 椎间盘disc, 小关节facet joints • 不对称畸形: 侧凸scoliosis, 后凸kyphosis • 常见于T11或T12到L5或S1 • 椎管或根管狭窄症状 • Stenosis of Spinal Canal • Root compression on the Concave • 凹侧神经根压迫 • Root Stretching on the Convex • 凸侧神经根的牵拉
2016 The Spine Journal
神经根性疼痛
• 神经根性疼痛相关因素研究 • interpedicular height (IPH) • Aassociated with side- and level-specific radicular pain
椎管狭窄原因Causes of spinal stenosis
• 目的 Goal • 评价平衡情况 • 评价退变程度 • 明确疼痛来源 • 明确神经受压情况 • X线评估 X-ray • 站立位正侧位片 • 卧位侧屈曲位摄片 • 卧位过伸过屈位摄片
腰椎正侧立位片
旋转脱位Subluxation
旋转脱位与神经症状
• The site of stenosis and different patterns or locations of lateral subluxation • 35 patients with DLS average age, 70.2 years • Subluxation level • Amount of listhesis • Subluxation angle • Axial rotation • Pattern or location of spinal stenosis
2013 Spine Deformity
旋转脱位与神经症状
旋转脱位与神经症状
• 60 subluxations in 35 patients • Open:L3/4 convex • Closed:L1/2 concave
发病率及分类 Adult Spinal Deformity
IS DS CS NMS
20%
Morbility
ASD13.3%
19%
50%
11%
LESS≠UNIMPORTANT
成人退行性脊柱侧凸
3-Dimensional
Coraonal Sagital Axial
Sagital Local Regional Global
成人退行性脊柱侧凸
• 流行病学Demographic data • 年龄越大，发病率越高Aging population is increasing • 发病年龄Age of presentation: 50-60s • 发病率Prevalence: 6% • 伴随其他系统疾病 • 骨质疏松 Poor bone quality
4th Dimension: Time Disco-ligamentous structures Bone density Muscle mass and tone Neural control mechanisms
De Novo Scoliosis
Complex Spinal Deformity
临床评估 Clinical Evaluation
疼痛评估 Pain
• 专科情况 • 疼痛来源与程度 • 局限 or 广泛 • 间歇性跛行 • 神经系统检查 • 根性痛 • 神经功能障碍 • 弯曲柔软性 • 躯干总体平衡状况 • 站立姿势
• 步态 • 胸廓形状 • 肩部、骨盆是否对称 • 膝、髋关节屈曲情况
疼痛史 压痛点 疼痛范围 神经根封闭 小关节封闭 椎管内封闭 根管造影 椎间盘造影
CTM
神经根性疼痛
• 神经根性疼痛相关因素研究 • 200 patients, 50 year-old • 60/200 presented with radicular pain • Older age • >55 years • 8 times more likely to have RP • 5 times more likely to have sensory and motor defict