hypertrophic spondylitis
Introduction
Introduction to hypertrophic spondylitis The so-called hypertrophic (proliferative) spondylitis refers to the degenerative changes of the spine, or the degenerative change to the main, causing extensive hyperplasia of the vertebral joints and joints, and secondary to a series of clinical symptoms and signs. basic knowledge The proportion of illness: 0.001% Susceptible people: more common in older men Mode of infection: non-infectious Complications: lumbar isthmic spondylolisthesis and spondylolisthesis
Cause
Cause of hypertrophic spondylitis
(1) Causes of the disease
The disease is part of a systemic disorder, collectively referred to as hypertrophic arthritis or osteoarthropathy, also known as osteoarthritis, degenerative arthritis or proliferative arthritis, due to joint degeneration Chronic arthritis caused by destruction of articular cartilage. Osteoarthritis on the spine is called hypertrophic spondylitis. The cause of this disease is primary (or idiopathic) and secondary. In our country, the secondary is more common, the primary is less, and the normal vertebral section has no obvious cause and gradually undergoes degenerative changes, which is called primary spondyloarthropathy; if it is caused by some known reasons Cartilage destruction or joint structure changes, resulting in degenerative changes due to factors such as intra-articular friction or pressure imbalance, known as secondary spondyloarthropathy, some people believe that the essence of this disease is a kind of "spine vertebral failure" Similar to heart failure.
(two) pathogenesis
Age is an important factor in the onset. About 80% of people over the age of 60 have imaging changes in the disease, but not necessarily symptoms. The lesions of hypertrophic vertebral joint disease mainly occur in the intervertebral joints and intervertebral discs, causing the primary Most of the lesions are trauma (including fractures caused by direct or indirect violence, dislocation or intervertebral joint cartilage damage); chronic strain caused by long-term heavy physical labor; long-term excessive waist exercise, such as practicing gymnastics, acrobatics, martial arts, etc. Caused by osteophyte injury, etc., in addition, vertebral deformity, scoliosis or kyphosis, malposition, and vertebral body wedge caused by vertebral osteophytes or other lesions, resulting in uneven intervertebral joint and intervertebral disc load, Therefore, osteoarthrosis occurs in areas with excessive stress, and obesity will increase the load, which is also one of the causes of the disease. After the disc is protruded or degenerated, the elasticity is reduced and the ability to absorb shock stress is lost, which is also the cause of the disease.
After degeneration of the intervertebral disc, the fibrocartilage is replaced by fibrous tissue, which loses its anti-seismic ability, causing the corresponding vertebral body surface to be subjected to frequent excessive compression and impact, resulting in cartilage plate damage and reactive bone hyperplasia, resulting in irregular bone sclerosis. And the formation of marginal callus, narrow intervertebral space, vertebral wedge deformation and spinal deformity make the posterior intervertebral articular position abnormal, stress increase, uneven load distribution, articular cartilage wear, and joint space narrowing, cartilage The lower bone is hardened and irregular, and the apical bone hyperplasia becomes sharp, thereby causing subluxation of the intervertebral joint, the upper joint of the lower vertebra is displaced upward, or the upper vertebral body is slid forward on the lower vertebral body, so that Further narrowing of the intervertebral space, squeezing the nerve roots located in the nerve pores, can also cause so-called degenerative spondylolisthesis, or spine slippage of the invertebrate isthmus.
Prevention
Hypertrophic spondylitis prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Hypertrophic spondylitis complications Complications Lumbar isthmic spondylolisthesis and spondylolisthesis
Degenerative spondylolisthesis (false spondylolisthesis) can be performed concurrently.
Symptom
Hypertrophic inflammatory symptoms common symptoms persistent low back pain with morning stiff sciatica bulging ligament ossification lateral thigh pain
1. Patient overview : Although the disease can be seen in middle-aged people, more than 90% of the patients are elderly people over 60 years old. There are more males than females, more heavy physical workers than light physical workers, and the amount of activity and load is large. More than the amount of activity and load, the disease has a certain relationship with genetic factors.
2. Characteristics of the main complaint : There are many complaints in this case, and its characteristics are as follows:
(1) Low back pain in the morning, less after the activity: More than 80% of the cases complained of feelings of lower back pain after getting up in the morning, generally more tolerable, and limited activity, consciously waist stiffness, but after a little activity, the pain is relieved, then walk Hundreds of steps, not only the pain relief or disappearance, but also the range of waist activity gradually recovered, mainly due to the simultaneous rigidity of the lumbar spine joint capsule and the surrounding ligament.
(2) Multiple activities or more weight-bearing pain, relieve after rest: After excessive activity or weight-bearing in the waist, such patients feel low back pain and gradually increase, with limited activity. At this time, if you are lying flat or on the sofa, When the rest of the chair rests properly, the symptoms are obviously improved. Most of the symptoms in this group appear in the evening, that is, one day after the activity, but the severe condition may also occur after 1 to 2 hours of activity.
(3) The stiffness of the waist and the feeling of soreness are particularly obvious: unlike other patients with low back pain, the main pain is pain, and more of them complain of limited lumbar joint activity, inflexibility and symptoms of acid, stiffness, swelling, and hope for others. Sniper with a fist.
3. Signs of characteristics
(1) There are no clear tender points: more than 90% of the cases have no clear fixed tender points, and the symptoms are mainly caused by sinus reflex.
(2) Uniformity of lumbar activity is limited: that is, the range of lumbar activity is limited, and the range of limitation is large. The lumbar motion of early cases may be close to normal, but the function of different degrees in the middle and later stages is limited. .
(3) Comfortable feeling: When the examiner slams the patient's lower back, it reports more satisfaction with the comfort, and hopes that the examiner will take a few more times. This is mainly due to the rigidity of the small joint ligaments and the slowing of blood flow. The cause of venous congestion.
(4) more without sciatic radiation pain: there is no root symptom in this disease alone, so many are not accompanied by sciatic radiation pain, lower leg straight leg elevation test, along the sciatic nerve tenderness and other neurological symptoms of the lower limbs are mostly negative.
Examine
Examination of hypertrophic spondylitis
Whether it is X-ray, tomography or MRI, the typical degenerative signs are shown and the corresponding changes are made depending on the stage of the degeneration.
1. X-ray see
(1) instability of the vertebral node: in the early stage of the disease, or in the same case, the vertebral section with mild lesions may show looseness and instability during dynamic imaging (lateral position), generally the lower edge of the previous vertebral body is below The upper edge of a vertebral body slides back and forth, and a trapezoidal change occurs. Lateral looseness and instability are less common, mainly due to the bony structure of the lumbar spine and the strong muscles on both sides.
(2) Intervertebral space stenosis: due to degeneration of the intervertebral disc, the early stage can show the narrowing of the interstitial space, and the vertical height of the intervertebral space is significantly reduced with the dehydration intensification and the cartilage surface involvement, even for the normal intervertebral space. /3 or 1/4.
(3) vertebral osteophytes hyperplasia: at the edge of the vertebral body can show different sizes of bone hyperplasia.
The actual size of the epiphysis is slightly larger than that seen on the X-ray film. This is mainly due to the presence of a cartilage-like tissue around the bony tissue (if the X-ray tube is too close, the opposite result occurs). Small bones are not easy to show at the angle of the film, especially at the proximal root canal at the back of the vertebral body.
(4) small joint bone hyperplasia: in addition to vertebral edge bone spurs, small joint bone hyperplasia is also more common, because the bone tissue overlap is difficult to determine, therefore, when there is suspected bone hyperplasia, and accompanied If there is a symptom of root compression and a positioning procedure is required, a tomographic or CT examination is required.
(5) Other changes: In addition to the epiphysis, the loosening and instability of adjacent vertebrae can be found on the X-ray film. This is due to the increased activity of the adjacent vertebrae, and attention should be paid to the presence or absence of the fifth lumbar pedicle. Degenerative fracture, which can be accompanied by, at the same time, the sagittal diameter of the spinal canal and/or root canal is measured as appropriate to determine the presence or absence of secondary spinal stenosis.
2. CT examination: the diagnosis of lower lumbar injury is of great significance, and its positive detection rate is significantly higher than ordinary X-ray examination, especially in the determination of the shape and size of the spinal canal and lateral crypt. Three-dimensional spinal canal morphological reconstruction is more conducive to the determination of the state of the spinal canal and root canal, and can be used as a basis for surgical selection.
3. MRI examination: This examination is mainly used to determine the state of the dural sac, so those with spinal cord and spinal nerve root symptoms should be routinely examined.
Diagnosis
Diagnosis and treatment of hypertrophic spondylitis
Diagnostic criteria
The diagnosis of this disease is mainly based on:
1. Clinical symptoms: Most of the above-mentioned clinical symptoms are characterized by long or complete treatment, and the course of treatment is longer, which can occur from middle age (mostly strong physical labor).
2. Clinical examination: In addition to the stiffness of the waist, limited mobility and sniper comfort, about half of the cases may have no other special performance.
3. Age of patients: Generally more than 55 years old, except for strong physical workers or weightlifters (including ballet actors) under 50 years old, other rare.
4. Imaging examination: typical degeneration changes on the X-ray, and CT or MRI examination is feasible.
Differential diagnosis
The disease is mainly identified with the following conditions:
1. Lumbar muscle strain: Lumbar muscle strain is very common in clinical, should pay attention to identification, the characteristics of this disease are as follows:
(1) Age of onset: Mostly 35 to 40 years old.
(2) Past history: There is a history of lumbar trauma or long-term overwork, or working in a humid environment for too long.
(3) Clinical features: mainly lumbosacral or lumbar and persistent blunt pain, increased after overwork, and reduced after rest.
(4) tenderness points: more fixed.
(5) X-ray film: no more obvious.
2. Low back muscle fibrosis: This disease is similar to lumbar muscle strain, and can be seen at any age, but it is more middle-aged, but in addition to chronic lumbar strain, there is a history of dampness and cold disease, oral aspirin. It is effective, so it is not difficult to distinguish.
3. Lumbar intervertebral disc herniation (dislocation): This disease is more common, and should also pay special attention to identification, the main points are:
(1) Age of onset: It is also common in young adults aged 30 to 40 years old, and elderly patients are very rare.
(2) Root symptoms: all are obvious, and there are localized symptoms, which are episodes and disappear after bed.
(3) Lumbar symptoms: It is also obvious, so that the lumbar flexion is obviously restricted.
(4) MRI examination: there are signs of typical spinal nerve root compression.
4. Rheumatism: refers to the main symptoms of the lower back, especially the disease:
(1) Migratory pain.
(2) The rate of blood cell sedimentation increases.
(3) The serum anti-streptolysin O test is more than 400U.
(4) Sensitive to anti-rheumatic drugs.
(5) The range of spinal activity is basically unaffected.
(6) It can be seen at any age, especially among adolescents.
(7) abnormalities such as bone hyperplasia and other abnormalities.
5. Rheumatoid spondylitis: It is easy to distinguish from degenerative spondylitis in the later stage of the disease; but in the early stage, when the spine has not changed significantly, it is difficult to identify. The characteristics of this disease are as follows:
(1) The onset of the limbs is more common in small joints, such as hands, feet, wrists, etc., can have obvious symptoms.
(2) There are fewer symptoms in the lumbosacral spine on the spine, and more symptoms appear in the cervical spine.
(3) Sensitive to the treatment of gold preparations.
(4) Rheumatoid factor tests are mostly positive.
(5) The age of onset is lighter than degenerative spondylitis.
(6) There is no degenerative change on the X-ray film.
The identification of the above five diseases is summarized in Table 1.
In addition, the disease should be identified with the following various diseases, mainly:
6. Ankylosing spondylitis: Although this disease has many similar symptoms to rheumatoid spondylitis, it is another disease, which can be differentiated from degenerative spondylitis according to the following characteristics:
(1) More onset from the ankle joint.
(2) The neck, chest, waist and pelvis are both affected.
(3) The blood cell sedimentation rate is faster, especially during the active period; the latex test and HLA-B27 test are mostly positive.
(4) X-ray examination showed corresponding characteristics on the spine depending on different stages of disease: early osteoporosis, decalcification, and gradually showing joints and joints, thoracic rib joints and rib transverse joints were ambiguous, and finally ligaments Complete calcification and bamboo-like changes.
(5) Age is more common in young adults, and there are fewer people over 50 years old.
7. Spinal tuberculosis: Although it has been rare in recent years, clinical cases can still be found in sporadic cases, which can be identified according to the following characteristics of the disease:
(1) Most of the patients are adolescents.
(2) The lesion is more common in the thoracolumbar or thoracic segment.
(3) More accompanied by obvious kyphosis.
(4) The sample test is positive.
(5) X-ray films show typical vertebral destruction and paraspinal abscess syndrome.
(6) Systemic symptoms of tuberculosis.
8. Axillary joint disease: more common in women, especially in postpartum, its characteristics are as follows:
(1) Pain and tenderness points are mostly limited to one or both sides of the ankle joint.
(2) The various tests of the ankle joint are mostly positive.
(3) X-ray plain film (positive, lateral and left and right oblique positions) shows that the ankle joint is dense (compact ankle arthritis), loosening and widening (postpartum arthritis) or destructive (Abnormalities such as joint tuberculosis).
(4) There may be other different symptoms depending on the cause.
9. Other diseases: In addition, it should be differentiated from lumbar spinal stenosis, small joint arthritis and genitourinary system diseases.
