cervical spondylolisthesis
Introduction
Introduction to cervical spondylolysis The superior and inferior articular processes of the cervical vertebrae have a cylindrical structure, which is usually called the inter-articular process, not the isthmus. Because of the unclear congenital factors, the bone defect or continuous interruption of the bone is cervical spondylolysis; on this basis, due to degeneration or head and neck stress, the displacement of the diseased vertebrae is the cervical spondylolisthesis. Can cause instability of the cervical spine and spinal cord, nerve root stimulation symptoms. Cervical spondylolysis is a rare cervical deformity. In 1951, Perlman and Hawes first reported a sixth male cervical vertebral arch with cervical spondylolisthesis. So far, the total number of cases reported worldwide is only about 100 cases. basic knowledge The proportion of illness: 0.00054% Susceptible people: no special people Mode of infection: non-infectious Complications: cervical disc herniation Cervical spinal stenosis
Cause
Cervical spondylolysis
(1) Causes of the disease
The etiology of this disease is still unclear, and most scholars believe that it is a congenital malformation.
(two) pathogenesis
This disease often involves other congenital malformations of the cervical vertebrae, such as spina bifida, lack of pedicle, dysplasia of the articular process, etc., because the upper and lower joints of the fetus are formed as an ossified nucleus, that is, the defect is not ossified. The central fusion, so the original ossification center is not closed, may be in the early fetal, the original ossified vertebral arch caused by some factors, or caused by a slight fracture on the basis of this deformity, with age, local The defect is more and more obvious (but some people here are filled with soft tissue or cartilage, and relatively stable, it does not show clinical symptoms), because the cervical spine is adjacent to the nerve root in front of the upper and lower joints, when the part is degenerated, proliferated, unstable At the time, the intervertebral foramen is narrow and stimulated, and the possibility of sinus nerve and spinal nerve is compressed, and local or root symptoms are generated. In severe cases, the spinal cord can be compressed. However, the disease has not been found in the examination of newborns so far. In addition, it is difficult to explain why it occurs mostly in the neck 6. Morvan has proposed the theory of fatigue stress fracture, but the neck 5 with the greatest stress during the flexion and extension activities rarely occurs. 7 has never seen a report, and seems to be unable to support this view.
Prevention
Cervical spondylolysis prevention
The pathogenesis of this disease is unknown, there is no effective preventive measures at present, but most authors believe that this disease is a congenital malformation, so the prenatal diagnosis can be used to achieve the purpose of prenatal and postnatal care, to avoid the occurrence of this disease.
Complication
Cervical spondylolysis Complications Cervical disc herniation Cervical spinal stenosis
Combined cervical spondylolisthesis, relatively rare, occurs in the sixth cervical vertebrae, slipping generally does not exceed 1 °, may cause symptoms of nerve root compression, may also be combined with cervical disc herniation and cervical spinal stenosis.
Symptom
Cervical spondylolysis symptoms Common symptoms Spinal cord compression Shoulder pain Head and neck activity limitation Swallowing difficulties Cervical disc herniation Neck pain Neck and shoulder pain Spina bifida
This disease is more common in young men, the ratio of male to female is 2 to 3:1, the lesion segment can involve the neck 2 to the neck 7, the neck 6 is the most common, accounting for more than 70%, bilateral vertebral arch fracture more than Unilateral vertebral arch.
Cervical spondylolysis without slippage, clinical symptoms of cervical instability, mainly for neck occipital and shoulder pain, combined with cervical spondylolisthesis can occur with nerve root compression symptoms and dysphagia, spinal cord compression symptoms are less common However, if cervical spondylolisthesis combined with cervical disc herniation or cervical spinal canal stenosis is prone to spinal cord compression symptoms, some cases may have no clinical symptoms, only cervical X-ray examination with cervical spondylolisthesis and cervical spondylolisthesis.
Examine
Cervical spondylolysis
The clinical manifestations are non-specific. The diagnosis is mainly based on X-ray plain film, including positive, lateral, left and right oblique position and extensional flexion dynamic position. For patients with doubt, the tomographic film should be taken to show the lesion more clearly. Site, CT and MRI examinations only provide a reference for the diagnosis of this disease, but help to identify and discover other diseases, the X-ray features of the disease:
1. There is a clear boundary between the cervical intervertebral joints, and the edge of the broken end is hardened and dull.
2. The small facet joints in the lesions are triangular or bow-like deformities.
3. The posterior part of the vertebral arch is dislocated backward, and the vertebral body is slightly slipped forward (1 degree), and the intervertebral foramen can be small.
4. Multiple ipsilateral or adjacent pedicles, dysplasia of the articular processes and other deformities such as scapular spine.
It is worth noting that in the CT scan slice, the cervical vertebral arch fissure and the lumbar spondylolysis have different performances, which are mainly characterized by the continuous interruption of the joint between the articular process and the vertebral body, the smooth end, the articular process and the vertebral body. The angle is also different.
Diagnosis
Diagnosis and diagnosis of cervical spondylolysis
In the diagnosis of this disease should pay attention to the diagnosis of cervical vertebral arch destruction caused by trauma, tumor and other reasons, clinical manifestations and X-ray examination is sufficient to confirm the diagnosis of this disease.
