Deformity of the thoracic spine
Introduction
Introduction The thoracic spine is kyphosis during the embryonic period and gradually becomes lordosis after the child is sitting up. This change is called secondary curvature. The formation of secondary curvature is generally due to the thickness of the vertebral body and the anterior and posterior disc. The presence of thoracic physiologic curvature can increase the elasticity of the thoracic spine, reduce and cushion the shock of gravity, and prevent damage to the spinal cord and brain. Due to long-term sitting posture, poor sleeping posture and dehydration and degeneration of the nucleus pulposus of the intervertebral disc, the lordosis of the thoracic vertebra can gradually disappear, and even the straight or reverse bending, that is, the convexity of the back, which causes the thoracic kyphosis.
Cause
Cause
The cause of thoracic deformity
Congenital, but also caused by bad habits.
[Etiology] Congenital vertebral malformations are thought to be related to autosomal dominant and recessive inheritance. Winter reported a family history of 1%.
[Pathological changes] According to different vertebral lesions, it can be divided into vertebral body insufficiency and vertebral insufficiency.
1. Vertebral segmentation: According to Winter's observation, it is divided into the following four types:
(1) Lateral unsegmented: vertebral body insufficiency occurs on one side, eventually leading to severe scoliosis. Vertebral segmental insufficiency (lateral unsectioned)
(2) Unsegmented in front: Unsegmented in front of the vertebral body, leading to kyphosis deformity. Segmental insufficiency of the vertebral body (unsegmented in front)
(3) Undistributed on both sides of the rear: causing kyphosis. Vertebral segmental insufficiency (rear bilateral unsection)
(4) Symmetry is not distributed on both sides: the longitudinal axis of the vertebral body does not grow, and no angulation or rotational deformity occurs. Vertebral segmental insufficiency (double unsectioned)
2. Vertebral dysplasia: it can form partial or complete insufficiency. When part of the unilateral vertebral body is incomplete, the vertebral body has a wedge shape or a rhombic shape. X-ray film performance cuts work for a small hypoplasia experience life. The hemivertebra is caused by complete unilateral dysplasia. The hemivertebra and adjacent vertebral bodies may be non-distributed, semi-segmented or segmented. The segmented semi-vertebral body causes asymmetry of vertebral body growth, especially when two semi-vertebral bodies appear on one side, and severe scoliosis can occur. When a semi-vertebral body appears behind the vertebral body, it causes kyphosis to form an angular deformity. The semi-segmental vertebral body is fused with an adjacent vertebral body, and the scoliosis is relatively light. The unsectioned hemivertebrae fuse with adjacent vertebral bodies and generally do not cause progressive scoliosis. According to the Nasca report, 60 patients with semi-vertebral body were divided into 6 types:
1 Simple excess vertebral body: can be fused with one or two adjacent vertebral bodies. There may be pedicles and extra ribs when it occurs in the thoracic spine.
2 simple wedge-shaped semi-vertebral shape.
More than 3 semi-vertebral bodies.
More than 4 semi-vertebral bodies are accompanied by a vertebral body fusion.
5 flat and thin vertebral bodies: there are equal numbers of semi-vertebral bodies on both sides, generally do not cause scoliosis.
6 posterior vertebral body: easy to cause kyphosis.
The physiological kyphosis of the thoracic vertebra causes the body's line of gravity to pass through the front of the vertebral body, and the mechanical load is mainly transmitted through the front of the vertebral body. With the increase of age, the cumulative effect of human mechanical load leads to the progression of thoracic kyphosis, which is more pronounced in women and in senile osteoporosis. Previous studies have shown that thoracic kyphosis is largely determined by vertebral morphology and is closely related to the integrity of the disc. However, it is difficult to determine the specific effects of these factors on thoracic kyphosis.
In order to adapt to the conduction characteristics of the mechanical load of the spine, the thoracic vertebral body has a wedge shape with a narrow front and a wide back. In patients with osteoporosis, bone resorption and bone formation are out of balance, bone loss increases, resulting in changes in the bony structure and morphology of the vertebral body, prone to vertebral deformity or wedge fracture. Because the angle of the thoracic kyphosis is larger than that of the male, and the wedge shape of the vertebral body is more obvious than that of the male, the physiological pressure load in front of the female thoracic vertebral body is greater, and it is more prone to vertebral deformity or wedge fracture.
Normal thoracic disc degeneration occurs mostly in front of the annulus, causing tearing of the annulus. The incidence of thoracic disc degeneration is high, especially in men with a higher incidence of thoracic disc degeneration. This is mainly due to the fact that men are more likely to be exposed to repeated trauma. Weiler et al believe that an increase in vertebral body load can induce an increase in matrix metalloproteinases, leading to increased sensitivity of nociceptors, which ultimately leads to degeneration of the intervertebral disc tissue. The authors' findings suggest that male age is more correlated with intervertebral disc morphology, which may be due to an increase in the pressure of the male thoracic spine, which is more likely to cause an increase in intervertebral disc pressure, resulting in a degeneration of the annulus rather than a collapse of the vertebral body. Age-related changes in the degree of wedge discriation in male thoracic discs are likely to reflect potential pathological changes in the intervertebral disc.
The progression of normal thoracic kyphosis is significantly associated with age. Factors that contribute to the progression of thoracic kyphosis include factors such as loss of muscle tone, occupational influence, habitual posture, changes in vertebral morphology, and reduction in bone mass. The impact of these factors on women is even more pronounced. It may be related to the following factors: older women have relatively less physical activity, more muscle and ligament tension loss, and the influence of older women's breasts.
In general, the relationship between thoracic kyphosis and vertebral morphology is greater, but the relationship between female thoracic kyphosis and intervertebral disc is also very close. According to the results of stepwise regression analysis and the available evidence, the intervertebral disc is an important factor in determining thoracic kyphosis. Age, vertebral morphology and intervertebral disc morphology were used as independent variables, and thoracic kyphosis angle was added as a dependent variable to the stepwise regression model. The results showed that thoracic kyphosis was largely determined by the morphology of the vertebral body and intervertebral disc, but the age did not arise. Important role. Changes in the morphology of the intervertebral disc may be part of the normal human aging process, and to some extent, changes in age-related disc morphology may explain the progression of thoracic kyphosis during a lifetime. Conversely, the lack of correlation between male age and vertebral morphology indicates that although vertebral morphology has an important effect on thoracic kyphosis, the morphology of male vertebral bodies does not change with age, but remains relatively stable, so the thoracic vertebrae The effect of kyphosis is limited. The authors' findings suggest that vertebral and intervertebral disc morphology play a more important role in women's thoracic kyphosis, which may indicate that male extra-bone factors such as ligaments and muscle systems may play a greater role in maintaining thoracic kyphosis.
Examine
an examination
Thoracic deformity examination
The chest radiograph found congenital spinal deformity, which may be characterized by cervical abnormalities, irregular thoracic vertebrae, and abnormalities of the semi-vertebral body such as wedge-shaped vertebrae. If the thoracic vertebra is unhealthy, or the position is not good, it affects not only the internal organs of the thoracic cavity. Organs. The abdominal cavity, even the pelvis, the function of the lower body will be implicated. The lower the lower, the lower part of the thoracic vertebrae, the more dense the spinal nerves are distributed, that is, the visceral function caused by the unhealthy lower thoracic spine is not adjusted, the situation is even more Complex. For example, in the spinal canal between the 11th thoracic vertebra and the 12th thoracic vertebra, there are nearly 10 spinal nerves passing through. Here, if squeezed, the organs that the nerves are in charge, such as the kidney, adrenal gland, bladder, large intestine, and even the pelvis All organs are affected, causing illnesses in related organs.
Diagnosis
Differential diagnosis
Thoracic deformities need to be differentiated from the following symptoms:
Thoracic lumbar metaplasia: refers to the 12th thoracic vertebrae that loses the ribs and forms a lumbar vertebrae. If the 5th lumbar vertebrae are not accompanied by delirium, the lumbar spine is still present and has lumbar function.
Thoracic scoliosis: Thoracic scoliosis refers to a deformity of the spine in which one or more vertebral segments of the spine are laterally curved and accompanied by vertebral rotation. Thoracic scoliosis has a high incidence in the modern population, affecting a wide population, a large number, and gradually becoming younger. It is closely related to the professional characteristics of the modern population and work and living habits. It affects a wide range of human bodies, affects many tissues and organs, and the symptoms are complicated, including not only skeletal muscles. Neurovascular, visceral digestive system, cardiovascular circulatory system, etc. The harm caused to people is serious. The chest radiograph found congenital spinal deformity, which may be characterized by cervical abnormalities, irregular thoracic vertebrae, and abnormalities of the semi-vertebral body such as wedge-shaped vertebrae. If the thoracic vertebra is unhealthy, or the position is not good, it affects not only the internal organs of the thoracic cavity. Organs. The abdominal cavity, even the pelvis, the function of the lower body will be implicated. The lower the lower, the lower part of the thoracic vertebrae, the more dense the spinal nerves are distributed, that is, the visceral function caused by the unhealthy lower thoracic spine is not adjusted, the situation is even more Complex. For example, in the spinal canal between the 11th thoracic vertebra and the 12th thoracic vertebra, there are nearly 10 spinal nerves passing through. Here, if squeezed, the organs that the nerves are in charge, such as the kidney, adrenal gland, bladder, large intestine, and even the pelvis All organs are affected, causing illnesses in related organs.
