Bone spur formation at the posterior edge of the vertebral segment
Introduction
Introduction The posterior margin of the vertebral joint has the formation of spurs, that is, the vertebral bone hyperplasia. The foreign countries are mainly named osteoarthrosis, osteoarthritis, proliferative osteoarthritis, and degenerative osteoarthritis. It is a common disease in middle-aged and elderly patients. The main names of Chinese medicine include osteoarthrosis, intervertebral disc degeneration, proliferative arthritis, degenerative diseases of the bones and joints; the motherland medicine belongs to the scope of hysteria.
Cause
Cause
Causes of the disease: The pathogenesis of sagittal stenosis of the spinal canal is multifaceted. In addition to the flattening of the spinal canal itself, it is related to factors such as laminar hypertrophy, short pedicle, small joint hypertrophy or growth in the direction of the spinal canal. Of course, the ligament of the ligamentum flavum is also related to congenital development.
Bone hyperplasia is medically known as osteoarthritis, also known as hypertrophic arthritis or degenerative arthritis, mainly due to imbalance of mechanical stress distribution or excessive load causing cartilage wear. The articular cartilage of the human body is subjected to mechanical forces caused by various activities every day. After the middle age, the muscle function gradually declines, which easily leads to joint damage, cartilage destruction, and osteoarthritis. Therefore, osteoarthritis is very common in middle-aged and elderly people.
It has been reported that the incidence rate is about 40-50% among middle-aged and elderly people over 45 years old. It is a common and frequently-occurring disease in the elderly, which seriously affects the physical and mental health of the elderly. The pathogenic factors of bone and joint are not single. Changes in collagen, proteoglycan, chondrocytes, cartilage, and synovium can affect other components. Therefore, the form of articular cartilage degeneration is also diverse.
(1) aging: aging is the strongest risk factor for osteoarthritis. According to autopsy data, about 5% of people's joints have degenerative changes since the age of 20, and at the age of 40, almost 90% of the weight-bearing joints have more or less changes in bone hyperplasia. Professor Zhang Naijun and others conducted an epidemiological survey of knee osteoarthritis in 2063 adults in the suburbs of Beijing: knee pain in the age group of 16 to 30 years old, 31 to 40 years old, 41 to 50 years old, 51 to 60 years old, and older than 60 years old. Among them, the positive rates of osteophytes were 10.6%, 14.8%, 29.1%, 5 1.8%, and 78.5%, respectively, and the positive rate increased with age.
(2) Gender: According to the data of Professor Zhang Naiqi and others, the incidence of women before the age of 50 is 2 times higher than that of men, but after the age of 50, the two sexes are basically equal.
(3) Occupation: Bone hyperplasia is related to occupation. Repeated use of certain joints over a long period of time can increase the prevalence of these joints. Such as the elbow and shoulder joints of the foundry, the spine and knee joint of the miner, the knee joint of the loader, the shoulder joint of the driver, the wrist joint of the repairman and the weaver, the toe joint of the ballerina, long-term embroidery, typing, The cervical vertebrae of the desk workers worked for a long time, such as textile women workers, salespersons, Miss Yingbin, and the calcaneus of the honor guards. These parts are repeatedly subjected to a certain action for a long time, so that the joint is often worn and causes bone hyperplasia. According to the 1994 Rheumatology Yearbook, it was found that 109 male and female patients with osteoarthritis over 50 years of age compared with 218 people without osteoarthritis found that daily sputum or sputum was more than 30 minutes. Or people who climb more than 10 stories per day have a high incidence of knee hyperplasia.
(4) Ethnic genetic factors: British people have the highest incidence and West Africans have the lowest, Caucasians have higher incidence than blacks; women with osteoarthritis with Heber den nodules, their mothers and sisters with this disease It is 2 to 3 times that of the general population. And the detection rate of HLA-A1 and HLA-B8 in patients with osteoarthritis increased.
(5) Physique factors: Weight gain causes the degenerative joints that have been worn out to be heavily loaded, and of course, it is more likely to be destroyed. Therefore, bone hyperplasia occurs mostly in the hip, knee, calcaneus, lumbar vertebrae and other parts with heavy weight. In addition, due to joint pain, the patient unconsciously restricts the activity and increases the weight, and the mutual influence increases the joint disease. According to a study published in the American Arthritis Today, by tracking 1178 men aged 30 to 46, it is found that people over 20 pounds of standard weight have a 3.5 times more chance of developing osteoarthritis than normal weight. Most of the sites are hip and knee joints.
(6) Poor posture: The incidence of cervical hyperosteogeny is particularly high in long-term desk workers, poor sleep posture, and inappropriate pillows. This is due to the imbalance of the ligaments and joints of the paravertebral muscles. The side with large tension is liable to cause different degrees of strain, and because some of the muscles of the cervical vertebrae are in a state of constant tension, the muscles are statically damaged for a long time, and the cervical vertebrae are degenerated. Sexual changes cause bone hyperplasia. It is also unevenly affected by the long-term stress of the cervical vertebra joint, so that stress (stress) is concentrated in somewhere in the joint to cause excessive stress and damage the joint.
(7) Intraosseous venous stasis and intraosseous hypertension: Abnormal bone blood flow characterized by intraosseous venous stasis and resulting intraosseous hypertension, which reduces arteriovenous pressure difference and reduces blood flow of nutrient vessels Nutritional disorders can cause trabecular bone necrosis, and osteonecrosis of bone cells may be one of the causes of arthritis.
Examine
an examination
Related inspection
Spinal MRI examination of the spine palpation spine
1. X-ray plain film examination of conventional X-ray film, mainly on the lateral position can clearly show the sagittal diameter of the cervical spine. Anyone who has a sagittal diameter of less than 12 mm on a flat lens with a standard projection distance of 180 cm has diagnostic value; when it is 12 to 14 mm, it has diagnostic reference significance; and when it is less than 10 mm, it can be completely diagnosed. In addition, it can be judged according to the ratio of the sagittal diameter of the vertebral body to the spinal canal. It is abnormal if it is less than 1:0.75, and has diagnostic significance when it is less than 1:0.6. The ratio can be completely diagnosed when the ratio is less than 1:0.5.
2. CT (or CTM) and MRI examination can clearly show the size and shape of the sagittal diameter of the spinal canal and its relationship with spinal cord compression. CT examination mainly shows bone tissue, while MRI examination is more clear on soft tissue imaging. Therefore, the combination of the two is ideal, which is not only conducive to diagnosis, but also conducive to the determination of the state of the spinal canal tissue to determine the treatment plan and operation. s Choice.
Vertebral hyperplasia examination project:
Spinal plain spine vertebral body sweeping spinal tenderness and snoring pain spine exercise test:
Level 1: Only tiny bone spurs.
Level 2: Affirmation of bone spurs, accompanied by some vertebral anterior sclerosis.
Grade 3: obvious bone spurs and laminar sclerosis with mild intervertebral space stenosis.
Grade 4: large bone spurs, with obvious laminar sclerosis and significant intervertebral space stenosis.
The higher the level, the more severe the patient's spinal bone hyperplasia.
Diagnosis
Differential diagnosis
Differential diagnosis of spur formation at the posterior margin of the vertebral body :
1. Cervical spondylosis: Although cervical spondylotic stenosis and cervical spondylosis are often associated with clinical symptoms, even more than 80% of cervical spondylosis is based on the pathological anatomy of spinal stenosis, but single-shot patients can also encounter Therefore, the two should also be distinguished, especially for the development of developmental spinal stenosis and cervical spondylotic myelopathy.
2. Spinal sclerosis: In recent years, the incidence of spinal sclerosis has increased, and most of the patients are younger and need to be identified.
3, in combination with other diseases in addition to the above three diseases, it is still necessary to identify with the posterior longitudinal ligament ossification, idiopathic, diffuse, hypertrophic spondylitis, intraspinal tumor, syringomyelia and peripheral neuritis, In addition to the clinical characteristics of the above various diseases, it should be identified based on imaging findings.
