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
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
Morbility
ASD13.3%
20%
50% 19%
11%
LESS≠UNIMPORTANT
成人退行性脊柱侧凸
3-Dimensional
Coraonal Sagital Axial
Sagital Local Regional Global
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°
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
Hale Waihona Puke De Novo Scoliosis
Complex Spinal Deformity
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
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
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
临床评估 Clinical Evaluation
• 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
疼痛评估 Pain 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
旋转滑移Rotatory slip L2-L3 Central canal
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
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