退行性脊柱侧凸腰椎神经根受压的影像学特点

Imaging characteristics of lumbar nerve root compression following degenerative scoliosis

目的:分析退行性脊柱侧凸腰椎神经根压迫的特点及其与侧凸形式的关系。方法:收集2000-05/2004-05于解放军总医院骨科连续治疗的退行性脊柱侧凸患者51例,所有患者进行详细的神经系统检查和系统回顾,确定患者腰椎退行性侧凸的形式及临床检查有症状的神经根的分布,同时进行X射线平片、MRI检查和椎管造影,进一步确定神经根受压位置。采用CHI-SQUAREtest统计检验对受压神经根的分布特点与受压迫的部位及侧凸形式的关系进行系统分析,并分析受压神经根与骶正中平分线的关系。结果:51例全部进入结果分析。①31%(16/51)的患者存在L3神经根性症状,57%(29/51)存在L4神经根性症状,61%(31/51)存在L5神经根性症状,24%(12/51)存在S1神经根性症状。②在退行性脊柱侧凸患者中,L3或L4神经根症状多来自于椎间孔狭窄或椎间孔以外的狭窄;而L5或S1神经根症状多是由于侧隐窝狭窄造成的(P=0.0011)。③在退行性脊柱侧凸患者中,存在神经根症状的L3或L4神经根多是在腰椎侧凸的凹侧受压迫,而L5或S1神经根则更多的在腰椎侧凸的凸侧受影响(P=0.0012)。④无论源于椎间孔狭窄,还是源于侧隐窝狭窄的症状神经根侧大多临近骶正中平分线。结论:退行性脊柱侧凸患者中神经根影像学受压位置不仅出现在侧凸的凹侧,而且还出现在侧凸的凸侧,出现的概率相近。其分布接近于骶正中平分线,可能与退行性脊柱侧凸后腰椎的非正常的应力有关系。

AIM： To analyze the characteristics of nerve root compression of lumbar spine with retrograde scoliesis and the association with pattern of convex shape. METHODS： A total of 51 consecutive patients with retrograde scoliosis, who were treated at the Department of Orthopaedics, General Hospital of Chinese PLA between May 2000 and May 2004, were enrolled. Neurologic check and retrospective analysis design were used in all the patients in detail to make sure the pattern of retrograde scoliosis of lumbar spine and distribution of symptomatic nerve in clinic. Meanwhile, the place of root compression was ascertained further with X-ray plain film, MRI examination and canalis spinalis visualization. The relationship of feature of distribution of compressive root with place of compression and pattern of scoliosis was analyzed systematically with CHI-SQUARE test statistical examination, and the correlation between compressive nerve root and central line of sacrum was analyzed. RESULTS： Totally 51 patients were involved in the result analysis. ① 31%（ 16/51 ） of patients had L3 nerve root symptom; 57%（29/51 ） had L4 nerve root symptom; 61% （31/51 ） had L5 nerve root symptom; 24% （ 12/51 ） had S1 nerve root symptom. ②Among the patients with retrograde seoliosis, the L3 and L4 symptom mostly came from stenochoria of foramen intervertebrale or stenochoria of outside of intervertebral foramen; while L5 or S1 were due to stenochoria of cryptae （P=0.001 1 ）. ③Among the patients with retrograde scoliosis, the L3 or L4 nerve root was compressed at concave side of scoliosis of lumbar spine, while L5 or S1 nerve root was affected at protruding side of scoliosis of lumbar spine （P=0.0012）. ④No matter induced by the stenochoria of intervertebral foramen or stenochoria of lateral recessus, the symptom nerve root mostly closed to central line of sacrus. CONCLUSION： Nerve root compression is not only seen on the concave side of the scoliosis, but also involved on the convex side and which have almost equal chance. It mostly closes to central line of sacrus, which may be due to the abnormal stress of lumbar spine following retrograde scoliosis.