腰椎间盘早期退行性改变与超早期腰椎结核的鉴别

Identification between early degenerative changes of lumbar intervertebral disc and early lumbar tuberculosis

目的比较腰椎间盘退变与超早期腰椎结核的MRI表现,从而达到鉴别的目的。方法收集20例为经手术后证实或者穿刺后被证实为腰椎间盘退变患者,20例为临床证实的脊柱结核,分析比较其MRI征象。结果腰椎间盘早期退行性变与早期腰椎结核不同点表现在:①临床表现:腰椎间盘退变早期往往有下腰部疼痛,而椎体结核早期可无明显临床症状;②椎间盘改变:早期椎间盘退变就有信号的改变,包括终板退变和髓核退变。而椎体结核早期无明显改变,中后期椎间盘才会有改变;③相邻椎体骨质改变上:早期椎间盘退变相邻骨质无明显破坏,而早期结核可见椎体上下缘邻近终板部位虫蚀状、蜂窝状或小片状骨质破坏,骨破坏区周围伴有不同程度的炎性水肿;④椎旁软组织改变上:早期椎间盘退变无椎旁软组织改变,而早期腰椎结核可见椎旁和后方软组织肿胀。结论早期椎间盘退变与早期腰椎结核各有一定MRI特点,鉴别有一定困难,需仔细鉴别。

Objective To compare the MRI manifestations of lumbar disc degeneration and super early lumbar tuberculosis,so as to achieve the purpose of differentiation.Methods Twenty patients with lumbar disc degeneration confirmed by operation or puncture and20 patients with spinal tuberculosis were collected for analysis and MRI signs were compared.Results Early degenerative changes of lumbar intervertebral disc and early differences of lumbar tuberculosis were shown in these aspects.(1)In clinical manifestations,early lumbar intervertebral disc degeneration often had lower lumbar pain,and early vertebral body tuberculosis could not have obvious clinical symptoms;In disc changes,early disc degeneration was associated with signal changes,including endplate degeneration and nucleus pulposus degeneration.In patients with vertebral tuberculosis,there were not any significantly changes in the early stage,while disc would change in the late stage;(3)About bone changes in adjacent vertebral bodies,there was no obvious destruction of adjacent bone in early disc degeneration,while early tuberculosis could be seen in the wormy,honeycomb or lamellar bone destruction in the upper and lower edge of vertebral body adjacent to the endplate,with inflammatory edema of different degrees around the bone destruction area.(4)About paravertebral soft tissue changes,early disc degeneration had no paravertebral soft tissue changes,and early lumbar tuberculosis showed paravertebral and posterior soft tissue swelling.Conclusions Early disc degeneration and early lumbar tuberculosis each has certain MRI characteristics,and it is difficult to differentiate them.