脊柱非骨性结构影像学检查的再解读

Reinterpretation of imaging of non-bony structures of the spine

影像学检查是脊柱疾病诊疗过程中必不可少的工具。大多数脊柱外科医生在阅读影像学检查时多聚焦于骨性结构及脊髓等组织,而对诸如椎旁肌、脂肪等软组织的形态及特点判读一直都是"相对盲区"。随着对脊柱非骨性结构影像学特征的深入研究和重新解读,学者们逐渐发现这些非骨性结构变化与脊柱疾病亦存在相关性。其中CT、MRI等影像学检查中的软组织参数,如椎旁肌横截面积、皮下脂肪厚度、椎旁肌肉脂肪浸润率等,均已被证实在脊柱疾病的诊断、治疗及预后评估中具有良好的可重复性,具备临床应用潜力。此外,肌少症、硬膜外脂肪增多症与脊柱疾病的联系正逐渐得到重视。近年来,随着对脊柱疾病发病机制理解的加深,三维步态分析与基于外像摄影的姿势测量等技术在脊柱退行性疾病及青少年特发性脊柱侧凸的诊断及疗效评估方面也已展现出广阔的前景。鉴于此,总结脊柱非骨性结构的基础和临床的最新研究进展,分析上述非骨性结构的影像学变化特征在脊柱疾病的基础研究和诊疗工作中的意义。

Imaging is an essential tool in the management of spinal disorders.Most spine surgeons focus on bony structures and the spinal cord when reading imaging examinations,while the interpretation of the morphology and characteristics of soft tissues such as paraspinal muscles and fat has been a"relative blind spot".As the imaging features of the non-bony structures of the spine have been studied and reinterpreted,it has become clear that these non-bony structural changes are also associated with spinal diseases.Soft tissue parameters such as"paraspinal muscle cross-sectional area,""subcutaneous fat thickness,"and"paraspinal muscle fat infiltration rate"on CT,MRI,and other imaging studies have been shown to play a role in spine diseases,and have been shown to be reproducible in the diagnosis,treatment and prognosis of spinal disorders and have potential for clinical application.In addition,the association of sarcopenia and spinal epidural lipomatosis with spinal disorders is gaining attention.In recent years,with a better understanding of the pathogenesis of spinal disorders,techniques such as 3D gait analysis and photographic postural measurement have also shown promise in the diagnosis and assessment of the outcome of degenerative spinal disorders and adolescent idiopathic scoliosis.In view of this,this article summarizes the latest research progress in the basic and clinical aspects of non-bony structures of the spine and analyzes the significance of the imaging features of these non-bony structures in the basic research and diagnosis of spinal diseases.