Lumbar spine hypertrophy

Introduction Lumbar hypertrophy, also known as hypertrophic spondylitis or degenerative spondylitis, is a common cause of low back pain in the elderly. When people reach middle age, the lumbar vertebrae begin to proliferate, hypertrophy, and long bone spurs. Almost all the elderly have lumbar hypertrophy. On the X-slice, the sides of the spine are sharply pointed, like the raised lips, so some X-rays are reported as "lip-like hyperplasia."

Cause

The cause of lumbar hypertrophy:

Degenerative spondylitis has a significant relationship with vertebral body edge hyperplasia and intervertebral disc degeneration. After degeneration of the intervertebral disc, it loses its inherent elastic toughness, thinning the thickness, narrowing the intervertebral space, and thus weakening the resistance of the vertebral body to pressure. The body and facet joints are constantly subject to shock, impact and wear, which gradually produces bone spurs. The formation of bone spurs is both a pathological product and a protective response to the degenerated spine. Therefore, it usually only has pain and discomfort at the time of initial development. When it matures, the symptoms often reduce or disappear.

In addition, damage and strain can easily lead to the disease. Due to the long-term weight bearing and excessive activity of the waist, the chances of injury and strain increase, further accelerate the degeneration of the intervertebral disc, weaken the elasticity, and cause the surrounding ligaments to relax, the joints are unstable, and the vertebral body is continuously stimulated by the trauma, forming spurs for a long time.

an examination

Related inspection

Check the cremaster reflex in the lower back

Examination and diagnosis of lumbar hypertrophy:

The general symptoms of lumbar hypertrophy are: the patient has a sore back and discomfort, stiff and stagnant, not prosperous, standing for a long time, the waist is sore and stiff, can not complete the pitching action, the action is difficult, the symptoms are heavier after the morning, and the activity is relieved. Insomnia, can not turn side when sleeping, feet are sour, can not stand for a long time, usually accompanied by headache and dizziness, dreams more irritability, loss of appetite. Lumbar flexion and extension activities are unfavorable, but passive exercise is basically normal.

Low back pain is more acute in acute attacks, and can be dragged to the buttocks and lower limbs. If the spurs compress or stimulate the cauda equina, symptoms such as numbness and sensory disturbance of the lower extremities may occur.

Those with severe disease, limited pitching activity, abnormal waist physiological curve, narrow vertebral space gap, or lumbar joint deformation; some patients with knee, Achilles tendon reflex, accompanied by hip, leg traction pain.

Differential diagnosis

Related lesions that are easily confused with lumbar hypertrophy:

Lumbar disc herniation is also known as lumbar disc herniation or nucleus pulposus. When it is subjected to twisting and impacting at the waist of labor or sports activities, it is caused by excessive force and excessive fatigue when lifting heavy objects. Nuclear tissue is released from the rupture, stimulating or compressing the spinal nerve roots and causing pain in the lower back. Lumbar instability is one of the most important diseases in lumbar degenerative diseases. Lumbar instability refers to the pathological changes that occur when the lumbar position is under normal load and cannot maintain the normal positional relationship with each other, and a series of clinical manifestations. The disease occurs in middle-aged males and female obeses. It is not uncommon to see that the most popular parts are L4-5, followed by L5-S1.

Lumbar posterior joint disorders: the superior and inferior articular processes of the adjacent vertebral bodies constitute the posterior lumbar spine joint, which is the synovial joint and has a nerve distribution. When the relationship between the superior and inferior articular processes of the posterior joint is abnormal, the acute phase may cause pain due to incarceration of the synovial membrane, and chronic cases may produce post-articular traumatic arthritis and low back pain. This kind of pain occurs mostly 1.5 cm beside the spinous process, and can have radiation pain to the ipsilateral hip or thigh, which is easy to be mixed with lumbar disc herniation. The radiation pain of the disease generally does not exceed the knee joint, and is not accompanied by signs of nerve root damage such as sensation, muscle weakness and loss of reflex. For cases with difficult identification, 5 ml of 2% procaine can be injected near the small facet joint of the lesion. If the symptoms disappear, the lumbar disc herniation can be ruled out.

Lumbar spinal stenosis: Intermittent claudication is the most prominent symptom. After a patient walks for a distance, the lower limbs are sore, numb, and weak. They must walk down to rest and continue walking. Cycling can be asymptomatic. Patients with multiple complaints and few physical signs are also important features. A small number of patients have manifestations of root nerve damage. Severe central stenosis can lead to incontinence, special examinations such as spinal iodine angiography and CT scan can be further confirmed.

Lumbar tuberculosis: Early localized lumbar tuberculosis can stimulate adjacent nerve roots, causing low back pain and lower extremity radiation pain. Lumbar tuberculosis has a systemic reaction to tuberculosis, and the back pain is more dramatic. The destruction of the vertebral body or pedicle is seen on the X-ray film. CT scans have a unique effect on early localized tuberculosis lesions in vertebral bodies that X-ray films cannot.

The general symptoms of lumbar hypertrophy are: the patient has a sore back and discomfort, stiff and stagnant, not prosperous, standing for a long time, the waist is sore and stiff, can not complete the pitching action, the action is difficult, the symptoms are heavier after the morning, and the activity is relieved. Insomnia, can not turn side when sleeping, feet are sour, can not stand for a long time, usually accompanied by headache and dizziness, dreams more irritability, loss of appetite. Lumbar flexion and extension activities are unfavorable, but passive exercise is basically normal.

Low back pain is more acute in acute attacks, and can be dragged to the buttocks and lower limbs. If the spurs compress or stimulate the cauda equina, symptoms such as numbness and sensory disturbance of the lower extremities may occur. Patients with severe disease, limited pitching activity, abnormal waist physiological curve, narrow vertebral space gap, or lumbar joint deformation; some patients with knee, Achilles tendon reflex, accompanied by hip, leg traction pain.

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