Herniated disc

Introduction Intervertebral disc prolapse refers to a pathological state caused by the nucleus pulposus of the intervertebral disc and part of the fibrous annulus protruding to the surrounding tissue and compressing the corresponding spinal cord or spinal nerve root. Due to intervertebral disc degeneration, rupture of the annulus fibrosus, nucleus pulposus stimulation or compression of nerve roots, a syndrome of cauda equina is one of the most common causes of lumbar and leg pain. Common lumbar disc herniation and cervical disc herniation. It is related to factors such as degeneration and damage of the intervertebral disc. Waist 4/5, waist 5 / 1 is the most common part of disc herniation, followed by cervical vertebrae.

Cause

Intervertebral disc prolapse refers to a pathological state caused by the nucleus pulposus of the intervertebral disc and part of the fibrous annulus protruding to the surrounding tissue and compressing the corresponding spinal cord or spinal nerve root. It is related to factors such as degeneration and damage of the intervertebral disc. Waist 4/5, waist 5 / 1 is the most common part of disc herniation, followed by cervical vertebrae. There are three types of disc prolapse:

1 Central type: refers to those located in the center line.

2 posterior type: refers to those located in the spinal canal on both sides of the midline.

3 lateral type: refers to the prominent disc located outside the root canal, this type of spinal nerve root compression symptoms are heavy.

an examination

Related inspection

Lumbar activity CT examination of spinal activity Cerebrospinal fluid protein characterization (CSF.Pro) Cerebrospinal fluid protein characterization

More common in young adults, often caused by chronic injuries, acute trauma can aggravate the symptoms, mainly the nerve root or spinal cord compression symptoms, manifested as chronic low back pain and lower extremity radiation, sometimes paravertebral and lower extremity muscle spasm and even muscle atrophy Limited activity, positive nerve pulling test, etc.

Imaging performance:

1. X-ray film:

Indirect signs can be seen in the lateral radiographs, such as stenosis of the intervertebral space, which can be symmetrical or asymmetrical. Most of the wide side of the uneven gap is the side of the disc herniation. For example, the posterior disc of the intervertebral disc is mostly narrow and posterior. formation; abnormal curvature of the spine.

2. Spinal angiography:

Typical disc herniation is the filling of the nerve root sleeve or the shortening of the root sleeve. The nerve root is compressed and edema, and the shape is thickened, so that the root sleeve is funnel-shaped, the dural sac is compressed and narrowed, and the dural sac on the lateral radiograph shows an arc-shaped disc in the intervertebral space. Depth greater than 2mm is suspicious, and greater than 4mm is a positive value. Large disc herniation can cause medullary obstruction. The cauda equina in the dural sac is compressed and appears to be gathered and distorted. The above performance is obvious in the overextension position, the degree is aggravated, and the degree of overflexion is reduced.

3.CT performance:

1 The posterior margin of the normal lumbar disc does not exceed the posterior edge of the vertebral endplate, and the central part is slightly concave and has a kidney shape. Disc herniation appears as a soft, soft tissue shadow that protrudes locally from the posterior edge of the vertebral body. It is usually connected to the intervertebral disc, and the density is consistent, and the epidural free nucleus is visible. The nucleus pulposus is above or below the plane of the intervertebral disc, and its density is lower than that of the vertebra but higher than the dura mater and paravertebral soft tissue. The prominent intervertebral disc can be calcified.

2 The epidural fat is compressed, displaced, or even disappeared, and the leading or lateral side of the subdural space is compressed and deformed.

3 The intervertebral disc protruding to the lateral side can shorten the anterior and posterior diameter of the lateral recess, and press the corresponding spinal nerve root to shift it backward; the spinal nerve root can also be thickened due to edema. CT scans after vertebral iodine angiography help to show changes in the spinal nerve root sheath and the dura mater.

4 The posterior part of the vertebral body is hardened and sometimes the Schmorl nodules can be seen on the upper and lower edges of the adjacent vertebral bodies.

4.MR performance:

1 The degenerated disc is in the T1-weighted image, which is slightly higher than the subarachnoid space, and the T2-weighted image is reduced in the intervertebral disc.

2 Regardless of the type of prolapse, the pressure of the epidural and intervertebral foramen (high signal), nerve root, dural sac and epidural vein displacement can be clearly shown, and the exudate is generally connected to the intervertebral disc.

3 enhanced to identify scar and recurrence of intervertebral disc prolapse after disc surgery.

Differential diagnosis

Cervical disc herniation: It is one of the more common spinal diseases in the clinic, and the incidence is second only to lumbar disc herniation. Mainly due to the cervical disc nucleus, the annulus fibrosus, the cartilage plate, especially the nucleus pulposus, after different degrees of degenerative lesions, under the action of external factors, the intervertebral disc annulus ruptures, the nucleus pulposus tissue protrudes from the rupture or Peel out of the spinal canal, causing adjacent tissues, such as spinal nerve roots and spinal cord, to cause headache, dizziness; palpitations, chest tightness; neck soreness, limited mobility; shoulder and back pain, upper limb numbness and pain; gait loss Symptoms and signs such as weakness and weakness of the limbs. In severe cases, high paraplegia is life-threatening.

Intervertebral disc bulging: the annular uniformity of the intervertebral disc annulus exceeds the extent of the intervertebral space, and the intervertebral disc tissue is not limited.

Disc herniation: The localized displacement of the intervertebral disc tissue exceeds the intervertebral space. The displaced intervertebral disc tissue is still connected to the original intervertebral disc tissue, and the diameter of the basal continuum is larger than the displaced intervertebral disc portion beyond the intervertebral space.

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