Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
Eur Spine J. 2010 Jun;19(6):989-94. doi: 10.1007/s00586-010-1299-8. Epub 2010 Feb 6.
The number of patients showing lumbar degenerative scoliosis, including disc wedging, has increased, and examination of the mechanism of spinal nerve compression due to lateral and rotational mobility of the lumbar spine is necessary. Thirty-two patients with L4-L5 disc wedging but without antero- or retrospondylolisthesis and ten age-matched controls were examined. The angle of disc wedging and change in the angle between left and right bending were evaluated by anterior-posterior X-ray images of patients while they were in a standing position. The degree of disc degeneration and existence of vacuum phenomena were evaluated at the L4-L5 discs. Rotational mobility between maximal right and left rotation was examined by computed tomography (CT). Rotational mobility was measured using the spinal transverse processes of L4 and L5. The relationship between these factors was statistically evaluated using multivariate analysis and Spearman's correlation test. There was a significant increase in the average rotational mobility of the L4-L5 disc-wedging group. In the L4-L5 disc-wedging group, the increased angle of disc wedging and change in the angle between left and right bending correlated with increased rotational mobility. The degree of disc degeneration did not affect rotational mobility. However, existence of vacuum phenomena increased the rotational mobility of the L4-L5 disc-wedging group. This is the first study to evaluate the rotational hypermobility of L4-L5 disc wedging in patients without antero- or retrospondylolisthesis using kinematic CT. Increases in the wedging angle and abnormal instability of lateral bending correlated with increased rotational mobility. For surgical planning of degenerative L4-L5 disc wedging, it is important to consider rotational hypermobility using kinematic CT or X-ray imaging findings of lateral bending.
腰椎退行性侧凸患者数量增加，包括椎间盘楔形变。因此，有必要对腰椎侧方和旋转活动导致脊神经根受压的机制进行研究。我们对 32 例 L4-L5 椎间盘楔形变但无前后滑脱的患者和 10 例年龄匹配的对照者进行了研究。患者站立位时行前后位 X 线片检查，评估椎间盘楔形变的角度和左右弯曲角度的变化。在 L4-L5 椎间盘评估椎间盘退变的程度和真空现象的存在。采用 CT 检查最大左右旋转之间的旋转活动度。旋转活动度通过 L4 和 L5 的脊柱横突来测量。采用多元分析和 Spearman 相关检验对这些因素之间的关系进行统计学评估。L4-L5 椎间盘楔形变组的平均旋转活动度显著增加。在 L4-L5 椎间盘楔形变组，楔形变角度的增加和左右弯曲角度的变化与旋转活动度的增加相关。椎间盘退变的程度不影响旋转活动度。然而，真空现象的存在增加了 L4-L5 椎间盘楔形变组的旋转活动度。这是首次使用运动学 CT 评估无前后滑脱的 L4-L5 椎间盘楔形变患者的 L4-L5 旋转过度。楔变角度的增加和侧向弯曲的异常不稳定性与旋转活动度的增加相关。对于退行性 L4-L5 椎间盘楔形变的手术规划，使用运动学 CT 或侧屈 X 线成像发现考虑旋转过度非常重要。
