Cov ntsiab lus ntawm cov yam ntxwv ntawm ntau yam kab mob txha caj qaum

Spinal discitis suav txog 2% mus rau 7% ntawm tag nrho cov kab mob musculoskeletal tshwm sim los ntawm cov kab mob, fungi, thiab, tsis tshua muaj, los ntawm cov kab mob cab. Kwv yees li ib nrab ntawm tag nrho cov mob ntawm tus txha caj qaum yog nyob rau hauv lub lumbar qaum, me ntsis ntau tshaj li ib feem peb nyob rau hauv lub thoracic qaum, thiab cov seem nyob rau hauv lub ncauj tsev menyuam nqaj qaum.

Cov kab mob purulent

Purulent spinal discitis (PS) feem ntau yog tshwm sim los ntawm cov kab mob hematogenously nthuav tawm, nrog Staphylococcus aureus yog cov kab mob ntau tshaj plaws, feem ntau cuam tshuam nrog lumbar qaum, thiab x-rays tsis muaj qhov tshwj xeeb thiab rhiab heev nyob rau theem pib ntawm tus kab mob. Enhanced MRI yog txoj kev xaiv rau kev kuaj mob thaum ntxov ntawm tus txha caj qaum; MRI qhia txog cov pob txha pob txha edema thiab txhim kho ntawm lub cev vertebral, intervertebral discs, epidural qhov chaw, thiab / los yog ib puag ncig cov ntaub so ntswg nrog los yog tsis muaj abscess tsim nyob rau hauv feem ntau ze ntawm lub vertebral endplates.

Lus Cim: (a) Lateral lumbar spine radiograph qhia L4 -L3 disc qhov siab poob thiab kev puas tsuaj ntawm sab sauv kawg ntawm L4 ( xub xub). 

(b) Cov ntawv me me tom qab ntawm L3. Kev puas tsuaj ntawm L3 - L4 disc nrog erosive hloov mus rau qhov chaw nyob ib sab (cov xub). 

(c) Cov duab sib nqus resonance (MR) uas qhia txog kev hloov pauv ntawm vertebral endplates thiab cov teeb liab txawv txav ntawm cov pob txha pob txha uas nyob ib sab ( xub xub). Cov ntaub so ntswg prevertebral yog markedly edematous thiab muaj inflammatory kev hloov. 

(d) Sagittal t1 tom qab txhaj tshuaj intravenous contrast qhia pom cov teeb liab txhim kho hauv cov pob txha pob txha (asterisk), txhim kho cov teeb liab hauv qhov chaw epidural thiab cov nqaij mos prevertebral. Nco ntsoov qhov indentation ntawm lub hauv paus kwj dej ( xub xub).

Spinal Tuberculosis

Tuberculosis ntawm tus txha caj qaum (TS), feem ntau tsis yog-purulent granulomatous spinal kab mob tshwm sim los ntawm Gram-positive Mycobacterium tuberculosis, thiab cov duab nta uas sib txawv TS los ntawm PS yog qhia nyob rau hauv cov lus hauv qab no:

Cov duab hluav taws xob lig qhia txog kev puas tsuaj ntawm pob txha, txo qis qhov siab thiab cov nqaij mos abscesses nrog lossis tsis muaj calcification ntawm cov ntaub so ntswg ib puag ncig.

Ntawm MRI, qhov t1 tsis tshua muaj teeb liab siv thiab lub teeb liab siab heev ntawm cov kua dej-sensitive sequences cuam tshuam rau lub cev vertebral anterior thiab tej zaum yuav txuas mus rau txoj kev subligamentous mus rau lwm yam vertebrae, feem ntau tsis muaj cov disc.

Lus Cim: Cov txiv neej hnub nyoog 65 xyoo nrog (a) axial thiab (b) lumbar abscesses (asterisks) nrog septal thiab phab ntsa txhim kho (dawb xub). Collapsed intervertebral disc uas tsis muaj kev txhim kho tseem ceeb. Dural sac compression (dawb xub). (c) ct reconstruction duab ntawm L3 rau S1 vertebral lub cev puas tsuaj.

Kab mob Brucella

Brucellosis yog ib hom kab mob thoob ntiaj teb uas tshwm sim los ntawm cov kab mob gram-negative bacillus. Nws feem ntau cuam tshuam nrog lumbar qaum, tshwj xeeb tshaj yog L4.

Tus kab mob pib nyob rau hauv lub anterior feem ntawm lub vertebral lub cev ntawm lub intervertebral disc thiab tej zaum yuav puas me me pob qij txha. Paravertebral abscesses tshwm sim tsawg zaus thiab me me dua TS. Lub vertebral anatomy tseem nyob tsis tu ncua.

Faj seeb: Brucella lumborum kab mob, radiographs qhia sclerosis ntawm lub lumbar vertebrae, pem hauv ntej slippage ntawm lub lumbar vertebrae, irregular step-zoo li kev puas tsuaj ntawm lub anterior margin ntawm lub vertebral lub cev, thiab tsim cov pob txha cribriforms ntawm lub anterior margin ntawm lub vertebral lub cev.

Cov kab mob fungal

Cov kab mob fungal spinal infections (FS) tsis tshua muaj thiab feem ntau pom nyob rau hauv cov neeg mob tiv thaiv kab mob. Ntau cov fungi muaj peev xwm koom nrog, suav nrog Pseudomonas, Aspergillus, Bacillus, thiab Coccidioides. Tus txha nqaj qaum yog qhov chaw uas muaj ntau tshaj plaws, thiab zoo ib yam li TS, cov txheej txheem kis tau pib nyob rau sab xub ntiag ntawm lub vertebrae thiab qee zaum tuaj yeem kis mus rau cov vertebrae uas tsis nyob ib sab.

Nco tseg: CT scan sagittal duab ntawm tus neeg mob nrog coccidioidomycosis. Cov pob txha pob txha uas tsis muaj cov kab mob sclerotic yog ib yam ntawm cov kab mob no hauv qhov kev nthuav qhia. Kev puas tsuaj loj ntawm T1 ua rau vertebral vau. Txawm hais tias muaj pob txha loj heev, qhov chaw C7-T1 intervertebral tau khaws cia, ib qho kev hloov pauv hauv coccidiooidomycosis (txoj cai vaj huam sib luag) Sagittal MRT2WI ntawm tib tus neeg mob tau lees paub kev khaws cia ntawm C7-T1 qhov chaw intervertebral lub hli, nrog rau T2 teeb liab tseem ceeb qhia txog kev koom tes ntxov ntawm C6-C7 discs. Cov pob txha lesion txuas mus rau hauv cov pob txha subcortical anterior mus rau lub vertebral lub cev, ua rau cov nqaij mos anterior IV. Kev hloov pauv kis mus rau ntau theem, yooj yim txheeb xyuas hom kev nthuav tawm ntawm hom subligamentous, uas tuaj yeem ua rau ntau qhov mob ntawm cov qib tsis sib xws.

Ankylosing Spondylitis

Ankylosing spondylitis (AS) yog ib qho mob autoimmune kab mob uas feem ntau cuam tshuam rau tus txha nraub qaum thiab tuaj yeem ua rau mob hnyav los ntawm tus txha caj qaum.

Lwm qhov teeb meem hauv cov neeg mob AS yog kev txhim kho ntawm cov kab mob tsis tshua muaj, thiab ntawm kev kuaj pom, AL tuaj yeem txawv ntawm qhov mob spondylitis los ntawm focal defects nyob rau hauv ib los yog ob qho tib si vertebrae, nqaim ntawm qhov chaw disc, thiab thaj chaw ntawm reactive sclerosis nyob ib ncig ntawm osteolytic defects.

Lus Cim: Tus neeg mob uas muaj tus mob ankylosing spondylitis, 44-xyoo-laus txiv neej uas muaj mob sab nraub qaum thiab tsis tshua muaj zog. Sagittal ct ntawm (a) thoracic thiab (b) lumbar spine pob txha qhov rais qhia diffuse ligamentous syndesmosis raws li anterior longitudinal ligament ( xub). Tseem muaj ossification thiab fusion ntawm lub lumbar interspinous ligaments ( xub qhia). (c) Coronal duab ntawm lub lumbar nqaj qaum qhia fusion ntawm posterior ntsiab thiab articular synovial pob qij txha ( xub).

Osteomyelitis Syndrome

Lub ntsiab lus SAPHO yog hais txog kev sib xyaw ntawm cov leeg nqaij thiab cov nqaij tawv nqaij (synovitis, pob txuv, pustulosis, osteomalacia, thiab osteomyelitis), nrog rau cov phab ntsa sab nrauv (xws li cov pob qij txha sternoclavicular, cov pob qij txha costothoracic, thiab sternoacetabular) feem ntau ua raws li cov pob qij txha. Lub ncauj tsev menyuam nqaj qaum.Qhov feem ntau tshwm sim ntawm x-ray duab hluav taws xob yog vertebral lub cev osteolysis nrog lossis tsis muaj kev sib tsoo, nrog rau osteomalacia thiab paraspinal ossification.MRI yog cov duab rhiab tshaj plaws ntawm MRI yog qhov kev xav pom zoo tshaj plaws, thiab nws cov kev tshwm sim tseem ceeb suav nrog kev nthuav dav lossis focal vertebral teeb liab kev hloov pauv ntawm cov kua dej cortical. irregularities nyob rau hauv lub intervertebral junctions ntawm lub intervertebral discs los yog anterior endplates, thiab cov nqaij mos edema.

Nco tseg: txiv neej hnub nyoog 62 xyoo nrog SAPHO syndrome. (a) Sagittal t2-weighted thiab (b) xam tomography (CT) cov duab qhia ossification ntawm lub anterior longitudinal ligament (dub xub) Tsis muaj qhov txawv txav ntawm lub disc los yog paravertebral kua. Lub L1 yog heev repositioned tom qab ib tug qub compression puas. (c) Axial CT qhia tau hais tias ankylosis ntawm txoj cai costovertebral sib koom (asterisk). (d) Oblique coronal CT reconstruction qhia ob sab thoracic ribcage clavicle ankylosis (dub asterisks). (e) Cov pob txha scan qhia cov xov tooj cua hauv ob qho tib si cuam tshuam (dawb hnub qub).

Dialysis-related Spondyloarthropathy

Dialysis-related spondyloarthropathy (DRS) yog ib qho kev hloov pauv pathologic hauv cov neeg mob ntawm lub sijhawm ntev hemodialysis. Nws yog feem ntau tshwm sim nyob rau hauv lub ncauj tsev menyuam nqaj qaum thiab feem ntau tshwm sim nrog nqaim ntawm qhov chaw intervertebral, kev puas tsuaj ntawm lub endplates, tsis muaj sclerosis, cov pob txha tshiab, kab mob paraspinal / abscesses, thiab ntxiv dag zog rau qhov chaw.

Nco tseg: Extensive osteoporosis ntawm lub lumbar thiab sacral pelvis. Kev puas tsuaj ntawm anterosuperior margin ntawm lub lumbar 5 vertebrae nrog sclerotic hyperplasia ntawm cov npoo (pom liab liab). Nyob ib sab caws pliav hyperplasia. Kev puas tsuaj ntawm sab laug sacroiliac kev sib koom ua ke nrog kev puas tsuaj ntawm lateral articular nto ntawm ilium, ntau cov pob txha tuag sab hauv, thiab hauv zos caws pliav zoo li cov ntaub so ntswg hyperplasia (pom xiav xub).

Nco tseg: Txhim kho MR: Lumbar 4/5 disc bulge nrog vertebral rim osteophytes, hypertrophy ntawm ligamentum flavum, me ntsis nqaim ntawm tus txha caj qaum, thiab compression ntawm ntug anterior ntawm lub dural hnab. Lub lumbar 5 vertebral lub cev tsuas yog concave thiab tuaj yeem pom raws li cov strips ntev T1 thiab T2 WI compression rog siab teeb liab, thiab kev txhim kho yog pom tom qab txhim kho. Ntau thaj chaw ntawm cov teeb liab txawv txav tau pom nyob rau hauv qhov kawg ntawm lub lumbar 5 thiab sacral 1 thiab nyob rau hauv cov pob qij txha sacroiliac, nrog cov teeb liab qis ntawm T1WI thiab me ntsis siab teeb liab ntawm T2WI, thiab kev txhim kho yog pom ntawm kev txhim kho scans (xub xub liab). Cov ntaub so ntswg thickening ntawm lub anterior margin ntawm lub sacral vertebrae tau pom, thiab kev txhim kho tau pom ntawm kev txhim kho scan (xiav xub). Cov pob txha cov cim ntawm lub ilium, lub duav, sacrum thiab femoral lub taub hau ntawm ob sab ntawm lub plab mog tsis pom muaj qhov txawv txav, thiab cov cim qhia ntawm cov leeg nqaij sab hauv thiab sab nraud ntawm lub plab yog qhov qub, nrog rau cov leeg nqaij ntshiab thiab qhov sib koom ua ke, tsis muaj cov tsos mob ntawm kev nthuav dav thiab nqaim.

Spinal Gout

Spinal gout yog tus cwj pwm los ntawm kev tso nyiaj ntawm monocrystalline urate crystals (MUCs) hauv qaum. Spinal gout feem ntau cuam tshuam rau lumbar qaum. radiographs qhia cov tsos mob tsis tshwj xeeb thiab CT zoo dua ua rau cov pob txha yaig nrog cov kab mob sclerotic. mri manifestations yog nonspecific.

Nco tseg: CT plain scan qhia tau hais tias qhov chaw sib koom ua ke nqaim thiab kev puas tsuaj ntawm ob sab articular nto. Arthrocentesis yuav tsum tau ua kom paub meej qhov kev kuaj mob.

Neurospondylitis

Neurogenic spondylitis (NS), kev puas tsuaj rau kev mob caj dab, tshwm sim tom qab tsis hnov ​​​​tsw thiab proprioception. Qhov tshwm sim feem ntau yog kev raug mob qaum qaum, uas suav txog 70% ntawm cov neeg mob. Lwm yam ua rau muaj xws li mob ntshav qab zib mellitus, kab mob txha caj qaum cavernous, thiab lwm yam kab mob neurologic xws li peroneal muscular dystrophy thiab Guillain-Barré syndrome. Vim lub luag hauj lwm ntawm lub thoracolumbar thiab lumbosacral junctions nyob rau hauv qhov hnyav-cov kabmob, lawv yog cov chaw feem ntau koom nrog.

Cov tsos mob ntawm NS yog cov pob txha tawg, kev sib koom ua ke ntawm intervertebral thiab inconsistencies ua rau vertebral lub cev slippage, ntau endplates thiab me me erosions nrog rau kev khaws cia ntawm pob txha ceev nyob rau hauv sclerosis, thiab cov ntaub so ntswg mos.

Nco tseg: 58-xyoo-laus txiv neej nrog neuropathic qaum. (a) Sagittal thiab (b) coronal computed tomographic reconstructions qhia ntau lub lumbar vertebral endplates thiab articular synovial ob leeg erosions ( xub) nrog cov pob txha tawg. Kev puas tsuaj ntawm L2-L3 intervertebral disc unit nrog widening ntawm intervertebral chaw (asterisk). (c) Sagittal thiab (d) axial t2-weighted magnetic resonance sequences lees paub qhov dav ntawm L2-L3 intervertebral qhov chaw. Kev hloov pauv tseem ceeb ntawm tus txha nqaj qaum tom qab rau L2-L3-L4. Tseem muaj effusion nyob rau hauv cov ntaub so ntswg mos tom qab thiab anterior rau cov txheej txheem spinous (asterisks).