Chidule Cha Maonekedwe A Matenda Osiyanasiyana a Msana

Spinal discitis imayambitsa 2% mpaka 7% ya matenda onse a minofu ndi mafupa omwe amayamba chifukwa cha mabakiteriya, bowa, ndipo, kawirikawiri, ndi tizilombo toyambitsa matenda. Pafupifupi theka la zochitika zonse za matenda a msana zimakhala m'mphepete mwa msana, pang'ono kuposa gawo limodzi mwa magawo atatu a msana wa thoracic, ndi zotsalazo mu msana wa khomo lachiberekero.

Matenda a Purulent

Purulent spinal discitis (PS) nthawi zambiri imayamba chifukwa cha matenda omwe amafalitsidwa ndi hematogenously, Staphylococcus aureus ndiye tizilombo toyambitsa matenda, nthawi zambiri timakhudza lumbar msana, ndi ma X-ray omwe alibe chidziwitso ndi chidziwitso kumayambiriro kwa matendawa. MRI yowonjezera ndiyo njira yosankha kuti mudziwe msanga matenda a msana; MRI imawonetsa edema ya mafupa ndi kupititsa patsogolo matupi amtundu wa vertebral, intervertebral discs, epidural space, ndi / kapena zofewa zozungulira zozungulira kapena popanda mapangidwe a abscess omwe amapezeka makamaka pafupi ndi vertebral endplates.

Zindikirani: (a) Lateral lumbar spine radiograph yosonyeza L4 -L3 kutayika kwa msinkhu wa disc ndi kuwonongeka kwa mapeto apamwamba a L4 (muvi). 

(b) Kutsika pang'ono kumbuyo kwa L3. chiwonongeko cha L3 - L4 chimbale ndi kusintha erosive kwa oyandikana endplates (mivi). 

(c) Chithunzi cha magnetic resonance (MR) chowonetsa kusintha kosinthika kwa ma vertebral endplates ndi chizindikiro chachilendo cham'mphepete mwa fupa la msana (muvi). Minofu yofewa ya prevertebral imakhala ndi edematous ndipo imakhala ndi zotupa. 

(d) Sagittal t1 pambuyo pa jekeseni wosiyanitsa mtsempha amasonyeza chizindikiro chowonjezereka m'mafupa a fupa (asterisk), chizindikiro chowonjezereka mu epidural space ndi minofu yofewa ya prevertebral. Onani kuloza kwa ngalande yapakati (muvi).

Chifuwa cha Msana

Tuberculosis of the spine (TS), matenda ofala kwambiri omwe si a purulent granulomatous spinal omwe amayamba chifukwa cha Gram-positive Mycobacterium tuberculosis, ndi mawonekedwe omwe amasiyanitsa TS ndi PS akuwonetsedwa patebulo ili pansipa:

Ma radiographs ochedwa amawonetsa kuwonongeka kwa mafupa, kuchepa kwa kutalika kwa disc ndi zotupa zofewa zokhala ndi kapena popanda calcification ya minofu yofewa yozungulira.

Pa MRI, mawonekedwe a t1 otsika kwambiri komanso kuchulukitsidwa kwamphamvu kwamadzimadzi kumakhudza thupi lamkati la vertebral ndipo limatha kudutsa njira yocheperako kupita ku ma vertebrae ena, nthawi zambiri popanda kuphatikizira diski.

Zindikirani: Mnyamata wazaka 65 yemwe ali ndi (a) axial ndi (b) abscesses lumbar (asterisk) ndi septal ndi khoma zowonjezera (mivi yoyera) .L3 ku S1 kupititsa patsogolo thupi la vertebral. Kugwa kwa intervertebral disc popanda kukulitsa kwakukulu. Kuponderezana kwapawiri sac (muvi woyera). (c) ct kukonzanso chithunzi cha L3 ku S1 chiwonongeko cha vertebral body.

Matenda a Brucella

Brucellosis ndi matenda ofala padziko lonse lapansi omwe amayamba chifukwa cha bacillus ya gram-negative. Nthawi zambiri imakhudza lumbar msana, makamaka L4.

Matendawa amayamba mu gawo lakumbuyo la vertebral thupi la intervertebral disc ndipo akhoza kuwononga zimfundo zazing'ono. Ziphuphu za Paravertebral zimachitika kawirikawiri ndipo zimakhala zazing'ono kukula kuposa TS. The vertebral anatomy imakhalabe.

Zindikirani: Matenda a Brucella lumborum, ma radiographs amasonyeza sclerosis ya lumbar vertebrae, kutsogolo kwa lumbar vertebrae, chiwonongeko chosasinthika chofanana ndi masitepe pamphepete mwa msana wa thupi la vertebral, ndi mapangidwe a mafupa a msana pamphepete mwa thupi la vertebral.

Matenda a fungal

Matenda a fungal spinal (FS) ndi osowa ndipo nthawi zambiri amapezeka mwa odwala omwe ali ndi chitetezo chamthupi. Bowa ambiri amatha kukhudzidwa, kuphatikiza Pseudomonas, Aspergillus, Bacillus, ndi Coccidioides. Msana wa thoracic ndi malo omwe amapezeka kwambiri, ndipo mofanana ndi TS, njira yopatsirana imayambira kumbali yapambuyo ya vertebrae ndipo nthawi zina imatha kufalikira ku vertebrae yomwe siili pafupi.

Chidziwitso: CT scan sagittal chithunzi cha wodwala yemwe ali ndi coccidioidomycosis. Zotupa zochepa za mafupa opanda sclerotic m'mphepete ndizofanana ndi tizilombo toyambitsa matenda muwonetsero. kuwonongeka kwakukulu kwa T1 kumabweretsa kugwa kwa vertebral. Ngakhale kuti pali fupa lalikulu la bony, C7-T1 intervertebral space inasungidwa, kusintha kwa khalidwe la coccidioidomycosis (gulu lamanja) Sagittal MRT2WI wa wodwala yemweyo amatsimikizira kusungidwa kwa mwezi wa C7-T1 intervertebral space, ndi chizindikiro chachikulu cha T2 chosonyeza kukhudzidwa koyambirira kwa ma disks a C6-C7. Kutupa kwa mafupa kumapitirira mpaka ku fupa la subcortical kumtunda kwa thupi la vertebral, zomwe zimapangitsa kuti pakhale matenda amtundu wofewa IV. Kusintha kwa matenda kumafalikira kumagulu angapo, kuzindikira mosavuta njira yofalitsira mtundu wa subligamentous, womwe ungayambitse zilonda zambiri pamagulu osakhala oyandikana nawo.

Ankylosing Spondylitis

Ankylosing spondylitis (AS) ndi matenda otupa omwe amakhudza kwambiri msana ndipo amatha kupweteka kwambiri chifukwa cha kusakanikirana kwa msana.

Vuto linanso kwa odwala omwe ali ndi AS ndi chitukuko cha matenda ochepa a disk, ndipo pojambula, AL akhoza kusiyanitsidwa ndi spondylitis yotupa ndi zofooka zamtundu umodzi kapena ziwiri zoyandikana ndi vertebrae, kuchepetsa danga la disk, ndi madera a reactive sclerosis ozungulira osteolytic defects.

Zindikirani: Wodwala ndi ankylosing spondylitis, mwamuna wazaka 44 yemwe ali ndi ululu wammbuyo wammbuyo komanso kuyenda kochepa. Sagittal ct ya (a) thoracic ndi (b) mazenera a fupa la msana wa msana amasonyeza kufalikira kwa ligamentous syndesmosis pamodzi ndi anterior longitudinal ligament (mivi). Palinso ossification ndi kuphatikizika kwa lumbar interspinous ligaments (mivi ikuwonetsedwa). (c) Chithunzi cha Coronal pamlingo wa lumbar spine chikuwonetsa kuphatikizika kwa zinthu zam'mbuyo ndi ma articular synovial joints (mivi).

Osteomyelitis Syndrome

Mawu akuti SAPHO amatanthawuza kuphatikizika kwa mawonetseredwe a minofu ndi mafupa (synovitis, ziphuphu zakumaso, pustulosis, osteomalacia, ndi osteomyelitis), ndi khoma lakunja la thoracic (kuphatikiza mafupa a sternoclavicular, mafupa a costothoracic, ndi chigongono cha sternoacetabular ndi mtsempha wodziwika bwino) Mawonetseredwe ambiri pa x-ray radiographs ndi vertebral body osteolysis ndi kapena popanda kugwa, komanso osteomalacia ndi paraspinal ossification.MRI ndi chithunzithunzi chodziwika kwambiri cha MRI ndiyo njira yowonongeka kwambiri, ndipo ziwonetsero zake zazikulu zimaphatikizapo kufalikira kapena kusintha kwa vertebral vertebral kusintha pamayendedwe amadzimadzi ndi ma intervertebral intervertebral intervertebral intervertebral. intervertebral discs kapena anterior endplates, ndi edema ya minofu yofewa.

Chidziwitso: Mwamuna wazaka 62 yemwe ali ndi matenda a SAPHO. (a) Sagittal t2-zolemera ndi (b) computed tomography (CT) zithunzi zimasonyeza ossification ya anterior longitudinal ligament (mivi yakuda) Palibe zovuta zazikulu za disc kapena paravertebral fluid. L1 imayikidwanso kwambiri pambuyo pa kupanikizana kwakale. (c) Axial CT imasonyeza ankylosis ya malo oyenera a costovertebral (asterisk). (d) Oblique coronal CT reconstruction imasonyeza mbali ziwiri za thoracic ribcage clavicle ankylosis (nyenyezi zakuda). (e) Kujambula kwa fupa kusonyeza kutengeka kwa radiotracer m'magulu onse okhudzidwa (nyenyezi zoyera).

Spondyloarthropathy yokhudzana ndi Dialysis

Dialysis-related spondyloarthropathy (DRS) ndikusintha kwapathologic kwa odwala pa hemodialysis yayitali. Zimakhala zofala kwambiri mu msana wa khomo lachiberekero ndipo nthawi zambiri zimakhala ndi kuchepa kwa intervertebral space, kuwonongeka kwa ma endplates, kusowa kwa sclerosis, mapangidwe atsopano a mafupa, matenda a paraspinal / abscesses, ndi kulimbitsa danga.

Zindikirani: Kuchuluka kwa mafupa a mafupa a m'chiuno ndi m'chiuno. Kuwonongeka kwa malire a anterosuperior a lumbar 5 vertebrae ndi sclerotic hyperplasia ya m'mphepete (yosonyezedwa ndi muvi wofiira). Pafupi mabala hyperplasia. Kuwonongeka kwa gawo lakumanzere la sacroiliac ndikuwonongeka kwa lateral articular pamwamba pa ilium, mafupa angapo akufa mkati, ndi hyperplasia yamtundu wamtundu wamtundu wamtundu (wowonetsedwa ndi mivi yabuluu).

Zindikirani: Kupititsa patsogolo MR: Lumbar 4 / 5 disc bulge ndi vertebral rim osteophytes, hypertrophy ya ligamentum flavum, kuchepa pang'ono kwa msana wa msana, ndi kupanikizana kwa m'mphepete mwa m'mphepete mwa dural sac. The lumbar 5 vertebral thupi ndi pang'ono concave ndipo akhoza kuoneka ngati mizere yaitali T1 ndi T2 WI compression mafuta chizindikiro mkulu, ndipo kupititsa patsogolo kumawoneka pambuyo kupititsa patsogolo. Zigamba zingapo za chizindikiro chosazolowereka zimawoneka pansi pa ma endplates a lumbar 5 ndi sacral 1 ndi pansi pa zolumikizira za sacroiliac, ndi chizindikiro chotsika pa T1WI ndi chizindikiro chapamwamba pang'ono pa T2WI, ndipo kupititsa patsogolo kumawoneka pazithunzi zowonjezera (mivi yofiira). Kukula kwa minofu yofewa m'mphepete mwa msana wa sacral vertebrae kunawoneka, ndipo kupititsa patsogolo kunkawoneka pakujambula kowonjezereka (muvi wabuluu). Zizindikiro za mafupa a ilium, chiuno, sacrum ndi mutu wa chikazi kumbali zonse ziwiri za chiuno sizinawonetse zolakwika zoonekeratu, ndipo zizindikiro za minofu yamkati ndi yakunja ya m'chiuno inali yachibadwa, yokhala ndi mipata yomveka bwino ya minofu ndi mipata yodziwika bwino, popanda zizindikiro za kufalikira ndi kuchepa.

Matenda a Spinal Gout

Gout ya msana imadziwika ndi ma depositi a monocrystalline urate crystals (MUCs) mumsana. Gout ya msana imakhudza kwambiri lumbar msana. ma radiographs amawonetsa mawonetseredwe osadziwika ndipo CT ikuwonetsa bwino kukokoloka kwa mafupa ndi m'mphepete mwa sclerotic. mri mawonetseredwe ndi nonspecific.

Chidziwitso: CT plain scan ikuwonetsa kuchepera kwa malo olumikizana komanso kuwonongeka kwapadziko lonse lapansi. Arthrocentesis imafunika kutsimikizira matenda.

Neurospondylitis

Neurogenic spondylitis (NS), kuwonongeka kopitilira muyeso kwa arthropathy, kumachitika pambuyo potaya chidwi komanso kuzindikira. Chifukwa chofala kwambiri ndi kuvulala koopsa kwa msana, komwe kumapangitsa 70% ya milandu. Zomwe zimayambitsa ndi matenda a shuga, matenda a msana, ndi matenda ena a ubongo monga peroneal muscular dystrophy ndi Guillain-Barré syndrome. Chifukwa cha gawo la thoracolumbar ndi lumbosacral junctions polemera, ndi malo omwe amapezeka kwambiri.

Mawonetseredwe odziwika bwino a NS ndi zidutswa za mafupa, kusagwirizana kwa mafupa amtundu wa intervertebral ndi kusagwirizana komwe kumapangitsa kuti vertebral body slippage, ma endplates angapo ndi kukokoloka kwamagulu ang'onoang'ono komanso kusungidwa kwa mafupa mu sclerosis, komanso minofu yofewa.

Zindikirani: Mwamuna wazaka 58 yemwe ali ndi msana wa neuropathic. (a) Sagittal ndi (b) coronal computed tomographic reconstructs amasonyeza angapo lumbar vertebral endplates ndi articular synovial joint erosions (mivi) ndi zidutswa mafupa. Kuwonongeka kwa L2-L3 intervertebral disc unit ndi kukula kwa intervertebral space (asterisk). (c) Sagittal ndi (d) axial t2-zolemera maginito resonance sequences kutsimikizira kufalikira kwa L2-L3 intervertebral space. kusintha kwakukulu kwa msana wamtsempha wokhudzidwa ndi L2-L3-L4. Palinso effusion mu minofu yofewa kumbuyo ndi kutsogolo kwa njira za spinous (asterisk).