Kakaretso ea Litšobotsi tsa mafu a fapaneng a mokokotlo

Spinal discitis e etsa karolo ea 2% ho isa ho 7% ea mafu 'ohle a mesifa le masapo a bakoang ke libaktheria, li-fungus,' me, ka seoelo, ke likokoana-hloko. Hoo e ka bang halofo ea linyeoe tsohle tsa tšoaetso ea lesapo la mokokotlo li fumaneha mokokotlong oa lumbar, hanyenyane ho feta karolo ea boraro mokokotlong oa thoracic, 'me karolo e setseng e le mokokotlong oa mokokotlo.

Tšoaetso ea Purulent

Purulent spinal discitis (PS) hangata e bakoa ke ts'oaetso e phatlalalitsoeng ka mali, 'me Staphylococcus aureus ke eona kokoana-hloko e atileng ka ho fetisisa, hangata e amang lesapo la mokokotlo, le mahlaseli a x-ray a haelloang ke ho hlaka le kutloelo-bohloko mekhahlelong ea pele ea lefu lena. MRI e ntlafalitsoeng ke mokhoa oa khetho bakeng sa tlhahlobo ea pele ea mafu a mokokotlo; MRI e bonts'a edema ea masapo le ntlafatso ea 'mele ea mokokotlo, li-intervertebral discs, sebaka sa epidural, le / kapa li-tissue tse bonolo tse potolohileng tse nang le kapa ntle le sebopeho sa lesapo le fumanehang haholo-holo haufi le li-endplates tsa vertebral.

Tlhokomeliso: (a) Lateral lumbar spine radiograph e bontšang L4 -L3 tahlehelo ea bophahamo ba disc le ho timetsoa ha karolo e ka holimo ea L4 (motsu). 

(b) Letlapa le bonolo la ka morao ho L3. timetso ea L3 - L4 disc e nang le liphetoho tse senyehang ho li-endplates tse haufi (metsu). 

(c) Setšoantšo sa Magnetic resonance (MR) se bontšang liphetoho tse senyehang tsa li-endplates tsa vertebral le letšoao le sa tloaelehang la mokokotlo oa lesapo la mokokotlo (motsu). Li-tissue tse bonolo tsa prevertebral li na le edematous haholo 'me li na le liphetoho tsa ho ruruha. 

(d) Sagittal t1 ka mor'a ente ea ho fapana ka methapo e bonts'a pontšo e ntlafetseng mokong oa masapo (asterisk), pontšo e ntlafetseng sebakeng sa epidural le lisele tse bonolo tsa prevertebral. Ela hloko ho kenngoa ha kanale e bohareng (motsu).

Lefuba la Mokokotlo

Lefuba la mokokotlo (TS), tšoaetso e tloaelehileng ka ho fetisisa e sa purulent granulomatous ea mokokotlo e bakoang ke lefuba la Gram-positive Mycobacterium, le likarolo tsa litšoantšo tse khethollang TS ho PS li bontšitsoe tafoleng e ka tlase:

Li-radiographs tsa morao-rao li bonts'a tšenyo ea masapo, bophahamo bo fokotsehileng ba disc le li-abscesses tse bonolo tse nang le kapa ntle le calcification ea lisele tse bonolo tse potolohileng.

Ho MRI, mokhoa o tloaelehileng oa t1 o tlaase-signal intensity le matla a phahameng a matšoao a tatellano ea mokelikeli o nang le mokelikeli o kenyelletsang 'mele oa mokokotlo oa mokokotlo' me o ka fetela ka tsela e nyenyane ho ea ho li-vertebrae tse ling, ka kakaretso ntle le ho kenyelletsa disc.

Lintlha: Monna ea lilemo li 65 ea nang le (a) axial le (b) li-abscesses tsa lumbar (asterisk) tse nang le septal le lebota la ntlafatso (metsu e tšoeu) .L3 ho S1 ho ntlafatsa 'mele oa vertebral. Intervertebral disc e oeleng e se nang ntlafatso e kholo. Dural sac compression (motsu o mosoeu). (c) ct setšoantšo sa tsosoloso ea L3 ho S1 timetso ea 'mele oa vertebral.

Tšoaetso ea Brucella

Brucellosis ke lefu la zoonosis lefatšeng ka bophara le bakoang ke bacillus ea gram-negative. Hangata e ama lesapo la mokokotlo, haholo-holo L4.

Lefu lena le qala karolong e ka pele ea 'mele oa mokokotlo oa disc intervertebral' me e ka senya manonyeletso a manyenyane. Li-abscesses tsa Paravertebral li etsahala hangata mme li nyane ka boholo ho feta TS. The vertebral anatomy e lula e tiile.

Tlhokomeliso: Tšoaetso ea Brucella lumborum, radiographs e bontša sclerosis ea lumbar vertebrae, ho thella ho ea pele ea vertebrae ea lumbar, timetso e sa tloaelehang e kang mohato karolong e ka pele ea 'mele oa lesapo la mokokotlo, le ho thehoa ha li-cribriform tsa masapo karolong e ka pele ea' mele oa mokokotlo.

Tšoaetso ea fungal

Tšoaetso ea fungal spinal (FS) ha e tloaelehe 'me hangata e bonoa ho bakuli ba nang le immunosuppressed. Li-fungus tse ngata li ka ameha, ho kenyelletsa Pseudomonas, Aspergillus, Bacillus, le Coccidioides. Mokokotlo oa thoracic ke sebaka se tloaelehileng ka ho fetisisa, 'me se tšoana le TS, ts'ebetso ea tšoaetso e qala karolong e ka pele ea vertebrae' me ka linako tse ling e ka hasana ho li-vertebrae tse seng haufi.

Tlhokomeliso: CT scan sagittal setšoantšo sa mokuli ea nang le coccidioidomycosis. Maqeba a lekanyelitsoeng a masapo a se nang sclerotic margins a tloaelehile ho pathogen ena tlhahisong. timetso e pharaletseng ea T1 e lebisa ho putlama ha lesapo la mokokotlo. Ho sa tsotellehe leqeba le leholo la masapo, sebaka sa C7-T1 sa intervertebral se ile sa bolokoa, phetoho ea sebopeho sa coccidioidomycosis (phanele e nepahetseng) Sagittal MRT2WI ea mokuli a le mong e tiisa ho bolokoa ha khoeli ea C7-T1 intervertebral, e nang le pontšo ea bohlokoa ea T2 e bontšang ho kenya letsoho pele ho li-discs tsa C6-C7. Lesapo la masapo le ile la atoloha lesapong la subcortical le ka pele ho 'mele oa lesapo la mokokotlo, la baka ts'oaetso ea pele ea lisele tse bonolo IV. Liphetoho tse tšoaetsanoang li hasana ho ea maemong a mangata, ho khetholla habonolo mokhoa oa ho hasana ha mofuta o fokolang, o ka lebisang ho liso tse ngata maemong a sa tsitsang.

Ankylosing spondylitis

Ankylosing spondylitis (AS) ke lefu le sa foleng le sa foleng le amang lesapo la mokokotlo 'me le ka lebisa ho bohloko bo tebileng bo sa foleng bo tsoang ho fusion ea mokokotlo.

Bothata bo bong ho bakuli ba nang le AS ke nts'etsopele ea lefu le lekanyelitsoeng la disc, 'me litšoantšong, AL e ka khetholloa ho spondylitis ea ho ruruha ka bokooa bo ka sehloohong ho vertebrae e le' ngoe kapa tse peli tse haufi, ho fokotsa sebaka sa disc, le libaka tsa reactive sclerosis tse potolohileng bokooa ba osteolytic.

Tlhokomeliso: Mokuli ea nang le ankylosing spondylitis, monna ea lilemo li 44 ea nang le bohloko bo sa foleng ba mokokotlo le mefuta e fokolang ea ho tsamaea. Sagittal ct ea (a) thoracic le (b) lifensetere tsa lesapo la mokokotlo oa lumbar li bonts'a li-ligamentous syndesmosis tse pharalletseng hammoho le li-anterior longitudinal ligament (metsu). Ho boetse ho na le ossification le fusion ea lumbar interspinous ligaments (metsu e bontšitsoeng). (c) Setšoantšo sa Coronal sebakeng sa lumbar spine se bontša fusion ea likarolo tse ka morao le li-articular synovial joints (metsu).

Osteomyelitis Syndrome

Lentsoe le khutsufalitsoeng SAPHO le bolela motsoako oa matšoao a mesifa le masapo le letlalo (synovitis, acne, pustulosis, osteomalacia, le osteomyelitis), e nang le lebota le ka pele la sefuba (ho akarelletsa le manonyeletso a sternoclavicular, manonyeletso a costothoracic, le tsoeno ea sternoacetabular le marako a mangata a amanang le lumbar). Lipontšo tse atileng haholo ho x-ray radiographs ke vertebral body osteolysis with or without collapse, hammoho le osteomalacia le paraspinal ossification.MRI is the most sensitive imaging MRI is the most sensitive imaging modality, 'me lipontšo tsa eona tse ka sehloohong li kenyelletsa liphetoho tse atileng kapa tse tsepameng tsa lesapo la mokokotlo holim'a li-sequences tsa mokelikeli le li-intervertebral intervertebral. li-intervertebral discs kapa li-endplates tse ka pele, le edema ea lisele tse bonolo.

Tlhokomeliso: Monna ea lilemo li 62 ea nang le lefu la SAPHO. (a) Sagittal t2-weighted and (b) computed tomography (CT) litšoantšo li bontša ossification ea anterior longitudinal ligament (metsu e ntšo) Ha ho na lintho tse sa tloaelehang tsa disc kapa paravertebral fluid. L1 e behiloe sebakeng se phahameng haholo kamora ho robeha ha khale ha khatello. (c) Axial CT e bontša ankylosis ea motsoako o nepahetseng oa costovertebral (asterisk). (d) Oblique coronal CT reconstruction e bontša mahlakore a mabeli a thoracic ribcage clavicle ankylosis (li-asterisk tse ntšo). (e) Tlhahlobo ea masapo e bontšang ho kenngoa ha radiotracer manonyeletsong a mabeli a amehang (li-asterisk tse tšoeu).

Spondyloarthropathy e amanang le Dialysis

Dialysis-related spondyloarthropathy (DRS) ke phetoho ea pathological ho bakuli ba hemodialysis ea nako e telele. E tloaelehile ka ho fetisisa mokokotlong oa mokokotlo 'me hangata e fana ka ho fokotseha ha sebaka sa intervertebral, ho timetsoa ha li-endplates, ho hloka lefu la sclerosis, ho thehoa ha masapo a macha, tšoaetso ea paraspinal / abscesses, le ho matlafatsa sebaka.

Tlhokomeliso: Osteoporosis e pharaletseng ea pelvis ea lumbar le sacral. Ho senyeha ha karolo ea anterosuperior ea lumbar 5 vertebrae e nang le sclerotic hyperplasia ea margins (e bontšitsoeng ke motsu o mofubelu). Hyperplasia ea maqeba a haufi. Ho senyeha ha lenonyeletso le letšehali la sacroiliac ka ho timetsoa ha karolo e ka morao ea thipa ea ilium, masapo a mangata a ka hare a shoeleng, le hyperplasia ea lisele tse kang lebali (e bontšitsoeng ke metsu e putsoa).

Tlhokomeliso: MR e ntlafalitsoeng: Lumbar 4/5 disc bulge e nang le vertebral rim osteophytes, hypertrophy ea ligamentum flavum, ho fokotseha hanyenyane ha mokokotlo oa mokokotlo, le khatello ea karolo e ka pele ea mokotla oa dural. The lumbar 5 vertebral body is limitedly concave and can be seen as strips of long T1 le T2 WI compression fat high signal, ‘me ntlafatso e bonoa ka mor’a ntlafatso. Li-patches tse ngata tsa pontšo e sa tloaelehang li bonoa tlas'a li-endplates tsa lumbar 5 le sacral 1 le tlas'a manonyeletso a sacroiliac, ka letšoao le tlaase ho T1WI le letšoao le phahameng hanyenyane ho T2WI, 'me ntlafatso e bonoa ho lisebelisoa tsa ntlafatso (metsu e khubelu). Ho ile ha bonoa ho teteana ha lisele tse bonolo karolong e ka pele ea lesapo la mokokotlo la mokokotlo, 'me ntlafatso e ile ea bonoa ho skena se ntlafalitsoeng (motsu o moputsoa). Matšoao a lesapo la ilium, hip, sacrum le hlooho ea botšehali ka mahlakoreng ka bobeli a pelvis ha aa ka a bontša ntho leha e le efe e sa tloaelehang, 'me lipontšo tsa mesifa ea ka hare le ea ka ntle ea pelvic e ne e tloaelehile, e na le likheo tse hlakileng tsa mesifa le likheo tse tloaelehileng tsa manonyeletso, ntle le matšoao a ho atolosa le ho fokotseha.

Gout ea Mokokotlo

Gout ea mokokotlo e khetholloa ke li-deposit tsa monocrystalline urate crystals (MUCs) mokokotlong. Spinal gout e ama haholo-holo lesapo la mokokotlo. li-radiographs li bonts'a liponahatso tse sa tobang, 'me CT e tsebahatsa khoholeho ea masapo hantle ka methapo ea sclerotic. mri ponahatso ba nonspecific.

Tlhokomeliso: CT plain scan e bonts'a sebaka se kopaneng se tšesaane le ho senyeha ha bokaholimo ba mahlakore a mabeli. Arthrocentesis ea hlokahala ho netefatsa lefu lena.

Neurospondylitis

Neurogenic spondylitis (NS), arthropathy e tsoelang pele e senyang, e etsahala ka mor'a tahlehelo ea maikutlo le proprioception. Lebaka le tloaelehileng ka ho fetisisa ke kotsi e bohloko ea mokokotlo oa mokokotlo, e leng karolo ea 70% ea linyeoe. Lisosa tse ling li kenyelletsa lefu la tsoekere, lefu la mokokotlo oa mokokotlo oa mokokotlo, le mathata a mang a neurologic a kang peroneal muscular dystrophy le Guillain-Barré syndrome. Ka lebaka la karolo ea likarolo tsa thoracolumbar le lumbosacral ho boima ba 'mele, ke libaka tse atisang ho ameha.

Lipontšo tse tloaelehileng tsa NS ke likaroloana tsa masapo, ho se tsitse ha manonyeletso a intervertebral le ho se lumellane ho lebisang ho thellang ha 'mele oa mokokotlo, li-endplates tse ngata le ho khoholeha ha manonyeletso a manyenyane hammoho le ho sireletsa masapo a masapo ho sclerosis, hammoho le bongata ba lisele tse bonolo.

Tlhokomeliso: Monna ea lilemo li 58 ea nang le mokokotlo oa neuropathic. (a) Sagittal le (b) coronal computed tomographic reconstructions e bonts'a li-endplates tse ngata tsa lumbar vertebral le erosions ea articular synovial joint (metsu) e nang le likaroloana tsa masapo. Ho senyeha ha L2-L3 intervertebral disc unit ka ho atolosa sebaka sa intervertebral (asterisk). (c) Sagittal le (d) axial t2-weighted magnetic resonance sequences e tiisang ho atolosa sebaka sa L2-L3 intervertebral. liphetoho tse kholo tsa mokokotlo oa mokokotlo o amehileng ka morao ho L2-L3-L4. Ho boetse ho na le effusion meleng e bonolo e ka morao le e ka pele ho mekhoa ea spinous (asterisk).