峡部裂及腰椎滑脱症的磁共振成像课件

MagneticresonanceimagingofspondylolysisandisthmicspondylolisthesisPascalNiggemann JohannesKuchta DieterGrosskurth Hans KonradBeyerJanineH ffer KarlStefanDelankXIXSymposiumNeuroradiologicum p niggemann mrt koeln de iWiZ PartI StaticmagneticresonanceimagingIncidenceofvertebralhypoplasiaImpactofvertebralhypoplasiaonmeasurementandclassificationPartII PositionalmagneticresonanceimagingPositionalMRIfindingsClinicalimplicationofpositionalMRfindings Staticmagneticresonanceimaging Spondylolysisandisthmicspondylolisthesis multi factorialcommondisorder prevalence2 5to10 5 highprevalenceinspecificpopulationsandincertainfamiliesaquireddisorder acquireddisorderwithageneticpredispositionPathogenesis factureoftheparsinterarticularis spondylolysisVertebraloosesdorsal hock isthmicspondylolisthesisHypoplasiaiscommoninpatientswithspondylolysisandisthmicspondylolisthesis Material 181patientswith184levelsofspondylolysis 53women 128men176bilateral 8unilateralmeanage 50 5 13 5yearsLevelofspondylolysis L5 S1 157patients85 L4 L5 20patients11 L3 L4 6patients3 L2 3 1patient1 PositionalMRIusingtheFonarUprightMRIScansinflexion extension supineandsittingposition MethodsI SagittalT2weightedscanofthemidline A B C LineA dorsalmarginofL5 LineB paralleltolineAatthedorsaledgeofS1 LineC distancebetweenAandB MethodsII MRIinseatedpositionusingtheFONARUprightMRI sagittalT2weightedscan D E LineD lowermarginofL5 LineE uppermarginofS1DifferenceinsizebetweenLineAandlineBinmm MethodsIII C E GradeMeyerding CdividedbyEin Hypoplasia EminusDinmmRealSpondylolisthesis C HypoplasiaRealSlip Meyerding C Hypoplasia E Control Groupof526patientswithoutspondylolysisorspondylolisthesis IsL4smallerthanL5orL5smallerthanS1 Dorsalalignment D ResultsI Hypoplasiawasfoundin62levelsoutof184 L5 61 L4 1 Rangeofhypoplasia 3to13mm 5 2mm Hypoplasia classic Grade0 0Adjusted Grade0 24GradeI 37GradeI 31GradeII 24GradeII 7GradeIII 1In41patientsthegradeofsliphadtobeadjusted 24patientswerereclassifiedasspondylolysis ResultsII Hypoplasiawasfoundin10levelsin526controls p 0 001 L5washypoplasticin8patients 8outof526 L4washypoplasticin2patients 2outof526 Hypoplasiawas3to4mminthecontrols Nottakenintoaccountwereotherhypoplasia S1 combinedhypoplasia ventralhypoplasia ConclusionI Hypoplasiaiscommoninspondylolysis34 ofallsegments 39 oflevelL5HypoplasiamightmimicspondylolisthesisGradingafterMeyerdingtakesnotintoaccounthypoplasiaCarefulnottomisdiagnosespondylolysisasspondylolisthesis whenhypoplasiaispresentMeasurethehypoplasiaandgradeaccordingly ConclusionII Pathogeneticimplications Istheshorteningacquiredorinborn Hypoplasiaexistsinnonspondylolyticvertebrae butisrare Hypoplasiaispredisposition Inborn mightexplainfamilypredispositionisfoundinpatientswithoutspondylolysisAcquired mightbeacquiredduringgrowthboneovergrowthatthefracturesitegrowthofthevertebralbodyhindered Positionalmagneticresonanceimaging StabilityofthelumbarspinePanjabi 1980 definesspinalinstabilityas thelossoftheabilityofthespineunderphysiologicalloadstomaintainrelationshipsbetweenthevertebraeinsuchwaythatthereisneitherdamagenorsubsequentirritationtothespinalcordornerveroots Cross sectionalimagingfunctionalX RayPositionalMRI MethodsIV Classificationofthecomplaintsintoradicularvs nonradicular accordingtopain numbness paralysis solelywiththeclinicalneurologicalfindingsPositionalImaging UnstableanteriorslipIncreasedangularmovementMovementinthespondylolyticdefect Movement 3mm Unstableanteriorslip AnteriorInstability Supine Flexion Increasedangularmovement AngularInstabilityAngularchange 6 Movementinthespondylolyticdefect PosteriorInstability ResultsIII AnteriorInstability 21patients max 7mm AngularInstability 46patients max 18degrees PosteriorInstability 48patientsAnteriorandangularinstability 3patientAnteriorandposteriorinstability 5patientsAngularandposteriorinstability 15patientsAllthreeformstogether 3patientNoInstability 98patients ResultsIV Patientswithradicularsymptoms 69 of184 patientsNoinstabilityandradicularsymptoms 17patients of98 Anteriorinstabilityandradicularsymptoms 15patients of21 Angularinstabilityandradicularsymptoms 30patients of46 Posteriorinstabilityandradicularsymptoms 28patients of48 Allformsofinstabilityarestatisticallymoreoftenassociatedwithradicularsymptoms 2 Test p 0 0001 ConclusionIII PositionalMRI differentformsofinstabilityasdescribedusuallyonX Ray threecommonformsassociatedwithradicularsym