inspection items: anterior and posterior X-rays, lateral x-rays, lumbar CT, lumbar MRI 1, anterior and posterior X-rays ". It is not easy to show isthmic lesions. Through careful observation, it may be found that there is an oblique or horizontal fissure with reduced density in the shadow of the pedicle, mostly bilateral. In patients with obvious spondylolisthesis, the vertebral body of the spondylolisthesis is inclined and the lower edge is blurred. Second, lateral X-ray can clearly show the shape of vertebral arch fracture. The fissure is located behind and below the pedicle, between the superior and inferior articular processes, and the edges often show signs of sclerosis. Lateral radiographs can show signs of lumbar spondylolisthesis, and can measure the spondylolisthesis index. The Meyerding grading is commonly used in China, that is, the upper edge of the lower vertebral body is divided into 4 equal parts, which are divided into I-IV degrees according to the degree of forward sliding of the vertebral body relative to the lower vertebral body. Ⅰ: Refers to the forward sliding of the vertebral body not exceeding 1/4 of the mid-sagittal diameter of the vertebral body. Ⅱ: more than 1/4 but not more than 2/4. Ⅲ: more than 2/4 but not more than 3/4. Ⅳ: more than 3/4 of the sagittal diameter of the vertebral body. Third, oblique X-ray can clearly show isthmic lesions. When the vertebral arch bursts, a band-shaped fissure may appear in the isthmus, which is called the Scotty dog neck rupture sign. Fourth, dynamic position X-ray can judge the mobility of slippage, which is of higher value for judging whether there is lumbar instability. The X-ray diagnostic criteria for lumbar instability include hyperextension, forward or backward displacement on the hyperflexion film>3mm or endplate angle change>15°. 5. The CT findings of lumbar spine CT lumbar spondylolisthesis mainly include: ① bilateral sign ② double tube sign ③ intervertebral disc deformation, that is, fibrous annulus deformation at the level of spondylolisthesis, which is manifested as a symmetrical soft tissue shadow on the posterior lower edge of the previous vertebral body, while the next There is no intervertebral disc tissue at the lower edge of the posterior body. ④ The isthmus fissure appeared in the plane of the lower edge of the pedicle, the direction of travel was uncertain, and the edge was jagged. Three-dimensional CT or multiple sagittal reconstructions can clarify the changes in the foramina and the degree of spondylolisthesis. 6. Lumbar magnetic resonance MRI can observe the compression of the lumbar vertebral nerve roots and the degree of degeneration of the intervertebral discs, which helps to determine the scope of decompression and fusion.
1. Congenital hypoplasia lumbar spine has vertebral body and vertebral arch ossification centers during development. Each vertebral arch has two ossification centers, one of which develops into upper articular process and pedicle, and the other develops into lower articular process. , Lamina and half of the spinous process, if there is no healing between the two, it will cause congenital isthmus cracking and disconnection, causing lumbar spondylolisthesis. In addition, spondylolisthesis may occur due to abnormal development of the upper sacrum or L5 vertebral arch, but in this case, the isthmus is not broken. Second, trauma acute trauma, extension trauma and acute fracture can lead to lumbar spondylolisthesis, this situation is more common in competitive sports activities or labor porters. 3. Fatigue fracture or chronic strain When the human body is standing, the lower lumbar spine bears a lot of weight, which causes the component of forward movement to act on the isthmus of relatively weak bone. Long-term repeated action can lead to fatigue fractures and chronic strain injuries. Fourth, degenerative factors. Due to long-term continuous lower back instability or increased stress, the corresponding facet joints are worn out, degenerative changes occur, joints become level suddenly, plus intervertebral disc degeneration, intervertebral instability, and anterior ligament relaxation, gradually A spondylolisthesis occurs, but the isthmus remains intact. It is also called pseudo-slippage, which is more common in the elderly. 5. Pathological fractures are mostly caused by systemic or local tumors or inflammatory lesions, involving the vertebral arch, isthmus, and articular processes, causing the loss of the stability of the posterior vertebral structure and causing pathological spondylolisthesis.
Patient story ”Dr. Zhang’s medical skills are really brilliant”! This is the evaluation of Dr. Zhang Zhengping from a patient with lumbar spondylolisthesis. The patient is more than 50 years old this year. Because of lumbar spondylolisthesis, a series of symptoms such as back pain and sciatic nerve pain have been brought to the patient’s daily life. After undergoing surgical treatment by Director Zhang Zhengping of the Spinal Disease Hospital of Xi’an Honghui Hospital, he is now recovering well. The patient said: “I can now go up to the sixth floor in one breath.” This seemingly simple action, from the mouth of the elderly patient, we can feel the excitement, joy and satisfaction of the elderly. It is this satisfaction that made the old man have such an evaluation of Doctor Zhang. This is exactly: the gold and silver cups are not as good as the common people’s reputation, and the gold and silver awards are not as good as the common people’s praise. Introduction to medical science of lumbar spondylolisthesis . . The incidence of lumbar spondylolisthesis varies in different regions, which may be related to race and genetic inheritance. According to reports, it is 4~6% in Europe and about 4.7~5% in China ; In all lumbar spondylolisthesis, spondylolisthesis caused by spondylolisthesis accounts for about 15%, and degenerative spondylolisthesis accounts for about 35%. In my country, the age of onset of lumbar spondylolisthesis is mostly 20-50 years old, accounting for 85%; males are obviously more than females, and the ratio of male to female is 29:1. The most common parts of lumbar spondylolisthesis are L4~L5 and L5~S1, and the incidence of lumbar 5 vertebrae is 82~90%.  . .Causes of lumbar spondylolisthesis . .1. Congenital hypoplasia . . During the development of the lumbar spine, there are vertebral bodies and vertebral arch ossification centers, each side of the vertebral arch has two ossification centers, one of which is developed It is the upper articular process and the pedicle, and the other one develops into the lower articular process, lamina and half of the spinous process. If the two are not healed, it will cause the congenital isthmus to split and cause lumbar spondylolisthesis. In addition, spondylolisthesis may occur due to abnormal development of the upper sacrum or L5 vertebral arch, but in this case, the isthmus is not broken.  . . Two. Trauma . . Acute trauma, extension trauma and acute fractures can lead to lumbar spondylolisthesis. This situation is more common in competitive sports activities or labor porters.  . . Third, fatigue fracture or chronic strain . . When the human body is standing, the lower lumbar spine bears a lot of weight, which causes the component of forward movement to act on the isthmus of relatively weak bone. Long-term repeated action can lead to fatigue fractures and Chronic strain injury.  . .Four. Degenerative factors . . Due to long-term continuous lower back instability or increased stress, the corresponding facet joints are worn out, degenerative changes occur, joints suddenly become level, plus intervertebral disc degeneration, intervertebral disc The anterior ligament is stable and loose, so that spondylolisthesis occurs gradually, but the isthmus remains intact. It is also called pseudo-slippage, which is more common in the elderly.  . .V. Pathological fractures . . Mostly due to systemic or local tumors or inflammatory lesions, involving the vertebral arch, isthmus, and articular processes, so that the stability of the posterior vertebral body is lost and pathological spondylolisthesis occurs.  . .