Four MRI signs of diagnosis of lumbar spinal tube stenosis, must not be ignored

Lumbar spinal stenosis (LSS) is a common degenerative disease in middle-aged and elderly people in ChinaAs the population ages, so does the incidencethe current clinicaldiagnosislumbar spinal stenosis is mainly based on the patient's symptoms, electrophysiological and imaging tests, and imaging on the lumbar spinal stenosis diagnosis, classification and classification of many reference indicators, but because of the measurement time, complex, low repeatability and individual differences and other reasons are not widely usedbut in the long-term practical work, we find that some special imaging performance can objectively reflect the narrowness, the diagnosis of LSS has important clinical significancethe horsetail nerve redundancythe spinal nerve roots of the horsetail nerve almost vertically down the vertebral tube, gathered around the end wire into bundles to form a horsetailPhysiologically, the horsetail nerve floats in the cerebrospinal fluid, is subjected to gravity when lying on the back, and the walking distribution is close to the back sidewhen the human body is standing or sitting, under the influence of the conduction of the mechanical system, the lumbar disc is compressed, the vertebral joint tension, the joint gap narrows and other changes, at this time the pressure in the lumbar vertebral tube increases, especially when the front bendIn order to resist and adapt to this increase in the additional load, the body will instinctively make adjustments, so that the above changes increase, the same level of vertebral volume shrinks;However, when the lumbar tube stenosis to a certain extent, the epidural sac is narrowed by pressure, which is trapped in its horsetail nerve, limiting its normal activityWhen lumbar vertebral flexion, the horsetail nerve is pulled, moved up through the narrow, wait until the lumbar spine returns to the upright or back stretch, the horsetail nerve through its own anatomical maintenance structure is difficult to reset, so in the narrow level above the appearance of ring, twisting, relaxation, winding and other phenomena, this is what we call the horsetail nerve redundancyaccording to relevant literature reports, age, lumbar vertebral tube multi-section stenosis, narrow-level epidural sac area, lumbar vertebral stenosis position, narrow protrusions and other sharp protrusions are its risk factorsHowever, there are also a small number of patients with lumbar spinal stenosis who do not see this sign, such as young, single vertebral stenosis, and patients with congenital lysy spinal altruionFigure 1 Patients, female, 76 years old, lumbar pain for many years with occasional neurogenic lameness A: MRI sacroon indicative lumbar upper edge to the lumbar 4/5 intervertebral disc interval, visible lumbar vertebral multi-sectional stenosis and intra-vertebral nerve twisting lengthy B: MRI axis show the abnormal distribution of the horsetail nerve in the narrowly
arranged Double lower limb alternate pain powerless numbness for many years A: MRI sacrotat position lumbar 1 lumbar upper edge to waist 4/5 horizontal segment, showing the lumbar disc multiple protruding and lumbar vertebral tube multi-section alestnosis, narrow vertebral tube long horsetail nerve long B: MRI shaft position shows the normal structure
of the horsetail nerve disappeared, the form thickens, distributed into a group, arranged disorders 3
A: MRI sacroon indicated the normal vertebral tube and its vertebral tube distribution arrangement of the horsetail nerve root, waist 1 to waist 5 vertebral upper-edge horsetail nerve are back side of the whole beam walking, the form of natural B: MRI axis show that the horsetail nerve is distributed in the vertebral tube 1/3, uniform, arranged horsetail nerve deposition another the lumbar nerve is another As we mentioned above, under normal circumstances the horsetail nerve floats in the cerebrospinal fluid, spread over the back of the vertebral tube when lying on it If the patient's horsetail nerve is still floating in the cerebrospinal fluid while he is lying on his back, it can be defined as a positive for settlement Figure 4 Negative and positive manifestations of horsetail neurodeposition A: patient, female, 56 years old, physical examination health, no obvious lumbar and lower limb discomfort, lumbar MRI cross-section T2W1 image shows that the nerve root is located on the back side of the vertebral tube, manifested as a horsetail neurodeposition negative B: patient, female, 65 years old, intermittent lame ness for more than 1 year, MRI cross-section W1 image shows vertebral stenosis, yellow ligament thickening, horsetail nerve suspended in the vertebral tube, part of the nerve root is located in the abdominal side of the vertebral tube, the performance of the horsetail nerve deposition positive in addition, there are studies confirmed that in L5 plane symptoms and imaging in line with patients with central vertebral tube stenosis, the positive rate of sedimentation is 94%; This also shows that another important significance of the horsetail nerve deposition is that it can be used as a characteristic indicator to distinguish between simple lower back pain and lumbar spinal stenosis the front of the cerebrospinal fluid space blocking 2011, some scholars proposed to assess the severity of lumbar spinal stenosis by the size of the space in front of the cerebrospinal fluid, and that the severity of vertebral stenosis could be understood by observing the degree of blocking of space in front of the cerebrospinal fluid And based on the relative ratio of the residual cerebrospinal fluid space of the horsetail nerve and the epidural sac, the classification is determined by the degree of separation of the horsetail nerve: 0 level: there is no cleft space of the front cerebrospinal fluid, the horsetail nerve is clearly bound to each other, and there is no vertebral stenosis; level 1: mild vertebral stenosis, mild blockage of front cerebrospinal fluid, but the horsetail nerve seisples can be clearly distinguished between the
2 levels: moderate vertebral stenosis, moderate blocking of the front cerebrospinal fluid space, part of the horsetail nerve saced, indistinguishable; 3 levels: severe vertebral stenosis, front cerebrospinal fluid space completely closed, the endothelial sac significantly closed, the mare nerve is not significantly suppressed Figure 5 The pre-cerebrospinal fluid spatial blocking degree classification (from left to right: 0, 1, 2, 3) studies confirmed that there was a different degree of correlation between the degree of blockation of the front cerebrospinal fluid space and the front and back diameter and area of the epidural sac in patients with spinal stenosis Especially at the L3-4 and L4-5 levels, there are significant differences between the front and back diameters of the epidural sacs and the area Therefore, the degree of blocking of the front cerebrospinal fluid space can objectively reflect the severity of vertebral stenosis epidural fat increase in the lumbar spinal tube stenosis imaging diagnosis, in addition to subjective vertebral tube size assessment, commonly used there are the front and back diameter of the vertebral tube, area, epidural sac area, joint protrusion level of the yellow ligament distance and other quantitative indicators, of which the front and back diameter of the vertebral tube and the hardest membrane sac area are most commonly used we usually use the front and back diameters of the vertebral tube and the epidural sac area of 100mm2 as the diagnostic criteria for lumbar spinal stenosis but clinically there is such a class of patients, their bone vertebral space, whether diameter or area are in the normal range, but the measured area of the epidural sac is significantly less than the normal value such patients are often due to the relative narrowness caused by the occupation of the vertebral tube, resulting in the pressure of the epidural sac In addition to common factors such as tumors and hematomas, there is spinal stenosis caused by excessive hyperplup of normal adipose tissue outside the epidural, but because fat is "normal" tissue, we tend to ignore it Figure 5 Patients, male, 60 years old, intermittent lameness of both lower limbs for more than 3 years, aggravated half a year A: MRI positive sacroon T1W1 image shows a significant increase in epidural adipose tissue, especially L4-5 vertebral gap level B:L4-5 vertebral gap level bone vertebral tube did not see significant stenosis, but the measurement of the endo
thelial sac area is only about 55mm, the apparent lyve stenosis