外科学八年制腰椎病
69页1、Lumbar Degenerative Diseases Lumbar Degenerative Diseases Epidemiology of Low Back PainEpidemiology of Low Back Pain 25.9 million Americans complain of low back pain a cumulative expense of about $50 billion per year the most common cause of job-related disability the second most common neurologic ailment Five lumbar vertebrae five intervening intervertebral disks (IVDs). vertebra = anterior vertebral body + posterior neural arch neural arch = pedicles+ facet joints + transverse processes + lami
2、nae + spinous process 3 A good understanding of the normal anatomy of the spine is of utmost importance for the appreciation of spinal disorders. Physiological Anatomy of Lumbar SpinePhysiological Anatomy of Lumbar Spine 4 1.Cartilaginous end plates for the purpose of nutrition and anchoring 2.Anulus fibrosis made of concentric sheets of collagen for the purpose of containing the pressurized nucleus 3.Nucleus pulposus made of a soft, semigelatinous collagen that can absorb axial compressive load
3、s Anatomy of the disc Physiological Anatomy of Lumbar SpinePhysiological Anatomy of Lumbar Spine 5 Cauda Equina L1 level Physiological Anatomy of Lumbar SpinePhysiological Anatomy of Lumbar Spine Physiological Anatomy of Lumbar SpinePhysiological Anatomy of Lumbar Spine 6 Nerve root contains both motor and sensory components Cross the intervening intervertebral disc space, traveles in the lateral recess, passes underneath the pedicle and through the intervertebral foramen. Biochemical change in
4、the Biochemical change in the degenerative discdegenerative disc 7 Nucleus loses its ability to bear compressive loads Load transfer, shifts to the anulus, that is poorly suited to withstand compression, causes fatigue failure, fissuring, and possibly rupture A herniation of a fragment of the nucleus pulposus follow Load transfer is concentrated at the periphery of the vertebral end plates Lead to osteophyte formation: spondylosis Subsequently, as the degenerating disk becomes less able to resis
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