| Objective: Spinal disc herniation is most commonly found on the cervical spine and lumbar spine, but thoracolumbar intervertebral disc herniation is relatively rare in clinic. At present there is a little literature about thoracolumbar intervertebral disc herniation. In recent years, With the further understanding of the thoracolumbar intervertebral disc herniation and unceasing development of imaging diagnosis technology , especially MRI is being applied more and more widely, the diagnosis of this disease at present is rising trend. The clinical manifestations of thoracolumbar intervertebral disc herniation are complex and lack of specificity, so it is prone to misdiagnosis or missed diagnostic. Besides, the pathogenesis of thoracolumbar intervertebral disc herniation is still not very clear. Different experts have different ideas and they failure to form a unified consensus. Due to the complexity of anatomical structure of thoracolumbar intervertebral disc herniation,the risk of surgical treatment is more than the lower lumbar spine. Therefore, to study the etiology of thoracolumbar intervertebral disc herniation and avoid it appear very important. thoracolumbar spine located in the junction of lumbar lordosis and thoracic kyphosis and it is the sites which beared stress concentration. Thoracolumbar spine was apt to suffer from Spinal fracture. Wedge compression fracture barely involved the anterior column, so it was considered stable fracture. Mild compression fractures in the clinical were considered very little significance. Because there is not immediate symptoms of nerve compression, non-surgical treatment was widespread use in mild compression fractures. The aim of this research is to make a comparison on target vertebral kyphosis angles and cobb angles of the patients who suffered from thoracolumbar intervertebral disc herniation (experimental group) and the age and gender-matched volunteers (control group) , so as to reach a conclusion on whether is there any correlation between the thoracolumbar intervertebral disc herniation and adjacent wedge-shaped vertebral body.Methods: Totally 56 patients with thoracolumbar intervertebral disc herniation who were operated from 2003 to 2009 at the Third Clinical Hospital of Hebei medical university were retrospectively analyzed. Exclusion the patients who had a history of trauma in recent period, infection, cancer and osteoporosis, the remaining was 43 cases. The 43 patients were the experimental group. There is a total of 29 male and 14 female patients. The average age was 43 years (19-66 years). In 2010, a total of 43 healthy volunteers formed the control group. The control group and experimental group were matched by age and gender. In experimental group, 31 patients had the history of lower back injury caused by falls from a height or traffic accidents. The history of trauma from the surgery date was more than 3 years. The remaining denied history of lower back injury. All 43 cases of control group patients denied history of lower back injury. All patients and volunteers underwent standing lateral X-ray examination. Target vertebra is defined as adjacent wedge-shaped vertebral body of thoracolumbar intervertebral disc herniation. In the experimental group, T12/L1 disc herniation 17 cases, L1 / 2 disc herniation 15 cases, L2 / 3 disc herniation 11 cases. 10 wedge-shaped vertebral body at T12, 19 were in L1, 14 were in L2. According to the target vertebra, Two groups were divided into 3 subgroups. In experimental group, the cobb Angles and the kyphosis angles of target vertebra were measured respectively (figure 1).According to correspondence of age, In the control group cobb angle and kyphosis angle of the corresponding vertebral body with the experimental group's target vertebra were measured. It is defined that Kyphosis angle as a positive and lordosis angle as a negative To avoid errors, all X-ray films were printed on papers and 3 copies of copies. According to blind, they were distributed to three spine professional graduate studentsand we took their measurements average value. Statistical analysis of all data was used by statistical software package for statistical analysis SPSS13.0. Cobb angles of the two groups using two-sample t test (the normal distribution) to compare. Kyphosis angles of the two groups were compared by rank sum test (does not meet the normal distribution). Kyphosis angles were compared between the two groups and the corresponding subgroups. cobb angles were compared between the corresponding subgroups. Correlation test of cobb angle and kyphosis angle used the linear regression analysis. Statistical standard is defined as less than 0.05.Results: Cobb angle Cobb angles of the experimental group was higher than the control group. Cobb angle of T12 for the experimental group was 19±7 o, and control group was 6±3°(p = 0.0002 <0.05). Cobb angle of L1 for the experimental group was 13±7 o, and control group was3±6o(p=0.0001<0.05). Cobb angle of L2 for the experimental group was 10±6o,and control group was -2±7o(p=0.0001<0.05)).kyphosis angle kyphosis angle in the experimental group and subgroup were higher than the control group. The kyphosis angle of T12 in experimental group was 10 o±4 o,and Control group was 2°±2°(p = 0.0002 <0.05). The kyphosis angle of L1 in experimental group was 12o±4o,and Control group was 3o±3o(p=0.0001<0.05). The kyphosis angle of L2 in experimental group was 11o o±4 o,and Control group was 2°±2°(p = 0.0001 <0.05).All of the Cobb angle in experimental group were less than 22°(4°to 22°),and All of kyphosis angle of the control group were less than 7°(0°to 7°). There is the no correlation between Kyphosis angle and the cobb angle in two groups (p <0.05). Kyphosis angle of the experimental group (average 11 o, range 4-22°) larger than the control group (average 2°, range 0-7 o),with statistically significant (p <0.05). Cobb angle in the experimental group and the various sub-groups are also larger than the control group, with statistical significance (p <0.05). There is no linear correlation between the Cobb angle and the kyphosis angle.Conclusion: There is correlation between thoracolumbar intervertebral disc herniation and adjacent wedge-shaped vertebral body. According to our research, the smaller vertebral kyphosis should not be ignored, and long-term follow-up should be carried out. Surgical treatments such as percutaneous kyphoplasty should probably be considered to operate to prevent biomechanical changes and adjacent disc degeneration caused by vertebral compression.
|
PDF Full Text Request