İnterspinöz ligamentte dejeneratif değişimler

Year 2014, Volume: 48 Issue: 6, 661 - 666, 16.01.2015

Jian-Feng Zhang Chao Liu He-Jun Yu Hong-Xin Cai Shun-Wu Fan

https://doi.org/10.3944/AOTT.2014.13.0149

Abstract

Amaç: Bu çalışmanın amacı bel ağrısı (BA) bulunan hastalarda interspinöz ligament dejenerasyonunun (İSLD) radyolojik bulgularının değerlendirilmesi idi.

Çalışma planı: Çalışmadaki gruplar BA bulunan 60 olgu (Grup A) ve yaş ve cinsiyet frekansları eşleşen 60 diğer olgudan (Grup B) oluşmaktaydı. İSLD için MRG tabanlı bir derecelendirme sistemi ile yapılan skorlama Tip A (normal) ile Tip D (şiddetli) arasında dağılım gösterdi. Dört lomber seviyedeki dejenerasyona göre lomber diskin derecelendirmesi yapıldı.

Bulgular: Grup A’da 161 (%67.1), Grup B’de 172 (%71.7) seviyede rastlanan Tip A en fazla rastlanan İSLD tipi oldu. Tip D en az rastlanan tipti ve Grup A’da 13, Grup B’de ise 3 seviyede görüldü. Tip D İSLD’nin Grup A’daki insidansının (%5.4) Grup B’ye (%1.3) oranla anlamlı derecede yüksek olduğu saptandı (p<0.05). Grup A’da Tip D İSLD görülen hastaların yaşının Tip A, B ve C’ye göre daha yüksek olduğu belirlendi (Tip A ve B için p<0.01, Tip C için p<0.05). Grup B’de Tip D İSLD bulunan hastaların yaşı Tip A hastalara göre anlamlı derecede yüksekti (p<0.05). İSLD’nin ileri safhalarında her iki grupta da disk derecesinin arttığı görülse de, sadece Grup D’deki Tip D ile Tip A ve B arasındaki fark istatistiksel olarak anlamlı idi (p<0.05).

Çıkarımlar: Bel ağrısı olan veya olmayan hastalarda ileri derecede İSLD’ye daha az rastlanmaktadır. İSL’nin ileri derecede değişiminin BA olan hastalarda daha sık olduğu görülmüştür. Daha şiddetli disk dejenerasyonunda İSLD oluşmaktadır.

Keywords

İnterspinöz ligament; intervertebral disk; lomber omurga; manyetik rezonans görüntüleme (MRG).

Degenerative changes in the interspinous ligament

Abstract

Objective: The aim of this study was to investigate the imaging assessment of interspinous ligament degeneration (ISLD) in patients with or without low back pain (LBP).

Methods: Sixty patients with LBP were enrolled in Group A and 60 subjects frequency-matched by age and sex in Group B. An MRI-based grading system for ISLD was scored and ranged from Type A (normal) to Type D (severe). The lumbar disc was also graded according to degeneration at four lumbar levels.

Results: Type A ISLD was the most prevalent type with 161 levels (67.1%) in Group A and 172 (71.7%) in Group B. Type D was the least frequent, seen in 13 levels in Group A and 3 in Group B. There was a significantly higher incidence of Type D ISLD in Group A than Group B (5.4% vs. 1.3%, p<0.05). The average age of patients with Type D ISLD in Group A was higher than Types A, B and C (Type A and B p<0.01, Type C p<0.05). In Group B, the age of patients with Type D ISLD was significantly higher than those with Type A (p<0.05). Although disc grade increased in advanced ISLD in both groups, only the difference between Type D and Types A and B in Group A were statistically significant (p<0.05).

Conclusion: More advanced ISLD grades were less common in patients with or without LBP. Advanced change of the ISL was more common in patients with LBP. ISLD occurred in more severe disc degeneration.

Keywords

Interspinous ligament, intervertebral disc, lumbar spine, magnetic resonance imaging (MRI)

References

• Adams MA, Hutton WC, Stott JR. The resistance to flex- ion of the lumbar intervertebral joint. Spine 1980;5:245- 53. CrossRef
• Dumas GA, Beaudoin L, Drouin G. In situ mechanical behavior of posterior spinal ligaments in the lumbar re- gion. An in vitro study. J Biomech 1987;20:301-10. CrossRef
• Hindle RJ, Pearcy MJ, Cross A. Mechanical function of the human lumbar interspinous and supraspinous liga- ments. J Biomed Eng 1990;12:340-4. CrossRef
• Gillespie KA, Dickey JP. Biomechanical role of lumbar spine ligaments in flexion and extension: determination using a parallel linkage robot and a porcine model. Spine 2004;29:1208-16. CrossRef
• Newman PH. Sprung back. J Bone Joint Surg Br 1952;34- B:30-7.
• Vaccaro AR, Rihn JA, Saravanja D, Anderson DG, Hili- brand AS, Albert TJ, et al. Injury of the posterior ligamen- tous complex of the thoracolumbar spine: a prospective evaluation of the diagnostic accuracy of magnetic reso- nance imaging. Spine 2009;34:E841-7. CrossRef
• Goobar JE, Sartoris DJ, Hajek PC, Baker LL, Haghighi P, Hesselink J, et al. Magnetic resonance imaging of the lum- bar spinous processes and adjacent soft tissues: normal and pathologic appearances. J Rheumatol 1987;14:788- 97.
• Fujiwara A, Tamai K, An HS, Shimizu K, Yoshida H, Saotome K. The interspinous ligament of the lumbar spine. Magnetic resonance images and their clinical sig- nificance. Spine 2000;25:358-63. CrossRef
• Keorochana G, Taghavi CE, Tzeng ST, Lee KB, Liao JC, Yoo JH, et al. MRI classification of interspinous ligament degeneration of the lumbar spine: intraobserver and in- terobserver reliability and the frequency of disagreement. Eur Spine J 2010;19:1740-5. CrossRef
• Keorochana G, Taghavi CE, Tzeng ST, Morishita Y, Yoo JH, Lee KB, et al. Magnetic resonance imaging grading of interspinous ligament degeneration of the lumbar spine and its relation to aging, spinal degeneration, and segmen- tal motion. J Neurosurg Spine 2010;13:494-9. CrossRef
• Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar interverte- bral disc degeneration. Spine 2001;26:1873-8. CrossRef
• Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas 1960;20:37-46. CrossRef
• Landis JR, Koch GG. The measurement of observer agree- ment for categorical data. Biometrics 1977;33:159-74.
• Kirkaldy-Willis WH, Wedge JH, Yong-Hing K, Reilly J. Pathology and pathogenesis of lumbar spondylosis and stenosis. Spine 1978;3:319-28. CrossRef
• Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clin Orthop Relat Res 1982;165:110-23.
• Jinkins JR. Acquired degenerative changes of the inter- vertebral segments at and suprajacent to the lumbosacral junction. A radioanatomic analysis of the nondiscal struc- tures of the spinal column and perispinal soft tissues. Eur J Radiol 2004;50:134-58. CrossRef
• Kong MH, Morishita Y, He W, Miyazaki M, Zhang H, Wu G, et al. Lumbar segmental mobility according to the grade of the disc, the facet joint, the muscle, and the liga- ment pathology by using kinetic magnetic resonance im- aging. Spine 2009;34:2537-44. CrossRef
• Kohler R. Contrast examination of the lumbar in- terspinous ligaments; preliminary report. Acta radiol 1959;52:21-7. CrossRef
• Scapinelli R. Morphological and functional changes of the lumbar spinous processes in the elderly. Surg Radiol Anat 1989;11:129-33. CrossRef
• Sartoris DJ, Resnick D, Tyson R, Haghighi P. Age-related alterations in the vertebral spinous processes and interven- ing soft tissues: radiologic-pathologic correlation. AJR Am J Roentgenol 1985;145:1025-30. CrossRef
• Maes R, Morrison WB, Parker L, Schweitzer ME, Car- rino JA. Lumbar interspinous bursitis (Baastrup disease) in a symptomatic population: prevalence on magnetic res- onance imaging. Spine 2008;33:E211-5. CrossRef
• Jinkins JR. Lumbosacral interspinous ligament rupture as- sociated with acute intrinsic spinal muscle degeneration. Eur Radiol 2002;12:2370-6. CrossRef
• Tsao H, Tucker KJ, Coppieters MW, Hodges PW. Exper- imentally induced low back pain from hypertonic saline injections into lumbar interspinous ligament and erector spinae muscle. Pain 2010;150:167-72. CrossRef
• Rissanen PM. The surgical anatomy and pathology of the supraspinous and interspinous ligaments of the lumbar spine with special reference to ligament ruptures. Acta Orthop Scand Suppl 1960;46:1-100.
• Iida T, Abumi K, Kotani Y, Kaneda K. Effects of aging and spinal degeneration on mechanical properties of lum- bar supraspinous and interspinous ligaments. Spine J 2002;2:95-100. CrossRef
• Harris RI, Macnab I. Structural changes in the lumbar in- tervertebral discs; their relationship to low back pain and sciatica. J Bone Joint Surg Br 1954;36-B:304-22.
• Postacchini F, Gumina S, Cinotti G, Perugia D, DeMar- tino C. Ligamenta flava in lumbar disc herniation and spi- nal stenosis. Light and electron microscopic morphology. Spine 1994;19:917-22. CrossRef
• Scapinelli R, Stecco C, Pozzuoli A, Porzionato A, Macchi V, De Caro R. The lumbar interspinous ligaments in hu- mans: anatomical study and review of the literature. Cells Tissues Organs 2006;183:1-11. CrossRef