RU2299014C2 - Method for diagnosing pathologic intervertebral joints state in lumbar segment of the vertebral column - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves carrying out ultrasonic intervertebral joints examination in horizontal and para-sagittal planes and estimating para-articular structures and articular surfaces condition. Hyaline cartilage of articular surfaces is measured on perpendicular drawn to subchondral bone plates of the articular processes from subchondral layer of the superior articular process of underlying vertebra. Hyaline cartilage height of articular surfaces being reduced from 2.5 to 3.0 mm, isolated hyperechogenic inclusions being observed in cartilage layer and articular capsules, increased echogenicity and thickenings of articular capsules and increased echogenicity of para-articular structures being found, reflex syndrome and lumboischialgia are to be diagnosed. Hyaline cartilage layer height on articular surfaces being reduced to 1.9-2.6 mm, deformities and subchondral bone plates congruence disorders, increased echogenicity of para-articular structures, articular cartilages and capsules, thickening of articular capsules, plurality of different scale hyperechogenic inclusions articular cartilage layer and articular capsules being observed, radicular syndrome of lumbar osteochondrosis is to be diagnosed.

EFFECT: increased information capacity level.

4 dwg

Description

The invention relates to medicine, namely to ultrasound diagnostics and vertebral neurology, and can be used to diagnose the pathology of the intervertebral joints of the lumbar spine (POP) and assess the state of paraarticular tissues.

The problem of spinal osteochondrosis remains relevant today, because of the most common causes leading to massive material and labor losses among the working population, osteochondrosis takes the third place in the frequency of diseases. Among all patients with a neurological profile with damage to the peripheral nervous system caused by osteochondrosis, 75% are osteochondrosis of the lumbar spine.

A known method for the diagnosis of pathology of the intervertebral joints of the lumbar spine by computed tomography (CT) and magnetic resonance imaging (MRI) (L.D. Lindenbraten, I.P. Korolyuk, Medical Radiology. M: Medicine, 2000, p. 416-422).

Despite the high information content, the disadvantages of the known methods include the limitations associated with the examination of patients with claustrophobia, as well as the high cost of equipment, which reduces the possibility of its use in individual medical institutions.

Closest to the technical result (prototype) is a method for diagnosing the pathology of the intervertebral joints of the lumbar spine by means of a panoramic radiography (L.D. Lindenbraten, I.P. Korolyuk. Medical radiology. M: Medicine, 2000, p. 419), allowing to give a general assessment and indicative diagnosis of changes in the spine.

However, the disadvantage of this method is not sufficiently high information content and getting patients certain doses of ionizing radiation.

The authors suggest a highly informative method that is safe for the subjects, allowing the diagnosis of pathology of the intervertebral joints of the lumbar spine in the early stages of the disease.

The technical result of the proposed method is to increase the information content regarding pathological changes in the intervertebral joints of POP.

The technical result is achieved by conducting an ultrasound examination of the intervertebral joints in the horizontal and parasagittal planes, followed by assessing the state of the paraarticular tissues, articular surfaces and measuring the hyaline cartilage of the articular surfaces along the perpendicular conducted to the subchondral plates of the articular processes from the subchondral process of the lower articular vertebral to the lower articular layer of the upper articular process of the underlying vertebra.

The method is as follows.

Ultrasound images are presented to illustrate the method.

For examination, use any ultrasound scanner, for example Logiq Book (General Electrik, USA), using multi-frequency sensors: convex with operating frequencies from 2.0 to 5.0 MHz and linear - from 6.0 to 10.0 MHz (preference in the choice the sensor depends on the constitutional features of the subject and is associated with the physical properties of ultrasound). The subject is in the "lying on his stomach" position. The position of the limbs and head is arbitrary, but symmetry must be observed at the level of the crests of the ilium and scapula. The sensor is located in the region of the lumbar spine, first in a horizontal plane, while the scanning beam passes between the spinous processes of the vertebrae and is directed anteriorly. Access is necessary to remove the posterior horizontal scans, determine the position of the intervertebral joints and the level of the studied motor sigment. On the received scans you can see:

- the spinous processes of the vertebral bodies located in the median sagittal plane, giving a characteristic "acoustic path", and clearly dividing the lower back into the right and left halves;

- lower articular processes of superior vertebrae in the form of linear hyperechoic lines from their posterior surface located almost horizontally between the “acoustic path” from the spinous process and the ultrasonic “defect” obtained as a result of the passage of ultrasound along the hyaline cartilage of the articular surfaces of the intervertebral joints;

- upper articular processes of the lower vertebrae in the form of linear hyperechoic lines located at an angle of approximately 45 ° relative to the horizontal hyperechoic line from the posterior surface of the lower articular process of the superior vertebra between the ultrasound "defect" obtained by passing ultrasound along the hyaline cartilage of the articular surfaces of the intervertebral joints and muscle backs;

- hyaline cartilage of the articular surfaces of the intervertebral joints in the form of an ultrasonic "defect" obtained as a result of the passage of ultrasound between the articular processes of the vertebrae;

- the joint capsule in the form of a thin arched hypoechoic structure located between the articular processes;

- paraarticular tissues (muscles and muscle tendons located in the lumbar spine).

Ultrasound image 1 (figure 1) shows the normal intervertebral joint at the level of L ₂ -L ₃ horizontal scan.

Then the sensor is rotated 90 ° and advancing laterally from the spinous processes to the right and left to the level of scanning of the intervertebral joint. Thus, a sagittal scan is obtained, passing through the articular surfaces of the intervertebral joints. Several intervertebral joints fall into the resulting scan. To conduct a qualitative and quantitative assessment of the anatomical components of the intervertebral joint and paraarticular tissue, the segments are scanned in order.

On the sagittal scan you can see:

- subchondral plates of the articular processes of adjacent vertebrae in the form of thin paired congruent hyperechoic lines;

- a homogeneous anechogenic layer between the subchondral plates, consisting of adjoining hyaline cartilage and joint space, which is so small that it is normally not visible;

- a capsule of the joint in the form of a thin arcuate hypoechoic structure located above the articular surfaces of the intervertebral joints;

- paraarticular tissues (muscles and muscle tendons located in the lumbar spine).

Ultrasound image 2 (figure 2) shows the normal intervertebral joint at the level of L ₃ -L ₄ and L ₄ -L ₅ sagittal scan.

A qualitative assessment of the anatomical components of the intervertebral joints and paraarticular tissues lies in their visual determination of pathology. In addition to a qualitative assessment, a hyaline cartilage of the articular surfaces is quantified. Measurements are taken perpendicular to the subchondral plates of the articular processes from the subchondral layer of the lower articular process of the overlying vertebra to the subchondral layer of the upper articular process of the underlying vertebra. The joint gap of the unchanged intervertebral joint is so small that the hyaline cartilage of the contacting articular surfaces is visualized as a solid homogeneous anechogenic layer between the subchondral plates 2.5-3.6 mm thick, and the thickness increases in the caudal direction.

The study examined patients without episodes of pain in the lumbar spine (normal) and patients with reflex and radicular syndromes of osteochondrosis of the lumbar spine. In the group of patients with reflex syndromes, with lumbar ischialgia, changes were revealed in the form of a decrease in the height of the hyaline cartilage of the articular surfaces from 2.5 to 3.0 mm (lower normal range), single hyperechoic inclusions in the thickness of the cartilage and articular capsules, an increase in echogenicity and thickening of the articular capsules, increased echogenicity of paraarticular tissues. The group of patients with radicular syndromes was distinguished by gross changes in the intervertebral joints in the form of a sharp decrease in the height of hyaline cartilage from 1.9 to 2.6 mm, deformation and violation of the congruence of subchondral plates, increased echogenicity of paraarticular tissues and articular cartilage and capsules, thickening of joint capsules and multiple times hyperechoic inclusions in the thickness of articular cartilage and capsules.

Ultrasound image 3 (figure 3) shows the intervertebral joint at the level of L ₃ -L ₄ in a patient with lumbar ischialgia, horizontal and parasagittal scans. On the horizontal scan, the hyperechoic contour of the spinous process of the third lumbar vertebra is visible, the acoustic “shadow” is distal to it, and the lateral hyperechoic linear structures are located - the dorsal surfaces of the articular processes. A thickened edematous articular capsule in the form of an inhomogeneous spherical formation of increased echogenicity is visualized above the ultrasound “defect” from the inter-articular gap. On the sagittal scan, thin paired congruent lines of high echogenicity are visible - subchondral plates of the articular surfaces of the articular processes of the vertebrae, between which there is an inhomogeneous layer of moderately increased echogenicity, consisting of hyaline cartilage, in the thickness of which a small hyperechoic inclusion is visible. A part of a thickened joint capsule in the form of a hemisphere of increased echogenicity is located above the altered articular cartilage.

Ultrasound image 4 (figure 4) shows the intervertebral joint at the level of L ₄ -L ₅ in a patient with radicular syndrome of lumbar osteochondrosis, sagittal and horizontal scans. The dorsal surfaces of the lower articular and superior articular processes both on the sagittal and horizontal scans are visualized in the form of hyperechoic lines interrupted by a powerful acoustic “shadow” at the site of the projection of the articular spaces. Degenerative changes in the thickened joint capsule are represented by multiple, fused with each other, calcifications in the form of a bright hyperechoic sphere. In the horizontal scan, we can distinguish the hyperechoic dome of the spinous process, which also gives an acoustic “track”.

The inventive method has high information content, as it allows high accuracy to conduct a qualitative and quantitative assessment of the anatomical structures that form the intervertebral joints of the lumbar spine to determine the presence of pathology in them; easy to use, does not require expensive equipment and can be used in ultrasound diagnostic departments.

Claims (1)

A method for diagnosing the pathology of the intervertebral joints of the lumbar spine by means of a hardware study, characterized in that they perform ultrasound examination of the intervertebral joints in the horizontal and parasagittal planes, followed by an assessment of the state of the paraarticular tissues, articular surfaces and measuring the hyaline cartilage of the articular surfaces from the perpendicular to the subchondral from the subchondral layer of the superior articular process of the underlying n call and the detection of the height reduction of hyaline cartilage articular surfaces from 2.5 to 3.0 mm, hyperechoic single inclusions in the thickness of the cartilage and joint capsules, and thickening enhance echogenicity joint capsules, increasing echogenicity paraartikulyarnyh tissues diagnose presence reflex syndrome with sciatica; and when detecting a decrease in the height of the hyaline cartilage of the articular surfaces from 1.9 to 2.6 mm, deformation and violation of the congruency of the subchondral plates, an increase in the echogenicity of paraarticular tissues and articular cartilage and capsules, thickening of the joint capsules, multiple different-sized hyperechoic inclusions in the thickness of the joint and x diagnose radicular syndrome of lumbar osteochondrosis.

Images