Anomaly of articular tropism: localization, treatment

The spine is the support of the body, so any changes in the structure lead to irreversible consequences, affecting the statics. Degenerative changes in the facet joints are the main cause of tropism. The disease occurs as a congenital mutation, the result of which is the asymmetric position of the articular processes involved in the formation of intervertebral joints. It also leads to changes in their location.

What is tropism?

Anomaly of tropism is not uncommon, the clinical picture occurs in approximately 20% of patients. To confirm the diagnosis, X-rays, computed tomography and magnetic resonance imaging are performed. The disease is a congenital variant of the ontogenesis of the articular processes of the vertebrae as a result of their location in different planes. Without appearing at birth and childhood, the disease reaches its peak towards the upper limit of youth. Degenerative changes in the facet joints in combination with other pathologies against the background of narrowing of the intervertebral foramen, which is observed with tropism, leads to other anomalies in the development of the spinal column, such as spondyloarthrosis, osteochondrosis and spondylosis. Such concomitant pathologies often have the same causes.

Reasons for appearance

Among the identified malformations of the lumbosacral region, the leading place is occupied by tropism of the spine. Formation factors remain unclear. The anomaly appears in utero at the stage of physiological development of the fetus. The cause of bone deformities of the spine is a violation of the embryonic growth of skeletal and spinal cord tissues. The influence of the mother’s lifestyle (smoking, alcohol), taking medications, illnesses suffered during pregnancy and genetics on the appearance of pathology is the subject of scientific research.

The nervous substance secretes substances to which chondroblasts (young cartilage tissue cells) react negatively. This protects the nerve tissue from the surrounding bone structures.

Types of anomalies of articular tropism

Violation of congruence leads to joint deformation and bursa rupture.
The configurations of the joints also belong to an anomaly of tropism and form a violation of congruence, which as a consequence leads to rupture of the bursa and unilateral underdevelopment of the joint. Different types of position of the articular processes also affect the diagnosis. Among them are:

asymmetry in the location of the axis;
wedge-shaped process;
differences in the size of symmetrical processes.

V.II. Anomalies of tropism of the cervical spine in children

Symptoms of the disease

The pathology affects the lumbosacral region.
Bruises, falls, heavy lifting or hypothermia contribute to the following manifestations of the disease:

pain in the lumbosacral region;
back muscle tension in the lumbar area;
pain when bending forward;
discomfort when palpating the paravertebral muscles;
myogenic back pain;
weakening of tendon reflexes;
decreased performance due to pain;
asymmetry in the location of joints;
pathologies of the spinous and articular processes of the vertebrae;
scarring of soft tissues.

Emergency medicine

Lateral hemivertebrae. There are single, double and even triple hemivertebrae, which are located mainly in the cervicothoracic or lumbar region.
In the thoracic region, the hemivertebra has an additional rib. Since each additional wedge-shaped vertebra has epiphyseal growth plates, the growth of a vertebra located on one side leads to deformation that follows the type of lateral curvature of the spine - scoliosis (Fig. 281). Blocking (congression) of the vertebrae. Blocking of the vertebral bodies (synostosis) can be complete or partial. With complete blocking, fusion of both the bodies and the posterior part of the vertebrae occurs. Soreness causes the development of deforming spondylosis in the upper and lower (outside the trochlea) parts of the spine, which develops as a compensatory factor. Blocking of the vertebral bodies is especially common in the cervical region (Klippel-Feil disease), and even fusion of the occipital bone with the atlas occurs, which can cause a narrowing of the foramen magnum.

Rice. 281. Developmental anomalies of the thoracic spine and ribs. 1—lateral hemivertebra; 2—synostosis of the ribs.

Blocking of vertebrae in all parts of the spine is unusually rare.

Vertebral nonfusion . Nonfusion of the anterior and especially posterior parts of the vertebrae is the most common congenital pathology. Incomplete fusion of the arches is observed in 30-35% of cases (Fig. 282), and a completely open spinal canal of the sacral vertebrae is observed in 3-5%.

Rice. 282 Nonfusion of the arch of the V lumbar vertebra. 1 — incomplete fusion of the arches; 2—sacralization; 3 - tropism anomaly.

Anterior and posterior clefts are usually located in the midline, although their asymmetrical arrangement is also observed; sometimes the gap is located obliquely. Often the edges of the unfused arch are pressed into the lumen of the spinal canal, causing compression of the dural sac.

Often in the area of non-fusion of the arches there are various formations such as fibrous cords, cartilaginous tissue, fibromas, adhesions, etc., which can cause the development of a pain syndrome that occurs as lumbosacral radiculitis. There are two main forms of this anomaly:

1) when the membranes of the spinal cord protrude through a congenital defect of the spine (spina bifida), the contents of which are often nerve roots;

2) simple splitting of the wall of the spinal canal.

The clinical picture of spina bifida is characterized by a tumor-like protrusion in the sacrum or lumbosacral region. The higher the spina bifida is located, the more severe the neurological phenomena, which are often characterized by paralysis.

Diagnosis and treatment

The need for diagnosis is associated with the similarity of the symptoms of tropism with other anomalies - fractures, calcification of the ligament, separation of exostosis.

Diagnosis is carried out using X-rays, MRI and CT (magnetic resonance and computed tomography). Treatment includes:

complete removal of the load from the spine;
bed rest using a shield;
warming with paraffin applications;
use of novocaine blockade;
underwater traction in a vertical position;
corseting;
use of electrophoresis;
exercise therapy classes;
massage.

For some indications, hydrogen sulfide baths are prescribed to accumulate biologically active substances, since hydrogen sulfide is a strong regenerator. If the disease is at an advanced stage or therapy is ineffective, one of the treatment options is surgery to fix the spine in the affected area. This type of therapy is used quite rarely.

Clinical picture

Incorrectly located intervertebral joints in tropism due to accidental spinal injury serve as the starting point for the development of such a common disease as arthrosis deformans. The same reasons can cause severe pain in the spine.

Another important diagnostic sign is scar changes, or even the presence of ossification of soft tissues that surround an anatomically incorrectly formed intervertebral joint. Another symptom that can be detected on a CT or MRI is narrowing of the intervertebral foramen by osteophytes or scar tissue. But these manifestations are secondary in nature and arise against the background of general pathology. All this leads to pronounced radicular manifestations.

Classification

This anomaly of the human spine is divided into two types:

Incomplete sacralization of the l5 vertebra is the union of one or two sides of the spine. It is also possible for the transverse processes to grow to the level where they begin to contact the ilium, up to the formation of a single element. The area between the sacral and lumbar spine becomes intermittent, unclear, or narrowed. The level of mobility in the lower back is noticeably limited.
Complete sacralization leads to fusion of the l5 and s1 vertebrae, as well as the fusion of the apex of the ilium with the transverse processes of the l5 bony body. On an x-ray, these vertebrae are combined into one vertebra, and in place of the dark spot from the spinal disc there is white bone tissue. The spinous processes of vertebrae s1 and l5 may not be different against this background. Mobility in the sacral segment is completely absent.

Such pathology is divided into false and true. True anomalies include those cases where there is a congenital union of one transverse process with the ilium or the sacrum on one side of the surface of the spine.

False pathologies can appear in the following cases:

Low landing of the l5 vertebra in the sacral region;
Between the vertebrae l5 and s1 the distance is maintained, but the ligaments partially obscure the appearance of the gap;
Ankylosing spondylitis, progressing in the sacrolumbar junction and lumbosacral region, causes ossification and fusion of the processes of joints and ligaments;
Against the background of the extreme stage of spondylosis, segments of the spine degenerate, and marginal osteophytes lead to the union of the vertebrae.

Sacralization is also classified into the following degrees:

Articular sacralization of the vertebra is considered mild. Constant contact of the transverse processes with the ilium leads to the formation of pits on its surface, as a result of which it provokes the appearance of neoarthrosis - a pathological joint. Freedom of rotation and other movements in the lumbar region remains without restrictions, but sometimes pain occurs.
The second degree includes cartilaginous sacralization. In this form, a rigid cartilaginous structure – synchondrosis – is formed between the transverse processes, vertebral segments l5 and s1 and the iliac crest. The level of mobility decreases, and when turning the body, noticeable pain appears.
Bone sacralization is the most severe degree of the disease. The vertebral bodies l5 and s1, the sacrum and the transverse processes are combined into a single bone unit. Immobilization of the l5 and s1 segments of the spine leads to acute pain when bending and turning the lower back.

All of the above degrees can occur on the left, right, or both sides of the vertebral segment. The cartilaginous and articular forms refer to partial fusion, and the bony sacralization refers to complete fusion.

Anatomical features

The strongest intervertebral disc in the human spine is located between the 1st sacral and 5th lumbar vertebrae. When walking in this disc, the depreciation of the spine is compensated, and it also eliminates pinching of the nerves of the lower part of the spinal column. When the spine is sacralized, the pressure on the lumbar segments located above the fused area increases.

Under standard load, the spine copes with the assigned tasks, but with increased pressure on the vertebrae, congenital pathology makes itself felt.

Consequences and complications

The manifestation of consequences in people with such a congenital structure of the vertebrae is as follows:

The intervertebral segments located above the part of the fusion begin to degenerate;
The spine is curved;
The spine experiences excessive structural pressure.

The transitional disc, located between adjacent vertebrae, usually bears the greatest part of the excess load.

If this disc is deformed, weakened or missing, the entire pressure force of the excess load is transferred to the bone segments of the spine. Under this influence, the vertebrae are subject to degenerative pathology, which contributes to the appearance of spondyloarthrosis or osteochondrosis. If changes in the structure of the spine compress the nerve roots in the lumbar region, and the patient experiences constant and unbearable pain.

Sacralization of the lumbar vertebra due to additional load provokes destruction of the bone tissue of the spinal segments located above the fused area. It is possible to develop diseases that significantly increase pain symptoms: spondylosis, osteochondrosis or spondyloarthrosis.

The main part of the manifestations of this disease does not bother the patient, having virtually no effect on his well-being. To completely eliminate such a pathology, surgery will be required, but surgery is prescribed extremely rarely.