There is a soft bag on the lumbar spine

Many people will find that a soft lump has inexplicably grown on the lumbar spine when taking a shower or touching their backs. To check whether there is pain, touch it with your hand to see if there is any local granular feeling. In addition, you need to go to the hospital for X-ray examination, lumbar CT scan, lumbar MRI, and other examinations to diagnose the cause of the lump from multiple aspects.

Examination items: Anteroposterior X-ray, lateral X-ray, lumbar spine CT, lumbar MRI

1. Anteroposterior X-ray

"It is not easy to show isthmus lesions. Through careful observation, a reduced density oblique or horizontal fissure may be found under the pedicle shadow, which is mostly bilateral. In patients with obvious slippage, the slipped vertebra is tilted and the lower edge is unclear.

2. Lateral X-ray

Can clearly show the morphology of spondylosis. The fissure is located at the posterior and inferior part of the pedicle, between the superior and inferior articular processes, and the edges often show signs of sclerosis. The lateral view can show signs of lumbar spondylolisthesis and measure the degree of spondylolisthesis. The Meyerding classification is commonly used in China, which divides the upper edge of the lower vertebra into 4 equal parts and divides it into grades I-IV according to the degree of forward sliding of the vertebra relative to the lower vertebra.

Ⅰ: refers to the case where the vertebral body slides forward no more than 1/4 of the sagittal diameter of the middle part of the vertebral body.

Ⅱ: More than 1/4 but not more than 2/4.

Ⅲ: More than 2/4 but not more than 3/4.

IV: Exceeding 3/4 of the sagittal diameter of the vertebral body.

3. Oblique X-ray

Can clearly show isthmus lesions. When the spondylosis occurs, a band-like fissure may appear in the isthmus, which is called the Scottish dog neck fracture sign.

4. Dynamic X-ray

It can determine the activity of the slip and is of great value in determining whether there is lumbar instability. The X-ray diagnostic criteria for lumbar instability are forward or backward displacement >3mm or endplate angle change >15° on hyperextension or hyperflexion films.

5. Lumbar spine CT

The main CT manifestations of lumbar spondylolisthesis are: ① bilateral sign ② double-tube sign ③ intervertebral disc deformation, that is, deformation of the annulus fibrosus at the level of the slippage, manifested as symmetrical soft tissue shadows at the posterior and inferior edge of the previous vertebra, while there is no intervertebral disc tissue at the posterior and inferior edge of the next vertebra. ④ The isthmus fissure appears in the plane of the lower edge of the pedicle, with an uncertain direction and a serrated edge. Three-dimensional CT or multiple sagittal reconstructions can clearly identify changes in the intervertebral foramen and the degree of slippage.

6. MRI of Lumbar Spine

Magnetic resonance imaging (MRI) can observe the compression of the lumbar nerve roots and the degree of degeneration of each intervertebral disc, which helps to determine the scope of decompression and fusion.