What are the pathological reflections of lumbar spine anteroposterior films in patients with lumbar disc herniation?

In the anteroposterior radiograph of the lumbar spine of patients with lumbar disc herniation, the following signs may be seen.

(1) Lumbar scoliosis. Scoliosis is more common in lumbar 4 and 5 intervertebral disc herniations. The direction of scoliosis can be either convex to the affected side or to the healthy side. It is generally believed that scoliosis is a compensatory change caused by protrusions compressing nerve roots. When the protruding nucleus pulposus is located inside the nerve root, the lumbar scoliosis is convex toward the healthy side; when the protruding nucleus pulposus is located outside the nerve root, the lumbar scoliosis is convex toward the affected side. When the lumbar 5 and sacral 1 intervertebral discs herniate, the scoliosis is often not obvious.

(2) The width of the intervertebral space is unequal from left to right. The intervertebral space on the convex side of the scoliosis widens. This is also a compensatory reaction and is not caused by the protrusion taking up space. This sign has no special significance for diagnosing lumbar disc herniation.

(3) Pelvic tilt. This is a protective posture commonly seen in patients with acute lumbar disc herniation.

Different patients will have different X-ray manifestations due to many factors such as age, disease course or congenital factors. Among them, the spinous process is distorted, especially the spinous process of the 5th lumbar vertebra, which is often due to development. result. It has no special clinical significance for the diagnosis of lumbar disc herniation.

In addition, some congenital developmental malformations of the lumbar spine, such as sacralization of the lumbar spine, lumbarization of the sacral spine, spina bifida occulta, hypertrophy of the 3rd lumbar transverse process, etc. will be clearly reflected on the X-ray anteroposterior films.