Intervertebral Ligament Injury

　　Etiology and pathology of interspinous ligament injury:

　　Long-term低头弯腰 workers who do not pay attention to changing their posture regularly; instability of the spine due to injury or disease can cause the supraspinous and interspinous ligaments to be in a state of tension, which can lead to small tears, bleeding, and effusion. If degenerative changes are present, injury is more likely. This type of inflammatory injury can stimulate the lumbar nerve posterior rami, leading to low back pain. In long-standing cases, the ligament can become calcified due to degeneration and necrosis. The supraspinous ligament at the junction with the spinous process can become degenerated, ruptured, and slip off the spinous process. In addition, due to violent rupture of the supraspinous and interspinous ligaments, the formation of more scars due to poor fixation after injury can also be a cause of chronic low back pain.

　　In daily life and work, the flexion and extension movements of the lumbar and thoracic spine often cause the spinous processes to separate and compress, resulting in mutual friction, traction, and compression between the parts of the interspinous ligament. Over time, this can lead to degeneration. On this basis, if trauma occurs, the ligament may become relaxed, ruptured, or perforated, causing interspinous ligament injury. Moreover, the supraspinous ligament is often absent in the lumbosacral region, so when the spine is bent excessively, the interspinous ligament in this area is subjected to greater tension. When bending over with the knees extended, the pelvis is fixed in a supinated position, and the interspinous ligament is subjected to high tension, which are reasons why interspinous ligament injury is prone to occur in the lumbosacral region. Interspinous ligament injuries above L4, especially tears, often occur with concurrent rupture of the supraspinous ligament.

　　Clinical manifestations of interspinous ligament injury:

　　Most patients have no history of trauma. Chronic low back pain, more pronounced when bending over, but pain can also occur when extending beyond due to compression of the affected interspinous ligament. Some patients may experience pain radiating to the sacrum or buttocks. Examination may show tenderness at the site of the injured ligament, spinous processes, or between spinous processes, but no redness or swelling. Sometimes, the supraspinous ligament can be felt sliding over the spinous processes. Interspinous ligament injury can be confirmed by B-ultrasound or MRI.

　　The main clinical manifestations of interspinous ligament injury include a clear history of trauma, immediate low back pain after trauma, pain and tenderness located in the middle of the two spinous processes, and increased pain with heavy pressure. Pain can worsen after fatigue and bending over, and can temporarily relieve after rest. Local pain relief can be achieved with Novocaine block, but tenderness will return after the medication wears off. The function of anterior flexion of the lumbar spine is limited. X-rays of the lumbar spine in the anterior flexion state can show widened interspinous spaces, and lumbar interspinous ligament angiography can detect partial or complete tears, relaxation, or perforation. Although lumbar interspinous ligament angiography has certain reference value, up to 70% of patients with lesions can have normal angiography.

　　The interspinous ligaments of the lumbar 1 to lumbar 3 are divided into four parts: anterior, anterior middle, middle, and posterior middle. The interspinous ligaments of lumbar 4 to lumbar 5 and lumbar 5 to sacral 1 are only divided into three parts: anterior, middle, and posterior, which are arranged in an interlaced manner.

　　1. Provide sufficient energy and maintain appropriate blood glucose levels. Carbohydrates account for 60% to 70% of total energy.

　　2. Timely fluid replacement, prevent dehydration.

　　3. Pay attention to calcium and iron nutrition, especially for female athletes.

　　4. Dietary fat can be slightly higher than other projects, accounting for 30% to 35% of total energy.

　　5. For strength-based competitive events, when athletes engage in high-intensity training, they should consume more protein because athletes need to increase the strength of their muscles, so their diet should be mainly meat, supplemented with eggs and milk. Among them, beef is rich in protein and has a good effect on supplementing physical strength, and most athletes prefer beef; while athletes training for endurance-based events need to supplement high-energy foods because they consume a lot of energy, using a large amount of glycogen in the body, so they have a high demand for rice, bread, and other foods, accounting for about 60% to 70% of their diet, followed by some high-protein and minerals, vitamins, and so on. In addition, endurance sports also consume a lot of pigments, and blood tonification requires the intake of foods rich in hemoglobin, such as animal liver, dark green vegetables, pitaya, jujube, and so on; for technical sports training, there are no special dietary requirements, and it is enough to achieve a balanced and sufficient nutrition. Skiing should belong to endurance sports and should be configured according to the characteristics of endurance

　　Treatment of interspinous ligament injury:

　　1. After the onset of symptoms, it is advisable to avoid bending over as much as possible to increase the conditions for repair.

　　2. Local injection of corticosteroids can significantly alleviate symptoms. If a lumbar belt is used for immobilization at the same time, the course of treatment can be shortened.

　　3. Physical therapy has certain efficacy. Massage and acupressure are not very helpful for this disease, and can only alleviate secondary sacrospinalis spasms.

　　4. For patients with long course of disease and ineffective treatment with non-surgical methods, some people undergo fascial strip repair surgery, but the efficacy is not yet certain.