| IntroductionSyndrome of lumbar intervertebral disc hemiation is a kind of common disease, and also a most frequently found cause of back pain. This syndrome is not simplely equal to lumbar intervertebral disc her-niation. Only when the hemiation oppress or irritate structures like the nerve root or the cauda equina, which subsequently cause a series of symptoms, can this syndrome be clinically diagnosed. Among the current radiodiagnostic methods, MRI has highly accurate in the diagnosis of lumbar intervertebral disc hemiation, while it is quite limited in telling the responsible focus especially when the hemiation is multi -planed. True that traditional spinal myelography is helpful in determination and exclusion of responsible focus, but it is rarely used for its invasiveness, high price, radiation, and possibly severe post - operative reactions or complications. MR myelography ( MRM) is to the contrary, save, noninvasive, economic, and operatively simple, giving similarly clear images to those from traditional spinal myelography. Some researchers abroad believe that in display of lumbar vertebral nerve root cuff, MRM has sensitivity similar to that of spinal myelography, and when it comes to terms with severe spinal stenosis, MRM is advantaged to the latter. Unfortunately, no reports on the correlation between nerve root oppression on MRM images and the clinical symptoms of nerve root oppression have been found by far, and this study was just intended for some discussions in this area.Materials and MethodsFifty - four patients with definite symptoms of singly involved nerve root of L3,4, L4,5, or L5S1 were selected for this study. All these patients came to the First Affiliated Hospital of China Medical University from May 2002 to March 2003, and were suspectedly diagnosed as syndrome of lumbar intervertebral disc herniation with clinical exclusion of other diseases. The studied 54 patients, 36 males, 18 females, with their ages averaged 41. 2 years old ranging from 16 to 74 years old, had different disease courses varying from one day to 12 years. Fifteen out of the 54 patients underwent surgery treatment within 4 days after their MRM examinations, and 1 patient underwent percutaneous laser nucleus pulposus ablation.Within 48 hours before and after the MRI and MRM of these patients , two experienced senior orthopaedists recorded the clinical data of the patients in detail, according to which they decide the extent of the involved intervertebral discs. If any one of the following 3 manifestations was found, the case was diagnosed as clinically severe. They were: straight leg raising angle <30; any sign of damage to nerve root (like muscular hypotonia, decreased or disappeared physiological reflex, atrophy of muscles) ; claudication within a walk of 100 meters. If no above symptom was found, the case was then diagnosed as non -severe.A Japanese TOSHIBA VISART 1.5 T superconductive MR scanner was applied for lumbar vertebral routine scan and then for coronary 3D FASE sequence MRM scan in the same area. And reconstruction of the source images with interval of 18 was made with method of maximum intensity projection (MIP) within the range of 180 .Under methodologically blind conditions, two experienced senior radiologists read MRI and MRM images. According to the standard of oppression of nerve root, responsible disc was diagnosed on the MRI and MRM images respectively. MRM images were classified into two groups of mild and severe according to the extent of nerve root oppression.Continuity revised fourfold table x tests were used to compare the MRI and MRM image results with the clinical results on diagnosed responsible intervertebral disc, so as to tell their consistency; Fourfold X2test was used to statistically compare the diagnosed values of MRI and MRM on the determination of responsible intervertebral disc in contrast with the clinical diagnosis; Fourfold x test was also used to statistically compare the number of clinically severe cases found in the two MRM groups of severe... |
PDF Full Text Request