Comparison Between MRI Performance Of Cervical Disc Injury With Intraoperative Cervical Discography In Lower Cervical Spine With Fracture And Dislocation

Objective In this study,through comparison between MRI performance with intraoperative cervical discography in lower cervical spine with fracture and dislocation, imaging diagnostic and therapeutic value of intraoperative cervical discography in lower cervical spine with fracture and dislocation, while assessing the diagnostic value of preoperative MRI. Methods From April 2007 to January 2011 53 cases were treated with complete data in anterior or a parallel anterior patients, 45 males and 8 females;age of 18～74 years old, average 43.7 years old. Injury factors: road accident in 25 cases, 23 cases of injury falling from height, heavy injured in 3 cases, 1 case falls, the other 1 case. Injured 4 hours～21 days, an average of 3.4 days,patients underwent MRI examination. Operative time average of 9 days after injury. MRI in all patients cervical disc grading by Pearce standard classification, based on preoperative imaging data to determine segment surgery and surgical approach, the anterior vertebral body reduction and decompression, discectomy,fusion,titanium fixation,or anterior corpectomy, iliac bone graft taken fusion plate fixation, first posterior reduction in some patients, lateral mass screws, rods and internal fixation, then the same period with anterior decompression of vertebral ligand fusion. Surgery for discography between the disc and adjacent to imaging, and observe the anterior and posterior longitudinal ligament and intervertebral disc damage, after the X-ray imaging,observation of intervertebral disc and posterior longitudinal ligament damage, and photographed image data, imaging Results discography Sort by Adams Categories of this study, 150 disc imaging, surgical resection 65. In this study, double-blind method, preoperative by a radiologist read the MRI films and the chief physician to determine intervertebral disc and posterior longitudinal ligament injury,orthopedic director of intraoperative angiography performed by a physician from the same time, intraoperative exploration records before and after longitudinal ligament and intervertebral disc injury situation. According to the results of intraoperative exploration, analysis and comparison of imaging results and the performance of preoperative MRI,intraoperative evaluation of cervical discography in the diagnosis and treatment of cervical spine fracture and dislocation of the role, and verify the value of MRI. Results (1) 53 cases of fracture and dislocation of lower cervical spine in patients with damage to the 150 and the adjacent discs to study the performance of the preoperative MRI of 43 discs abnormal high signal or low signal mixed injury, angiography grading by AdamsⅣLevel 8,Ⅴgrade 35;the remaining 107 discs MRI grading the performance of classification according to Pearce:Ⅰtype: 6,Ⅱtype: 34,Ⅲtype: 40,Ⅳtype:22,ⅤType:5.Angiography according to AdamsX line classification, fracture type 8,rupture 35;intraoperative discography of Adams X ray classification,Cotton-type:11,sub-leaftype:27,irregular:42,cracked:17,ruptu-red: 10, two sets of data contingency table data using Chi-square test,Pearson X2=101.454, P =0.000<0.05, it may be that preoperative MRI imaging classification and grading of cervical disc Pearce significant relationship, correlation coefficient Gamma=0.782,P=0.000<0.05,a correlation between the two.(2) 53 cases of cervical fracture and dislocation preoperative MRI diagnosis of anterior longitudinal ligament rupture in 24 cases,9 cases of rupture of the posterior longitudinal ligament,intervertebral disc injury 63 by intraoperative exploration and intraoperative angiography in the diagnosis of 33 cases rupture the anterior longitudinal ligament, posterior longitudinal Ligament rupture in 18 cases,68 disc injury, in which MRI diagnosis of anterior longitudinal ligament rupture in 3 cases of misdiagnosis, missed diagnosis in 12 cases,63.63% sensitivity and specificity of 85.00%;diagnosis of posterior longitudinal ligament in 4 cases of misdiagnosis, missed diagnosis in 13 cases, sensitivity of 27.77 %,Specificity 88.57%;diagnosis of intervertebral disc injury missed five, sensitivity 92.64%;Intraoperative diagnostic discography 68 discs injury by intraoperative exploration consistent with the diagnosis, sensitivity and positive predictive value was 100%.Conclusions (1) MRI is the preoperative diagnosis of fracture and dislocation of lower cervical intervertebral disc, ligament injury first choice.(2) By MRI screening in patients with cervical fracture and dislocation, Cervical disc surgery angiography discs damage can be clearly found between adjacent segments of occult disk injury or degeneration (3) intraoperative MRI cervical disc diagnostic imaging is effective and reasonable complement assessment for determining the scope and integration between adjacent disc degeneration after a reference value.