Clinical Study Of 3D-MRI In The Diagnosis Of Atypical Lumbar Disc Herniation

Background and Objective: For typical lumbar disc herniation,it is easy to diagnosis by the symptoms and signs,and combine CT,MRI examinations before operation.Atypical LDH in clinical,such as far lateral lumbar disc herniation,tumorlike disc herniation,often missed diagnosis and misdiagnosis.For spine surgeons,accurate diagnosis before surgery is an important guarantee for operation and treatment successfully.How to define the diagnosis of atypical LDH was still a technical problem faced by spine surgeons.At present,conventional MRI is the preferred imaging examination for the diagnosis of LDH.However,it does not show the complete picture of nerve roots,and it is difficult to satisfy the diagnosis of atypical LDH occasionally.With the continuous development and progress of imaging technology,3D-MRI technology can clearly show the anatomy,morphology and trajectory of nerve roots,and judge the positional relationship between nerve root and intervertebral disc.Based on the anatomical study of the relationship between the origin of the nerve root and the intervertebral disc by 3D-MRI,this paper further discussed and analyzed the value of 3D-MRI in the diagnosis of FLLDH and tumorlike lumbar disc herniation,and to revealed its superiority in the accurate diagnosis of special types of LDH,and to provide more reliable evidences for accurate diagnosis and treatment.First PartMaterials and Methods: 51 patients who all underwent 3D-MRI in the Second Affiliated Hospital of Nanchang University were collected from December 2016 to June 2019,including 24 males and 27 females.Among 51 patients,there was no lumbar instability and no obvious collapse of intervertebral space.Meanwhile,patients with spinal deformity,spinal fracture,spinal tumor and spinal infection were excluded.The relationship between the origin of L2-S1 root and the corresponding disc was observed by 3D-MRI.Results: 66.67% of the S1 roots originated above,31.37% at the L5/S1 disc.For the L5 root 5.88% originated above,3.92% below,56.86% at the L4/5 disc and 29.41% at the junction area between the disc and the inferior vertebral body.3.92% of the L4 root originated at,50.98% below the L3/4 disc,and 43.14% at the junction area of the intervertebral disc and the inferior vertebral body.The origin of the root was found to be below the corresponding disc for the L2 and L3 roots.At the same time,we also found that the starting points of bilateral nerve roots are not equal in height,that is,the mixed type of high and low starting points of nerve root variation and the high starting type of nerve root variation,which are mainly found in L4,L5 and S1 roots.Conclusions: 3D-MRI can clearly show the relationship between the origin of the nerve root and the corresponding disc;when the origin of the nerve root is under the disc,most of the herniated disc is difficult to compress the nerve root,which can help to identify the asymptomatic segment and the responsible segment;At the same time,it can also help us to diagnose the variation of lumbosacral nerve root,so as to explain some cases where clinical symptoms are not consistent with imaging,and guides intraoperative planning and reduce the risk of nerve root injury.Second PartMaterials and Methods: From October 2017 to June 2019,this study randomly enrolled 30 patients with single-segment FLLDH and 36 patients with paracentral lumbar disc herniation admit in the Second Affiliated Hospital of Nanchang University.All patients received surgical treatment,and were diagnosed with FLLDH or paracentral lumbar disc herniation through gross intraoperative examination and symptoms improvement postoperatively.Two experienced orthopedists used blind methods to analyze,evaluate,and make diagnosis of 66 patients with conventional MRI and 3D-MRI without knowing the surgical results or clinical relevant information.Taking the surgical results as the gold standard,compare the value of conventional MRI and 3D-MRI in the diagnosis of FLLDH.Results: The sensitivity(93.3%)and specificity(91.7%)of 3D-MRI in the diagnosis of FLLDH were higher than those of conventional MRI(70.0%,77.8%).At the same time,the consistency of FLDH diagnosis by 3D-MRI between observers(0.85)is also higher than that of conventional MRI(0.60).Conclusion: 3D-MRI is a very effective imaging method for the diagnosis of FLLDH,which helps to clarify the responsibility segment and provide a more reliable basis for clinical treatment.Third PartMaterials and Methods: From October 2017 to June 2019,this study randomly included 24 patients with tumor-like disc herniation and 18 patients with schwannomas admit in the Second Affiliated Hospital of Nanchang University.All patients underwent 3D-MRI,and all received surgical treatment.Through surgery and pathological results,they were diagnosed with tumor-like disc herniation or schwannomas.Two experienced orthopedics doctors used blind method to analyze,evaluate and diagnose the images of 3D-MRI of 24 cases of tumor-like disc herniation and 18 cases of schwannomas and analyzed the value of 3D-MRI in the differential diagnosis of tumor-like disc herniation and schwannoma.Results: The sensitivity and specificity of 3D-MRI in the diagnosis of tumorlike disc herniation were 95.8% and 94.4%,respectively,and the diagnostic consistency(0.90)between the observers was almost perfect agreement.Conclusion: 3D-MRI can effectively help distinguish tumor-like disc herniation from schwannomas,and has important guiding significance for the choice of surgical plan.