Derby Richard, Kim Byung-Jo, Chen Yung, Seo Kwan-Sik, Lee Sang-Heon
Spinal Diagnostics and Treatment Center, Daly City, CA, USA.
Arch Phys Med Rehabil. 2005 Aug;86(8):1534-8. doi: 10.1016/j.apmr.2005.02.012.
To analyze the relation between annular disruption determined by computed tomography (CT) scan and diskographic findings using pressure-controlled manometric diskography.
Cross-sectional using prospectively gathered data.
Ambulatory spine intervention unit.
Two hundred seventy-nine disks from 86 patients (55 men, 31 women) who were referred for diskography of suspected chronic diskogenic low back pain.
Not applicable.
The grade of annular disruption was rated using CT diskography and fluoroscopic imaging as follows: 0 (no disruption); 1 (extension into the inner third of the annulus); 2 (extension into the middle third of the annulus); 3 (extension into the outer third of the annulus); 4 (circumferential extension with a >30 degrees arc at the disk center); and 5 (contrast media leakage into the outer space). Diskography was performed via a pressure-controlled manometric technique using an injection rate of .05 mL/s and a restricted total volume of 3.5 mL. Pain was rated on a 0 to 10 numeric rating scale (NRS). Criteria for symptomatic disks included provocation of patient concordant pain (NRS score, > or =6/10) at 50psi or less above opening pressure, with 3.5 mL or less of total volume. Symptomatic disks were classified as "low pressure sensitive" or "high pressure sensitive" based on the pressure level that evoked pain. Disks classified as low pressure sensitive required an NRS score of 6 out of 10 or higher at 15 psi or less above opening pressure. Disks classified as high pressure sensitive required an NRS score of 6 out of 10 or higher at pressures within a range of 15 to 50 psi.
The numbers of disks at each annular disruption grade were 19 (6.8%) at grade 0, 29 (10.4%) at grade 1, 35 (12.5%) at grade 2, 42 (15.1%) at grade 3, 69 (24.7%) at grade 4, and 85 (30.5%) at grade 5. A total of 93 disks met the criteria for a symptomatic disk. The extent of annular disruption and the rate of symptomatic disks correlated significantly (P<.001). The highest symptomatic disk rate was observed in grade 4 disks. Of 93 symptomatic disks, 88 (94.6%) showed annular disruption of grade 3 or greater. Disks with grades 0 to 2 and grades 3 to 5 annular disruption differed significantly when the mean NRS relative to intradiskal pressure was compared (P<.001). Comparing the disk type of symptomatic disks at each annular disruption grade, there was a decreasing trend of low pressure sensitive disks relative to the extent of annular disruption (62.5% at grade 3, 39.4% at grade 4, 34.2% at grade 5).
Annular disruption reaching the outer annulus fibrosus is a key factor in pain generation. Disk morphology, including annular disruptions extending beyond the outer annulus, may permit increased diskography specificity.
使用压力控制测压椎间盘造影术分析计算机断层扫描（CT）扫描确定的纤维环破裂与椎间盘造影结果之间的关系。
利用前瞻性收集的数据进行横断面研究。
门诊脊柱介入科。
86例患者（55例男性，31例女性）的279个椎间盘，这些患者因疑似慢性盘源性下腰痛接受椎间盘造影。
不适用。
使用CT椎间盘造影和透视成像对纤维环破裂程度进行分级如下：0级（无破裂）；1级（延伸至纤维环内三分之一）；2级（延伸至纤维环中三分之一）；3级（延伸至纤维环外三分之一）；4级（在椎间盘中心处有>30度弧的周向延伸）；5级（造影剂漏入外部间隙）。采用压力控制测压技术进行椎间盘造影，注射速率为0.05 mL/s，总容量限制为3.5 mL。疼痛采用0至10数字评分量表（NRS）进行评分。有症状椎间盘的标准包括在高于开放压力50 psi或更低时诱发患者一致性疼痛（NRS评分，≥6/10），总容量为3.5 mL或更少。根据诱发疼痛的压力水平，有症状的椎间盘分为“低压敏感型”或“高压敏感型”。分类为低压敏感型的椎间盘在高于开放压力15 psi或更低时需要NRS评分为6/10或更高。分类为高压敏感型的椎间盘在15至50 psi范围内的压力下需要NRS评分为6/10或更高。
各纤维环破裂分级的椎间盘数量分别为：0级19个（6.8%），1级29个（10.4%），2级35个（12.5%），3级42个（15.1%），4级69个（24.7%），5级85个（30.5%）。共有93个椎间盘符合有症状椎间盘的标准。纤维环破裂程度与有症状椎间盘的发生率显著相关（P<0.001）。在4级椎间盘中观察到最高的有症状椎间盘发生率。在93个有症状的椎间盘中，88个（94.6%）显示纤维环破裂为3级或更高。当比较相对于椎间盘内压力的平均NRS时，0至2级和3至5级纤维环破裂的椎间盘有显著差异（P<0.001）。比较各纤维环破裂分级中有症状椎间盘的类型，低压敏感型椎间盘相对于纤维环破裂程度呈下降趋势（3级为62.5%，4级为39.4%，5级为34.2%）。
纤维环破裂累及外层纤维环是疼痛产生的关键因素。椎间盘形态，包括延伸至外层纤维环之外的纤维环破裂，可能会提高椎间盘造影的特异性。
