Weill Cornell Medical College, USA.
J Orthop Surg Res. 2008 Oct 2;3:46. doi: 10.1186/1749-799X-3-46.
MRI has proven to be an extremely valuable tool in the assessment of normal and pathological spinal anatomy. Accordingly, it is commonly used to assess containment of discal material by the outer fibers of the anulus fibrosus and posterior longitudinal ligaments. Determination of such containment is important to determine candidacy for intradiscal techniques and has prognostic significance. The accuracy of MRI in detecting containment has been insufficiently documented.
The MRI's of fifty consecutive patients undergoing open lumbar microdiscectomy were prospectively evaluated for disc containment by a neuroradiologist and senior spinal surgeon using criteria available in the literature and the classification of Macnab/McCulloch. An independent surgeon then performed the surgery and documented the actual containment status using the same methods. Statistical evaluation of accuracy was undertaken.
MRI was found to be 72% sensitive, 68% specific, and 70% accurate in detecting containment status of lumbar herniated discs.
MRI may be inaccurate in assessing containment status of lumbar disc herniations in 30% of cases. Given the importance of containment for patient selection for indirect discectomy techniques and intradiscal therapies, coupled with prognostic significance; other methods to assess containment should be employed to assess containment when such alternative interventions are being considered.
MRI 已被证明是评估正常和病理脊柱解剖结构的极其有价值的工具。因此，它通常用于评估纤维环的外纤维和后纵韧带对椎间盘物质的容纳情况。确定这种容纳情况对于确定椎间盘内技术的适应证具有重要意义，并且具有预后意义。MRI 在检测容纳情况方面的准确性尚未得到充分记录。
对五十例连续行开放性腰椎微切除术的患者的 MRI 进行前瞻性评估，由神经放射科医师和资深脊柱外科医师使用文献中提供的标准和 Macnab/McCulloch 分类来评估椎间盘的容纳情况。然后，由一位独立的外科医生使用相同的方法进行手术，并记录实际的容纳情况。对准确性进行了统计评估。
MRI 在检测腰椎间盘突出症的椎间盘容纳状态时，敏感性为 72%，特异性为 68%，准确性为 70%。
在 30%的情况下，MRI 可能无法准确评估腰椎间盘突出症的椎间盘容纳状态。鉴于椎间盘内技术和椎间盘内治疗的患者选择对容纳状态的重要性，以及其预后意义；在考虑这种替代干预措施时，应采用其他方法来评估容纳情况。
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