Janardhana Aithala P, Rao Sharath, Kamath Asha
Department of Orthopaedics, Kasturba Medical College, Manipal University, Manipal, India.
Indian J Orthop. 2010 Jul;44(3):263-9. doi: 10.4103/0019-5413.65148.
Lumbar disc prolapse is one of the common causes of low back pain seen in the working population. There are contradictorty reports regarding the clinical significance of various magnetic resonance imaging (MRI) findings observed in these patients. The study was conducted to correlate the abnormalities observed on MRI and clinical features of lumbar disc prolapse.
119 clinically diagnosed patients with lumbar disc prolapse were included in the study. Clinical evaluation included pain distribution, neurological symptoms and signs. MR evaluation included grades of disc degeneration, type of herniation, neural foramen compromise, nerve root compression, and miscellaneous findings. These MRI findings were tested for inter- and intraobserver variability. The MRI findings were then correlated with clinical symptoms and the level of disc prolapse as well as neurological signs and symptoms. Statistical analysis included the Kappa coefficient, Odd's ratio, and logistic regression analysis.
There were no significant inter- or intraobserver variations for most of MRI findings (Kappa value more than 0.5) except for type of disc herniation which showed a interobserver variation of 0.46 (Kappa value). The clinical level of pain distribution correlated well with the MRI level (Kappa 0.8), but not all disc bulges produced symptoms. Central bulges and disc protrusions with thecal sac compression were mostly asymptomatic, while centrolateral protrusions and extrusions with neural foramen compromise correlated well with the dermatomal distribution of pain. Root compression observed in MRI did not produce neurological symptoms or deficits in all patients but when deficits were present, they correlated well with the presence of root compression in MRI. Multiple level disc herniations with foramen compromise were strongly associated with the presence of neurological signs.
The presence of centrolateral protrusion or extrusion with gross foramen compromise correlates with clinical signs and symptoms very well, while central bulges and disc protrusions correlate poorly with clinical signs and symptoms. The presence of neural foramen compromise is more important in determining the clinical signs and symptoms while type of disc herniation (bulge, protrusion, or extrusion) correlates poorly with clinical signs and symptoms.
腰椎间盘突出症是劳动人群中腰痛的常见病因之一。关于这些患者各种磁共振成像（MRI）表现的临床意义，存在相互矛盾的报道。本研究旨在关联MRI观察到的异常与腰椎间盘突出症的临床特征。
119例临床诊断为腰椎间盘突出症的患者纳入本研究。临床评估包括疼痛分布、神经症状和体征。MRI评估包括椎间盘退变程度、突出类型、神经孔受累情况、神经根受压情况及其他表现。对这些MRI表现进行观察者间和观察者内变异性测试。然后将MRI表现与临床症状、椎间盘突出水平以及神经体征和症状进行关联。统计分析包括Kappa系数、优势比和逻辑回归分析。
除椎间盘突出类型观察者间变异系数为0.46（Kappa值）外，大多数MRI表现的观察者间和观察者内变异均无显著性差异（Kappa值大于0.5）。疼痛分布的临床水平与MRI水平相关性良好（Kappa值为0.8），但并非所有椎间盘膨出都会产生症状。中央型膨出和压迫硬脊膜囊的椎间盘突出大多无症状，而中央旁型突出和累及神经孔的脱出与疼痛的皮节分布相关性良好。MRI观察到的神经根受压并非在所有患者中都产生神经症状或功能障碍，但当出现功能障碍时，与MRI中神经根受压情况相关性良好。多个节段伴有神经孔受累的椎间盘突出与神经体征的存在密切相关。
伴有明显神经孔受累的中央旁型突出或脱出与临床体征和症状相关性非常好，而中央型膨出和椎间盘突出与临床体征和症状相关性较差。神经孔受累情况在确定临床体征和症状方面更为重要，而椎间盘突出类型（膨出、突出或脱出）与临床体征和症状相关性较差。
