Antti-Poika I, Soini J, Tallroth K, Yrjönen T, Konttinen Y T
Orthopaedic Hospital of the Invalid Foundation, Helsinki, Finland.
J Bone Joint Surg Br. 1990 May;72(3):480-5. doi: 10.1302/0301-620X.72B3.2140365.
Two different classifications of discograms have been used in a prospective study of 279 injected discs in 100 patients. The five-stage classification of Adams, Dolan and Hutton (1986) showed increased degeneration in the lower lumbar discs and more degenerative changes in men than in women. Exact reproduction of the patient's pain on injection was more common in fissured or ruptured discs than in less degenerate discs, with 81% sensitivity and 64% specificity of the discogram for pain. The additional information obtained by comparing computerised tomography (CT) with discograms was minimal. Discography was found to be useful in the evaluation of chronic low back pain in patients whose ordinary CT scans, myelograms and flexion-extension radiographs were normal. In spondylolysis and spondylolisthesis, discography can disclose whether fusion needs to be extended above the lytic level, and it may show if the pain in patients who have had posterolateral fusion is discogenic. Thus, discography gives information which is useful in deciding whether to operate on patients with chronic low back pain.
在一项针对100例患者的279个注射椎间盘的前瞻性研究中，采用了两种不同的椎间盘造影分类方法。亚当斯、多兰和赫顿（1986年）的五阶段分类法显示，下腰椎椎间盘退变增加，男性的退变变化比女性更多。注射时准确再现患者疼痛在有裂隙或破裂的椎间盘中比在退变较轻的椎间盘中更常见，椎间盘造影对疼痛的敏感性为81%，特异性为64%。将计算机断层扫描（CT）与椎间盘造影相比较所获得的额外信息极少。研究发现，椎间盘造影对于普通CT扫描、脊髓造影和屈伸位X线片均正常的慢性下腰痛患者的评估很有用。在椎弓根峡部裂和腰椎滑脱中，椎间盘造影可以揭示融合是否需要延伸至峡部裂水平以上，并且可以显示接受后外侧融合术的患者的疼痛是否由椎间盘源性引起。因此，椎间盘造影提供的信息有助于决定是否对慢性下腰痛患者进行手术。
