Brayda-Bruno Marco, Tibiletti Marta, Ito Keita, Fairbank Jeremy, Galbusera Fabio, Zerbi Alberto, Roberts Sally, Wachtel Ellen, Merkher Yulia, Sivan Sarit Sara
IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
Eur Spine J. 2014 Jun;23 Suppl 3:S315-23. doi: 10.1007/s00586-013-2960-9. Epub 2013 Aug 27.
One possible source of chronic low back pain is a degenerated intervertebral disc. In this review, various diagnostic methods for the assessment of the presence of degenerative changes are described. These include clinical MRI, a number of novel MRI techniques and nuclear magnetic resonance spectroscopy.
Non-systematic literature review.
Clinical MRI is the most commonly employed technique to determine the general "health status" of the intervertebral disc. Novel MRI techniques, such as quantitative MRI, T1ρ MRI, sodium MRI and nuclear magnetic resonance spectroscopy, are more sensitive in quantifying the biochemical changes of disc degeneration, as measured by alteration in collagen structure, as well as water and proteoglycan loss. As potential future diagnostic alternatives, miniature sensors are currently being developed to measure parameters associated with the disc degeneration cascade, such as intradiscal pressure and PG concentration. However, none of the methods listed above show sufficient specificity to identify a degenerated disc as the actual source of the pain. Provocative discography is the only test aimed at a direct diagnosis of discogenic pain, but it has a high false positive rate and there is some evidence of long-term adverse effects. Imaging techniques have also been tested for this purpose, but their validity has not been confirmed and they do appear to be problematic.
A reliable diagnostic tool that could help a clinician to determine if a disc is the source of the pain in patients with chronic LBP is still not available. New MRI techniques are under investigation that could result in a significant improvement over current methods, particularly as they can allow monitoring, not only of morphological but also of biochemical changes.
慢性下腰痛的一个可能来源是退变的椎间盘。在本综述中，描述了用于评估退变改变存在的各种诊断方法。这些方法包括临床磁共振成像（MRI）、一些新型MRI技术和核磁共振波谱法。
非系统性文献综述。
临床MRI是用于确定椎间盘总体“健康状况”最常用的技术。新型MRI技术，如定量MRI、T1ρ MRI、钠MRI和核磁共振波谱法，在量化椎间盘退变的生化改变方面更敏感，这些改变通过胶原蛋白结构的改变以及水分和蛋白聚糖的丢失来衡量。作为未来潜在的诊断替代方法，目前正在开发微型传感器来测量与椎间盘退变级联相关的参数，如椎间盘内压力和蛋白聚糖浓度。然而，上述任何一种方法都没有显示出足够的特异性来确定退变的椎间盘就是疼痛的实际来源。激发性椎间盘造影是唯一旨在直接诊断椎间盘源性疼痛的检查，但它有很高的假阳性率，并且有一些长期不良影响的证据。为此也对成像技术进行了测试，但其有效性尚未得到证实，而且它们似乎确实存在问题。
目前仍没有一种可靠的诊断工具能帮助临床医生确定在慢性下腰痛患者中椎间盘是否是疼痛的来源。正在研究的新MRI技术可能会比现有方法有显著改进，特别是因为它们不仅可以监测形态学变化，还可以监测生化变化。
