From the Department of Radiology (T.S.C., S.J.A.) and Department of Rehabilitation Medicine, Rehabilitation Institute of Neuromuscular Disease (J.H.P.), Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul 135-720, Korea; and Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea (H.E.Y.).
Radiology. 2015 Jun;275(3):755-62. doi: 10.1148/radiol.14141400. Epub 2015 Jan 22.
To assess the morphologic changes in herniated lumbar intervertebral disks and surrounding structures during lumbar traction by using real-time magnetic resonance (MR) imaging.
This prospective study was approved by the institutional review board, and written informed consent was obtained from all participants. Forty-eight consecutive patients with lumbar disk herniation (13 men and 35 women) were treated with continuous lumbar traction by using a nonmagnetic traction device. Real-time MR imaging of the lumbar spine was performed before the initiation of traction and at 10-minute intervals during 30 minutes of 30 kg of continuous traction. Sagittal and axial MR images were analyzed to determine qualitative changes during lumbar traction. Quantitative changes caused by traction on the lumbar spine were determined by measurement of lumbar vertebral column elongation and the disk reduction ratio.
Continuous traction on herniated lumbar disks and surrounding structures resulted in change in disk shape, disk reduction with opening in the intervertebral disk, reduction of herniated disk volume, separation of the disk and adjoining nerve root, and widening of the facet joint. Both the mean lumbar vertebral column length (elongation of 1.45% after 30 minutes, P < .001) and the mean disk reduction ratio (8.57%, 15.24%, and 17.94% after 10, 20, and 30 minutes of traction, respectively) increased with time of traction.
The results of this study demonstrated that the real-time effects of continuous traction on herniated lumbar intervertebral disks and their surrounding structures can be visualized by using MR imaging.
通过实时磁共振成像（MR）评估腰椎牵引过程中椎间盘突出症和周围结构的形态变化。
本前瞻性研究获得了机构审查委员会的批准，并获得了所有参与者的书面知情同意。对 48 例连续腰椎间盘突出症患者（13 名男性和 35 名女性）进行连续腰椎牵引治疗，使用非磁性牵引装置。在开始牵引前和 30 分钟 30 公斤持续牵引期间每 10 分钟进行一次实时腰椎脊柱 MR 成像。分析矢状面和轴位 MR 图像以确定牵引过程中定性变化。通过测量腰椎柱伸长和椎间盘缩小率来确定牵引对腰椎引起的定量变化。
对椎间盘突出症和周围结构的连续牵引导致椎间盘形状改变，椎间盘开放，椎间盘缩小，椎间盘与神经根分离，关节突关节增宽。腰椎柱的平均长度（30 分钟后伸长 1.45%，P<.001）和椎间盘平均缩小率（10、20 和 30 分钟分别为 8.57%、15.24%和 17.94%）随牵引时间增加而增加。
本研究结果表明，MR 成像可直观显示连续牵引对腰椎间盘突出症及其周围结构的实时影响。
