Dutta Shumayou, Bhave Arvind, Patil Sanjay
Department of Orthopaedics, Bharati Vidyapeeth Deemed Hospital and Medical College, Pune, India.
Asian Spine J. 2016 Dec;10(6):1115-1121. doi: 10.4184/asj.2016.10.6.1115. Epub 2016 Dec 8.
A single-center prospective study.
A magnetic resonance imaging (MRI) scan is undeniably the gold standard for the diagnosis of a lumbar disc prolapse. Unfortunately it shares a strong association with incidental findings. In this study, we aimed to determine the extent to which a 1.5 Tesla MRI correlates with the clinical features and intraoperative findings in cases of lumbar disc prolapse.
Few studies have correlated MRI with clinical findings, and none have extended this correlation to intraoperative findings.
Over a 2-year period, 50 consecutive patients with lumbar disc herniation requiring discectomy were studied. The MRI findings we observed consisted of the prolapse level, type, position, migration, high-intensity zones (HIZ), lateral recess, and foraminal stenosis. A logistic regression analysis was performed to determine the significance for the various MRI findings. Finally, the MRI observations were confirmed with intraoperative findings and inferences were drawn.
MRI scan sensitivity and specificity for determining surgically significant levels was 100% and 94.94%, respectively. Straight leg raising test was positive in 74% of patients, with 85%, 43%, and 75% for paracentral, central, and foraminal levels, respectively. A foraminal compromise was the only MRI parameter to share a significant association with neurological deficits. Patients with a HIZ on the MRI had a significant increase in back pain and 63% exhibited identifiable annular tears intraoperatively. The intraoperative anatomical findings correlated extensively with the MRI findings.
MRI findings strongly correlate with intraoperative features and can serve as a useful tool when planning surgery due to the accurate depiction of the morphometric features. However, the decision for surgery should be made only when detailed clinical findings in conjunction with MRI findings allow for an accurate identification of the culprit fragment and pain generators.
单中心前瞻性研究。
磁共振成像（MRI）扫描无疑是诊断腰椎间盘突出症的金标准。不幸的是，它与偶然发现密切相关。在本研究中，我们旨在确定1.5特斯拉MRI与腰椎间盘突出症病例的临床特征和术中发现的相关程度。
很少有研究将MRI与临床发现相关联，且没有一项研究将这种关联扩展到术中发现。
在两年期间，对50例连续需要进行椎间盘切除术的腰椎间盘突出症患者进行了研究。我们观察到的MRI结果包括突出水平、类型、位置、移位、高强度区（HIZ）、侧隐窝和椎间孔狭窄。进行逻辑回归分析以确定各种MRI结果的意义。最后，将MRI观察结果与术中发现进行对照并得出推论。
MRI扫描确定具有手术意义水平的敏感性和特异性分别为100%和94.94%。直腿抬高试验在74%的患者中呈阳性，其中旁中央型、中央型和椎间孔型水平分别为85%、43%和75%。椎间孔受压是唯一与神经功能缺损有显著关联的MRI参数。MRI上有HIZ的患者背痛明显增加，63%的患者术中可见明确的纤维环撕裂。术中解剖发现与MRI结果广泛相关。
MRI结果与术中特征密切相关，由于其能准确描绘形态学特征，在手术规划时可作为有用工具。然而，只有当详细的临床发现与MRI结果相结合能够准确识别罪魁祸首碎片和疼痛产生源时，才应做出手术决定。
