Lee Sung Ho, Lee Sang-Ho, Kim Soo-Beom, Park Eun Soo, Kim Soo-Nyung, Moon Ki-Hyoung
Department of Neurosurgery, Seoul Gimpo Airport Spine Health Wooridul Hospital.
Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea.
Clin Spine Surg. 2018 Feb;31(1):E13-E18. doi: 10.1097/BSD.0000000000000471.
This is a retrospective analysis.
To investigate and compare the sensitivities of computed tomography (CT) and magnetic resonance myelography (MRM) in the presurgical diagnosis of foraminal or extraforaminal entrapment of the L5 nerve.
CT is more clinically available than MRM. Foraminal or extraforaminal entrapment at the lumbosacral junction may cause L5 radiculopathy but is difficult to diagnose. Asymmetric enlargement of the anterior primary division (APD) of the L5 nerve on preoperative CT and dorsal root ganglion (DRG) swelling and abnormal L5 nerve course on MRM coronal images have been examined in cases of foraminal or extraforaminal L5 nerve entrapment, but have not been compared directly.
Ninety-five patients (mean age 63 y; 28-85 y) with L5 nerve entrapment at the lumbosacral junction who underwent preoperative CT and MRM, and microsurgical decompression by a single surgeon (K.-H.M.) from January 2010 to June 2014 were included. Symptomatic sites were diagnosed by confirming L5 nerve entrapment intraoperatively. Two spinal surgeons independently compared the bilateral APD diameters of the L5 nerve on CT and the L5 nerve courses and DRG swelling on MRM coronal images.
The interobserver agreement of asymmetric APD swelling on CT and abnormal nerve course and DRG swelling on MRM were excellent (κ=0.808, 0.811, and 0.849, respectively), and the sensitivities were 81%, 84%, and 82% on the right, and 86%, 92%, and 90% on the left sides, respectively. There was no statistically significant difference in the sensitivity between APD swelling on CT and an abnormal nerve course or DRG swelling on MRM on the right (P=1.000 and 0.789) and left (P=0.727 and 1.000) sides, respectively.
CT has comparable sensitivity to MRM for the presurgical diagnosis of L5 nerve entrapment at the lumbosacral junction.
Level II.
这是一项回顾性分析。
研究并比较计算机断层扫描（CT）和磁共振脊髓造影（MRM）在术前诊断L5神经椎间孔或孔外卡压方面的敏感性。
CT在临床上比MRM更易获得。腰骶部的椎间孔或孔外卡压可能导致L5神经根病，但难以诊断。在L5神经椎间孔或孔外卡压的病例中，已对术前CT上L5神经前初级分支（APD）的不对称增粗以及MRM冠状位图像上的背根神经节（DRG）肿胀和L5神经走行异常进行了检查，但尚未进行直接比较。
纳入2010年1月至2014年6月期间接受术前CT和MRM检查，并由同一外科医生（K.-H.M.）进行显微减压手术的95例腰骶部L5神经卡压患者（平均年龄63岁；28 - 85岁）。通过术中确认L5神经卡压来诊断症状部位。两位脊柱外科医生独立比较CT上L5神经的双侧APD直径以及MRM冠状位图像上的L5神经走行和DRG肿胀情况。
CT上APD不对称增粗、MRM上神经走行异常和DRG肿胀的观察者间一致性良好（κ分别为0.808、0.811和0.849），右侧敏感性分别为81%、84%和82%，左侧分别为86%、92%和90%。CT上APD肿胀与MRM上右侧（P = 1.000和0.789）及左侧（P = 0.727和1.000）神经走行异常或DRG肿胀之间的敏感性无统计学显著差异。
在术前诊断腰骶部L5神经卡压方面，CT与MRM具有相当的敏感性。
二级。
