传统脊髓造影在低收入社区退行性脊柱疾病诊断与治疗中的作用：前瞻性研究

Role of Conventional Myelography in Diagnosis and Treatment of Degenerative Spine Disease in Low-Income Communities: Prospective Study.

作者信息

Kitya David, Punchak Maria, Bajunirwe Francis

机构信息

Division of Neurosurgery, Department of Surgery, Mbarara Regional Referral Hospital, Mbarara, Uganda; Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.

Division of Neurosurgery, Department of Surgery, Mbarara Regional Referral Hospital, Mbarara, Uganda; David Geffen School of Medicine at University of California, Los Angeles, California, USA.

出版信息

World Neurosurg. 2017 Aug;104:161-166. doi: 10.1016/j.wneu.2017.04.121. Epub 2017 Apr 27.

DOI:10.1016/j.wneu.2017.04.121

PMID:28457932

Abstract

INTRODUCTION

Chronic back pain is a common problem, and imaging is crucial for effective diagnosis and treatment. In low-resource settings conventional myelography is a cheap alternative to magnetic resonance imaging and computed tomography. This study was conducted to reexamine the diagnostic reliability, effectiveness for surgical decision making, and safety of conventional myelography.

METHODS

The study was conducted at Tenwek Mission Hospital during June 2009 and March 2010. New patients who presented with features of radiculopathy and/or myelopathy were eligible. Standard anteroposterior views were taken; oblique views were obtained from patients with radiculopathy. Cervical and lumbosacral myelography was performed using iohexol contrast. Patients were observed for complications. Those with surgically remediable lesions underwent operation. Patients were monitored for symptom improvement and complication postoperatively.

RESULTS

Fifty-one patients underwent diagnostic myelography and 39 of them (77.8%) were positive. Lesions at levels L4/5 were the most common, occurring in 23 patients (59%). Of those with cervical lesions, 11 of them (73.3%) had a positive myelography compared with 28 patients (77.8%) with lumbosacral lesions. Patients presenting with claudication were more likely to have a positive myelography, compared with those with other symptoms. There were 16 patients (41%) with partial spinal canal block, 6 patients (15.4%) with total block, and 17 patients (43.6%) with recess compression. Thirty-eight (38) patients had surgery, and recess decompression was the most common procedure (n = 24, 63.2%). Following surgery, symptoms due to degenerative spine disease improved in the majority of patients.

CONCLUSIONS

Conventional myelography is a reliable and safe diagnostic test. Appropriate and sound surgical decisions can be made following conventional myelography tests.

摘要

引言

慢性背痛是一个常见问题，影像学检查对于有效诊断和治疗至关重要。在资源匮乏地区，传统脊髓造影是磁共振成像和计算机断层扫描的廉价替代方法。本研究旨在重新审视传统脊髓造影的诊断可靠性、对手术决策的有效性及安全性。

方法

本研究于2009年6月至2010年3月在滕韦克教会医院进行。出现神经根病和/或脊髓病特征的新患者符合条件。拍摄标准前后位片；对患有神经根病的患者拍摄斜位片。使用碘海醇造影剂进行颈椎和腰骶部脊髓造影。观察患者有无并发症。对有手术可治性病变的患者进行手术。术后监测患者症状改善情况及并发症。

结果

51例患者接受了诊断性脊髓造影，其中39例（77.8%）结果为阳性。L4/5节段病变最为常见，有23例患者（59%）。在颈椎病变患者中，11例（73.3%）脊髓造影结果为阳性，而腰骶部病变患者中有28例（77.8%）为阳性。与有其他症状的患者相比，出现间歇性跛行的患者脊髓造影阳性的可能性更大。有16例患者（41%）存在部分椎管梗阻，6例患者（15.4%）为完全梗阻，17例患者（43.6%）存在侧隐窝受压。38例患者接受了手术，其中侧隐窝减压是最常见的手术方式（n = 24，63.2%）。术后，大多数因退行性脊柱疾病引起的症状得到改善。