Morgalla Matthias, Frantz Sandra, Dezena Roberto Alexandre, Pereira Carlos Umberto, Tatagiba Marcos
Department of Neurosurgery, University Clinic of Tübingen, Eberhard Karls University, Tübingen, Baden-Würtemberg, Germany.
Department of Orthopedics, University of Tuebingen, Tuebingen, Germany.
J Neurol Surg A Cent Eur Neurosurg. 2018 Jul;79(4):316-322. doi: 10.1055/s-0037-1618563. Epub 2018 Jan 18.
The diagnosis of a lumbar spinal stenosis demands advanced diagnostic radiologic techniques. In recent decades magnetic resonance imaging (MRI) has replaced myelography, now considered an old-fashioned technique. It was our hypothesis that functional myelography still plays an important role in selected cases. We investigated how our surgical strategy was influenced by the results of MRI, functional myelography, and postmyelography computed tomography (CT) in patients with a lumbar spinal stenosis.
The sagittal diameters of the lumbar spinal canal were measured from L1 to S1 on patients with lumbar spinal stenosis. MRI, functional myelography, and postmyelography CT were compared in each of the patients. Sensitivity and specificity were calculated in each method. We examined how the surgical strategy was influenced by the results of these different methods.
Fifty consecutive patients (21 women and 29 men; mean age: 70 years, [range: 49-86 years]) fulfilled the inclusion criteria. Functional myelography revealed a sensitivity of 0.99, a specificity of 0.79, and a positive predictive value of 0.45. The MRI exhibited a sensitivity of 0.93, a specificity of 0.74, and a positive predictive value of 0.39. Postmyelography CT showed a sensitivity of 0.96, a specificity of 0.75, and a positive predictive value of 0.41. A functional myelography revealed more information than the MRI and resulted in a change in the surgical strategy in 11 of 50 patients (22%) in comparison with the sole results of MRI or a postmyelography CT.
In selected cases with multilevel lumbar spinal stenosis, functional myelography revealed the highest precision in reaching a correct diagnosis. It resulted in a change in the surgical approach in every fifth patient in comparison with the MRI and proved most helpful, especially in elderly patients.
腰椎管狭窄症的诊断需要先进的放射诊断技术。近几十年来，磁共振成像（MRI）已取代脊髓造影，脊髓造影现在被认为是一种过时的技术。我们的假设是，功能脊髓造影在某些特定病例中仍发挥着重要作用。我们研究了腰椎管狭窄症患者的手术策略如何受到MRI、功能脊髓造影和脊髓造影后计算机断层扫描（CT）结果的影响。
对腰椎管狭窄症患者从L1至S1测量腰椎管矢状径。对每位患者的MRI、功能脊髓造影和脊髓造影后CT进行比较。计算每种方法的敏感性和特异性。我们研究了这些不同方法的结果如何影响手术策略。
连续50例患者（21名女性和29名男性；平均年龄：70岁，[范围：49 - 86岁]）符合纳入标准。功能脊髓造影显示敏感性为0.99，特异性为0.79，阳性预测值为0.45。MRI显示敏感性为0.93，特异性为0.74，阳性预测值为0.39。脊髓造影后CT显示敏感性为0.96，特异性为0.75，阳性预测值为0.41。功能脊髓造影比MRI显示出更多信息，与仅依据MRI或脊髓造影后CT的结果相比，50例患者中有11例（22%）的手术策略发生了改变。
在多节段腰椎管狭窄的特定病例中，功能脊髓造影在做出正确诊断方面显示出最高的准确性。与MRI相比，每五分之一的患者手术方式发生了改变，并且证明功能脊髓造影最有帮助，尤其是在老年患者中。
