Akbari Keyur Kantilal, Badikillaya Vigneshwara, Venkatesan Muralidharan, Ramanan Rochita V, Hegde Sajan K
Apollo Hospital, Chennai, India.
Int J Spine Surg. 2021 Aug;15(4):788-794. doi: 10.14444/8101. Epub 2021 Jul 21.
Since the introduction of magnetic resonance imaging (MRI) into clinical practice in the mid-1980s, the role of computed tomography myelography (CTM) has become less important in spinal diagnostics but remains a method that is probably even superior to MRI for special clinical issues. The study aims to report the diagnostic utility of CTM as an adjunct to MRI in lumbar degenerative disc disorder (DDD).
Included were 20 patients who presented with symptomatic DDD but with MRI findings that did not correlate with the clinical features. These patients underwent CTM as an additional imaging technique to aid preoperative surgical decision-making. Both imaging modalities were compared for the identification of the impinging pathology as well as the number of levels of compression.
MRI revealed compression and/or impingement at 38 levels, whereas CTM revealed these at 29 levels. Of 20 patients, 18 underwent surgery, and a total of 29 levels were decompressed as localized in the CTM. The visual analog scale (VAS) score for back pain and leg pain at baseline were 6 ± 0.7 and 7 ± 0.4, respectively, and at 6 months postintervention (surgical/conservative) were 2 ± 0.8 and 0.3 ± 0.1, respectively. The Oswestry Disability Index scores at baseline and 6 months postintervention were 56 ± 6.9 and 18 ± 4.2, respectively ( < .0001). There was agreement on the number of levels between MRI and CTM in 10 patients (50%). MRI overestimated the number of involved levels in 9 patients (45%), whereas in the remaining 1 patient (5%), MRI underestimated the number of involved levels. The weighted κ value for agreement between MRI and CTM on the number of levels involved necessitating decompression was 0.4 (95% CI, 0.18-0.77; = .0009).
CTM has a role as an adjunct imaging modality to formulate an effective management plan in patients presenting with symptomatic lumbar DDD in cases where MRI findings are inconclusive and ambiguous.
自20世纪80年代中期磁共振成像（MRI）引入临床实践以来，计算机断层扫描脊髓造影（CTM）在脊柱诊断中的作用已变得不那么重要，但对于某些特殊临床问题，它可能仍是一种甚至优于MRI的方法。本研究旨在报告CTM作为MRI辅助手段在腰椎退变性椎间盘疾病（DDD）中的诊断效用。
纳入20例有症状的DDD患者，但其MRI表现与临床特征不相关。这些患者接受CTM作为额外的成像技术，以辅助术前手术决策。比较两种成像方式对压迫性病变的识别以及压迫节段数量。
MRI显示38个节段存在压迫和/或撞击，而CTM显示29个节段存在这些情况。20例患者中有18例接受了手术，共29个节段按CTM所示部位进行了减压。基线时背痛和腿痛的视觉模拟量表（VAS）评分分别为6±0.7和7±0.4，干预后6个月（手术/保守治疗）分别为2±0.8和0.3±0.1。Oswestry功能障碍指数评分在基线时和干预后6个月分别为56±6.9和18±4.2（P<0.0001）。MRI和CTM在10例患者（50%）中对节段数量的判断一致。MRI高估受累节段数量的有9例患者（45%），而在其余1例患者（5%）中，MRI低估了受累节段数量。MRI和CTM在需要减压的受累节段数量一致性方面的加权κ值为0.4（95%CI，0.18 - 0.77；P = 0.0009）。
在MRI结果不确定且不明确的有症状腰椎DDD患者中，CTM作为辅助成像方式在制定有效治疗方案中具有作用。
4级。
