Yrjämä M, Tervonen O, Kurunlahti M, Vanharanta H
Department of Physical Medicine, Oulu University Central Hospital, Finland.
Spine (Phila Pa 1976). 1997 Apr 1;22(7):808-13. doi: 10.1097/00007632-199704010-00020.
The results of two noninvasive methods, magnetic resonance imaging and a bony vibration test, were compared with discographic pain provocation findings.
To evaluate whether the combination of magnetic resonance imaging and vibration pain provocation tests could be used to replace discography in low back pain diagnostics.
Magnetic resonance imaging gives a wealth of visual information on anatomic changes of the spine with often unknown clinical significance. Discographic examination of the spine is still the only widely accepted diagnostic method that can relate the pathoanatomic changes to the patient's clinical pain. Internal anular rupture has been shown to be one of the sources of back pain. The bony vibration test of the spinal processes has been shown correlate well with discographic pain provocation tests in cases of internal anular rupture.
The three lowest lumbar discs of 33 patients with back pain were examined by means of magnetic resonance imaging and a bony vibration stimulation test, and the results were compared with those from computed tomography-discography.
In cases of intradiscal magnetic resonance imaging findings, the vibration provocation test showed a sensitivity of 0.88 and a specificity of 0.50 compared with the discographic pain provocation test. If the patients with previous back surgery were excluded, the specificity was 0.75. In the cases of total anular rupture, the sensitivity was 0.50, and the specificity was 0.33.
The combination of the two noninvasive methods, vibration stimulation and magnetic resonance imaging, gives more information on the origin of the back pain than magnetic resonance imaging alone. The pathoanatomic changes seen in magnetic resonance imaging can be correlated with the patient's disorder more reliably using the vibration provocation test in the cases of partial anular ruptures. The use of discography can be limited mostly to cases with total anular ruptures detected by magnetic resonance imaging.
将两种非侵入性方法（磁共振成像和骨振动试验）的结果与椎间盘造影疼痛激发试验结果进行比较。
评估磁共振成像和振动疼痛激发试验相结合是否可用于替代腰椎间盘造影术进行腰痛诊断。
磁共振成像可提供大量关于脊柱解剖结构变化的视觉信息，但其临床意义往往未知。脊柱椎间盘造影检查仍是唯一被广泛接受的诊断方法，可将病理解剖变化与患者的临床疼痛联系起来。已证明内部纤维环破裂是背痛的来源之一。在内部纤维环破裂的情况下，脊柱棘突的骨振动试验已被证明与椎间盘造影疼痛激发试验相关性良好。
对33例背痛患者的三个最低腰椎间盘进行磁共振成像和骨振动刺激试验检查，并将结果与计算机断层扫描 - 椎间盘造影结果进行比较。
与椎间盘造影疼痛激发试验相比，在椎间盘内磁共振成像结果的病例中，振动激发试验的灵敏度为0.88，特异性为0.50。如果排除既往有背部手术史的患者，特异性为0.75。在完全纤维环破裂的病例中，灵敏度为0.50，特异性为0.33。
振动刺激和磁共振成像这两种非侵入性方法相结合，比单独使用磁共振成像能提供更多关于背痛起源的信息。在部分纤维环破裂的情况下，通过振动激发试验，磁共振成像中看到的病理解剖变化可以更可靠地与患者的病症相关联。椎间盘造影术的使用大多可限于磁共振成像检测到完全纤维环破裂的病例。
