腰椎间盘磁共振正常的椎间盘源性腰痛

目的 研究MRI显示椎间盘正常信号强度但椎间盘造影显示纤维环破裂和存在疼痛复制反应的椎间盘源性腰痛特殊病例,并对其产生的原因和意义进行探讨.方法 2003年8月至2008年11月,慢性下腰痛且行腰椎间盘造影术病人288例.其中腰椎MRIT2加权显示正常信号强度,但椎间盘造影术显示纤维环撕裂和腰痛复制的病人12例.男7例、女5例.年龄20～44岁,平均29.6岁.病程8个月～3年,平均1.8年.应用Dallas CT椎间盘造影分级方法评估纤维环撕裂程度.结果 12例慢性腰痛但MRI显示正常信号强度的病人中,共行腰椎间盘造影33个椎间盘.12个病人12个椎间盘显示疼痛复制和纤维环撕裂,其中显示2级撕裂者3个,3级撕裂者9个.结论 对一些顽同性腰痛病人,保守治疗无效,提示是椎间盘源性的,但MRI检查正常需要行进一步治疗时,如行腰椎微创手术或腰椎融合术时,仍需考虑行腰椎间盘造影术,以确定疼痛的椎间盘.

A special type of discogenic low back pain: normal signal intensity of magnetic resonance imaging with abnormal discography

Objective To report a group of special patients showing a normal signal intensity of MRI with a positive discography and discuss its pathogenesis and clinical significance.Methods From August 2003 to November 2008,288 patients with chronic low back pain were treated.Of these patients,12 showed a normal intensity signal of MRI in lumbar intervertebral discs with a positive discography.There were 7 males and 5 females aged 20-44 years with an average of 29.6 years.The duration of disease was 8 months to 3 years with an average of 1.8 years.Dallas CT grading method was used for assessing the degree of annular disruption.Results Of these 12 patients,33 lumbar discs underwent discography.Twelve discs in 12 patients showed annular disruption and low back pain reproduction.Among 12 painful discs.3 showed grade 2 annular disruption and 9 showed grade 3 annular disruption.Conclusion Patients who are refractory to conservative care and have normal signal intensity in lumbar disc MRI and who are suggested as discogenic origin and might need further treatment such as minimal invasive surgery or lumbar interbody fusion should still be examined by discography.