Discography

Discography is a diagnostic tool that has been used for many years. Although controversial, it provides a physiologic test for evaluation of a disc with a volumetric, manometric, radiographic, and pain-provocative challenge. Although it has a controversial past, when the anatomy and pathophysiology are considered particularly in relation to intradiscal pressure and applied loads (that correlate with daily activities of the patient), the interpretation of the results of discography become more objective and reproducible. As with any procedure, indications for patient selection are an important step in successful outcomes. The equipment and technique used for performing discography using a manometry system are described in this article, as are a review of complications and outcomes. Discography is a safe, accurate, reproducible, objective diagnostic tool when tested for volume, pressure, fluoroscopic changes, and pain provocation.     

Discography: A review

The etiology of back pain appears elusive at times. Discography represents one tool that can help in the diagnosis. The following reviews the controversies and uses of this procedure.     

Discography: Its Comparative Value

Tabes dorsalis presents three basic surgical problems. (1) A patient with tabetic gastric crisis may exhibit confusing symptoms suggesting ruptured peptic ulcer, biliary colic or other acute abdominal condition, and unnecessary operation must be avoided. Incorporation of a basic neurologic investigation in a thorough physical examination will do much to solve this problem.(2) Because two clinical entities may coexist in the same patient, it is best to investigate thoroughly for organic disease even though tabetic gastric crisis is suspected.(3) Tabes can mask serious organic disease, and an abdominal catastrophe may be unrecognized because of absence of pain, tenderness or rigidity.     

经皮腰间盘切割术中髓核造影的X线分析

20例腰椎间盘脱出的患者在行经皮腰椎间盘切割术(PLD)前进行了髓核造影。28个髓核造影有三种表现:蕈伞征占28.6%,团块征占39.3%,纤维环破裂征占32.1％。髓核造影能直接显示髓核的变化,椎间盘脱出的方向和程度,以及纤维环破裂的直接征象.因此我们认为当X线检查与临床体征部位不一致时,行PLD前作髓核造影可起到进一步确诊的作用。     

Incidental Diagnosis of Intradural Lumbar Disc Herniation During Discography: A Case Report

▪ Abstract:   We describe an incidental finding of intradural lumbar disc herniation diagnosed radiographically during discography. A patient was referred to our center for discography with symptoms of worsening, intractable low back pain radiating to both hips and the left leg which was exacerbated when standing and walking. Magnetic resonance imaging of the lumbar spine revealed multiple disc bulges and lumbar facet arthroses with ligamentum flavum hypertrophy producing moderate central canal and lateral recess stenosis. Discography was performed at three levels (L3-4, L4-5, L5-S1). During fluoroscopically guided injection into L4-5 it was noted that contrast was not contained within the disc and spread intrathecally with a myelographic appearance. Computerized tomography confirmed accurate needle placement and a spread of contrast into the intrathecal space. To the best of our knowledge, this is the first report describing a finding of intradural disc herniation while performing discography. Physicians should be aware of this potential finding while performing this technique. ▪     

椎间盘突出症CT椎间盘造影诊断的荟萃分析

目的用荟萃(Meta)分析评价CT椎间盘造影(CTD)对椎间盘突出症的诊断价值。方法检索Pubmed、OVID、EBSCO外文数据库、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)和万方数据库中的相关文献,结合Cochrane协作网推荐内容制定纳入标准筛选文献,提取纳入研究的特征信息并采用2011年版QUADAS/STARD评价系统对纳入文献进行质量评估,绘制Deeks漏斗图检验发表偏倚。采用Bivariate模型进行数据分析、合并:进行异质性检验,亚组分析讨论异质性来源;合并得到阳性似然比、阴性似然比、诊断比值比、汇总灵敏度、特异度及95%可信区间,绘制灵敏度特异度的森林图;绘制汇总受试者工作特性曲线(SROC)并计算曲线下面积(AUC)。结果纳入文献8篇,共含病例533例(999个椎间盘);合并灵敏度、特异度及95%可信区间分别为0.901(0.773～0.960)、0.848(0.744～0.915)。AUC及95%可信区间为0.93(0.91～0.95)。结论对于椎间盘突出症的诊断,CTD具有较高的灵敏度、特异度和准确率,可作为椎间盘突出症重要的临床诊断方法之一。     

椎间盘造影在腰椎融合术中邻近正常椎间盘的应用

目的采取回顾分析的研究方法，探讨椎间盘造影术在腰痛融合邻近正常椎间盘的诊断价值。方法53例因椎间盘源性下腰痛行椎间盘切除和后路椎间融合术的患者，手术前行椎间盘造影时，不包括邻近融合节段的正常椎间盘。所有的患者随访35．6个月（24—80个月）。对所有患者的临床疗效和影像学结果进行评价分析。结果53例患者中49例临床效果优良，随访2年以上，38例患者无任何症状。15例患者在渡过21个月的无症状期后出现疼痛复发，采用腰椎MRI和椎间盘造影复查。结果MRI发现15例患者中的8例出现了邻近节段椎间盘的退变，而此8例中仅有1例（2％）经过MRI和椎间盘造影同时证实该节段为疼痛的原因，从而再次进行融合手术。结论术前MRI上表现为正常的相邻椎间盘在椎间融合术后不容易变成病变节段，因此没有必要常规在术前为了排除病变节段而行相邻于拟融合节段的正常椎间盘的造影检查。     

腰椎间盘气体造影在介入治疗中的价值

摘要:目的:了解纤维环、后纵韧带及髓核的形态,指导临床选择治疗方式。材料与方法:对126例确诊为腰椎间盘突出症的病人,在行介入治疗前常规做椎间盘空气和伊索显造影,通过两种不同造影剂的影像对照,总结空气椎间盘造影的影像表现及其临床价值。结果:空气椎间盘造影可分为4种类型:1.团块状型;2.分层状型;3.不规则状型;4.破裂型。本文分析了各种类型的影像表现,对比了两种不同造影剂存临床应用的优缺点。结论:空气椎间盘造影可以判断腰椎间盘突出症的患者是否存在纤维环、后纵韧带破裂,为介入治疗的方法选择提供依据,明显提高临床治疗效果。