EMG与颈椎MRI在神经根型颈椎病中的相关性分析

目的:探讨肌电图(EMG)与颈椎磁共振成像(MRI)在神经根型颈椎病(CSR)中定位诊断价值的相关性.方法:选择2014年7月～2015年7月在我院神经内科、骨科门诊及住院患者中确诊为CSR者80例;均给予颈椎MRI和EMG检查.结果:颈椎MRI累及4个以上节段者34例(占43％);累及3个节段者26例(占32％),累及2个节段者14例(占18％),仅累及1个节段者46例(占7％);EMG报告累及4个神经根者6例(占7％),累及3个神经根者8例(占10％),累2个神经根者20例(占25％),累及1个神经根56例(占58％).颈椎MRI所见累及颈4-5间盘者占50％,而EMG所见累及相应颈5神经根者占16％,差异有统计学意义;颈椎MRI所见累及颈5-6间盘者占57％,EMG所见累及颈6神经根占55％,差异无统计学意义;颈椎MRI所见累及颈6-7间盘者占36％,EMG累及颈7神经根占31％,差异无统计学意义;颈椎MRI所见累及颈7-胸1间盘者占4％,EMG累及颈8神经根占7％,差异有统计学意义.结论:EMG对CSR的定位诊断意义与颈椎MRI高度相关,且定位更加具体、精确.EMG与颈椎MRI联合检查可更加精确定位,对需要外科手术患者具有重大的指导意义.     

肌电图评价腰椎间盘突出症的临床价值

背景：肌电图对腰椎间盘突出症患者的诊断、治疗方法选择及治疗效果有客观的评价作用，并且在神经病变恢复的评定中具有客观、准确、定量等的作用。 目的：总结近年来肌电图在腰椎间盘突出患者诊断、治疗方法效果评定中所起的作用。 方法：以LDH，Lumbar disc herniation，sEMG，EMG为检索词，检索Pubmed数据库(1990-01/2010-10)，以腰椎间盘突出症，肌电图为检索词，检索中国期刊全文数据库(1998-01/2010-10)，文献检索语种限制为英文和中文。纳入肌电图及腰椎间盘突出症相关的内容。排除重复性研究。 结果与结论：通过34篇文献对肌电图在腰椎间盘突出症患者诊断以及疗效评估上的作用进行分析。不仅常规肌电图在腰椎间盘突出患者的诊断、疗效评价、治疗方法的选择具有客观的作用，表面肌电图也具有同样的作用，但是表面肌电图的干扰因素较多，所以把表面肌电图大规模应用在临床上还有很长的路要走，需进行进一步的研究。     

脊髓造影与CT脊髓造影对退行性腰椎侧凸性椎管狭窄的诊断价值

目的：探讨脊髓造影与CT脊髓造影在退行性腰椎侧凸性椎管狭窄（degenerative lumbar stenosis with scoliosis，DLSS）中的诊断价值，并与MRI扫描、手术所见相比较。 方法：选择2004-01/2007-06在北京协和医院骨科收治、并经手术证实的DLSS 患者97例。所有患者均经脊髓造影和CT脊髓造影观察，其中43例同时行MRI扫描。通过脊髓造影与CT脊髓造影的影像进行分析，确定其椎管狭窄部位、病变范围和病变程度，并与术中所见及MRI比较。 结果：①脊髓造影与CT脊髓造影的表现：DLSS对硬膜囊或神经根的压迫较退行性腰椎管狭窄症复杂，除与关节突肥大增生、黄韧带肥厚、椎间盘退变突出有关外，还与关节突关节半脱位、椎弓根移位压迫神经根等因素有关。②与手术所见的符合率：脊髓造影、CT脊髓造影的诊断正确率分别为87.6%和92.8%，二者联合应用的诊断正确率为95.3%；对于不同弯度的DLSS，二者的诊断正确率无明显差异。③与MRI比较：在弯度较大的DLSS中，脊髓造影与CT脊髓造影的诊断正确率高于MRI。 结论：脊髓造影和与CT脊髓造影的联合应用于DLSS诊断正确率较高，对于弯度较大的DLSS诊断正确率优于MRI。     

小儿椎管内肠源性囊肿

目的 总结小儿椎管内肠源性囊肿的临床特点和治疗经验。方法 回顾分析过去6年来我科收治的21例小儿椎管内肠源性囊肿的临床资料。结果 本组21例，占同期小儿椎管内肿瘤总数的13．7％，发病平均年龄为7．7岁，男女之比为6：1。囊肿位于颈段者占62％，位于胸段者19％，颈胸交界和腰骶段者各占9．5％；部分患儿合并有其他发育畸形。囊肿全切除率和近全切除率达到80．9％。结论 椎管内肠源性囊肿为良性病变，早期诊断和显微是治疗的最佳选择。     

MRI和EMG、NCV检查在脊髓病变的应用价值分析

对76例常见脊髓病病人的主要临床资料和磁共振（MRI）、肌电图（EMG）、神经传导速度（NCV）检查结果回顾性分析，认为MRI对脊髓有形态学上改变者异常检测率高，并有其特异的影像学表现。EMG、NCV对变性，遗传性疾病的异常检测率高，MRI和EMG、NCV与临床诊断符合率分别为84．3％和90．7％，二者结合对辅助临床诊断提供了有利依据。     

腰椎间盘突出症并椎管狭窄症的手术治疗分析

目的探讨腰椎间盘突出并椎管狭窄症手术治疗的临床疗效。方法 2009-03-2011-03我院诊治40例腰椎间盘突出症并椎管狭窄患者,择期实施手术治疗,术后随访6个月,对其临床资料进行回顾性分析。结果 40例患者经相应手术治疗,术后随访6个月,优24例（60.0%）,良12例（30.0%）,可4例（10.0%）,优良率90.0%。结论对于腰椎间盘突出并椎管狭窄症患者,应根据患者的病理特点和临床症状,严格掌握手术适应证,采用合适的手术方式,给予对症处理。     

腰椎间盘突出症行腰段硬脊膜外静脉造影和脊髓造影的选择

本文报告73例疑有腰椎间盘突出患者每例进行了腰硬脊膜外静脉造影和脊髓碘水造影。58例接受了手术探查,其中33例为腰椎间盘突出症。腰硬脊膜外静脉造影的诊断准确率为96.8％;脊髓碘水造影的诊断准确率为84.8％。此外,腰硬脊膜外静脉造影无1例并发症;而脊髓碘水造影有6例(8.2％)发生双下肢抽搐。所以我们推荐腰硬脊膜外静脉造影检查为诊断腰椎间盘突出的造影方法。     

脊髓造影对诊断腰椎间盘突出症的价值（附30例分析）

我院自1991年5月至1993年5月共收治腰椎间盘突出症65例。其中30例做了脊髓造影和CT扫描，经手术证实两种检查的准确率，以探讨脊髓造影对诊断腰椎间盘突出症的价值．     

椎管内肠源性囊肿11例临床分析

目的　对椎管内肠源性囊肿的临床表现 ,影像学特征及治疗方法进行探讨。方法　分析和总结我科 1994年至 2 0 0 1年收治的 11例椎管内肠源性囊肿的临床特点、影像学资料及手术方法。结果　 11例病人中 ,10例髓外硬膜下者 ,均一次性手术全切除 ;1例髓内患者 ,行大部分切除。结论　椎管内肠源性囊肿术前定性诊断困难 ,CT及MRI有助于定位诊断。手术全切除是唯一的根治方法     

脑脊液鼻漏的诊断和治疗

目的 :分析同位素和CT脑池造影对脑脊液鼻漏定位诊断的价值 ,比较各种手术入路的优劣。方法 :回顾性分析 35例脑脊液鼻漏手术疗效 ,并与术前定位比较。结果 :2 0例行同位素检查者有 1 6例 (80 % )、2 4例行CT脑池造影者有 1 9例 (79% )定位准确。术后 2 6例 (74% )获得随访 ,随访中有 2 1例患者鼻漏症状完全消失。结论 :同位素和CT脑池造影是提高定位诊断准确性的有效方法。经额硬膜外入路修补前颅底漏口创伤小、修补牢靠     

The incidence of herniated disc and varicella zoster virus infection in lumboradicular syndrome

121 patients suffering from lumboradicular syndrome were examined for the presence of varicella zoster virus (VZV) infection. Lumbar myelography was carried out on all. VZV-antibody determination in blood, as well as in spinal fluid, was by indirect ELISA. In 40% of cases lumbar myelography revealed no signs of a herniated disc; none had raised antibody titre in spinal fluid. VZV-antibody titre in blood indicated VZV infection in only 3.     

Vergleichende elektromyographische und myelographische Untersuchungen bei lumbalen Bandscheibenoperationen

Zusammenfassung Bei 156 wegen eines lumbalen Bandscheibenschadens hemilaminektomierten Patienten wurden die Ergebnisse der präoperativen elektromyographischen und myelographischen Befunde mit denen der Operationsprotokolle mittels einer Kovarianzanalyse verglichen. Die Operations-und Myelographiebefunde wurden in vier Schweregrade, in mono- und bisegmentalen Befall und je nach der Lage des Bandscheibenschadens in laterale, extrem laterale und mediale Vorfälle unterteilt. Das Elektromyogramm (EMG) der Bein- und autochtonen lumbalen Rückenmuskulatur wurde nach Myotomen geordnet und in sechs Stadien eingeteilt. Die statistische Auswertung zeigt, daß das EMG in 69,2% exakt Höhe und Ausmaß einer lumbalen Discushernie feststellen kann und der Myelographie mit 31,2% an Treffsicherheit (bisegmentaler Befall bei monosegmentaler Diagnose oder umgekehrt) deutlich überlegen ist. Zusätzlich liegt eine Teilübereinstimmung mit dem Operationsbefund beim EMG in 19,5%, bei der Myelographie in 33,8% vor. Das EMG versagt bei akuten radikulären Syndromen innerhalb der ersten 14 Tage und bei Discushernien am thorakolumbalen Übergang. An Hand der Operations-und EMG-Befunde werden die Kennmuskeln für die Myotome L1–S1 festgelegt. Denervierungszeichen in drei Kennmuskeln eines Myotoms und Ableitung aus mehreren Myotomen erhöhen die Treffsicherheit elektromyographischer Diagnosen. Denervierungszeichen in der autochtonen lumbalen Paravertebralmuskulatur sind immer ein sicheres Zeichen für eine Nervenwurzelbeteiligung.Die Elektromyographie ist eine ambulante Untersuchungsmethode und ohne Risiko für den Patienten, während die Myelographie nur stationär durchgeführt werden kann und für den Patienten eine wesentlich größere Belastung darstellt. Die diagnostische Aussagekraft eines EMG ist bei unserer Fragestellung in den meisten Fällen der einer Myelographie überlegen. Nur wenn das EMG nicht exakt Höhe und Ausmaß eines radikulären Syndroms feststellen kann, ist eine präoperative Myelographie indiziert.

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Comperative analysis of electromyography and myelography in cases of lumbar radiculopathy

Summary Preoperative electromyographical and myelographical findings in 156 patients undergoing surgery because of lumbar radiculopathy were compared with the corresponding surgical reports by means of covariance analysis.The EMG's of leg and lumbar paravertebral muscles were rated according to severity of pathological signs using a rating scale of 6 stages. The EMG's were also divided into groups according to myotomes involved. The surgical and myelographical reports were divided into 4 groups according to severity of the process and further classified according to mono- or bisegmental lesions and to localization of the herniated disc, i. e. lateral, extremely lateral and medial.The statistical analysis proved that the EMG accurately revealed level and extent of the lumbar radiculopathy in 69.2% of the cases with a respective figure of 31.2% for the myelography. There was a partial agreement between findings during surgery and those of the EMG in 19.5% and those of myelography in 33.8%. The EMG was inconclusive during the first 2 weeks of acute radicular syndromes as it was in herniated discs of the thoracolumbar region and in symptoms arising from affections of the cauda equina.The crucial muscles for the myotomes L1 to S1 as determined by comparing the findings during surgery with the EMG recordings of the ventral leg muscles were as follows: L1 and L2: M. adductores; L3: M. quadriceps femoris; L4: M. quadriceps femoris and M. tibialis anterior; L5: M. extensor hallucis longus, M. tibialis posterior and Mm. peronei, and S1: M. triceps surae and M. extensor digitorum brevis. Signs of denervation in three crucial of one myotome and in the lumbar paravertebral muscles were enhancing the diagnostic accuracy of the EMG.While the EMG may be performed on an outpatient basis without risk there is some stress inherent in myelography requiring the patient to stay in the hospital. Apart from the aforementioned exceptions recording the EMG from leg and paravertebral muscles should be preferred over myelography in cases of lumbar radiculopathy because of its greater diagnostic conclusiveness.

     

Correlation of computed tomography with surgical diagnosis in lumbar disc disease

The lumbar spines of one hundred patients with suspected lumbar disc herniations were analysed with computed tomography. The results are compared with the patients' surgical diagnosis and with myelography. CT scanning is with few exceptions the diagnostic procedure of choice in investigating lumbar disc disease.     

Lumbar nerve root "walled" by a calcified herniated mass in a young patient

INTRODUCTION: Discal calcification in childhood is rare. Calcifications are occasionally discovered during routine examinations, especially in the cervical spine. Generally, the calcification process is confined to the nucleus pulposus of the intervertebral disc. CASE REPORT: In this report, we describe the case of a 16-year-old girl who presented with acute low back pain, right S1 radiculopathy and a history of increasing paresthesia. The patient underwent a CT scan, which demonstrated a postero-lateral calcified disc hernia at the L5-S1 level. The surgical decompression of the lumbar nerve root was carried out; at the operation it was observed that the nerve root was "walled" into the calcified hernia. DISCUSSION: Only a few cases with evidence of calcification of the herniated portion of the disc have been previously described. In none of them was the phenomenon was so pronounced that it sealed the nerve root completely.     

Sciatica due to unusual causes: Tarlov cysts and nerve roots anomalies

Tarlov cysts and nerve roots anomalies usually involve lumbosacral roots and are often asymptomatic. MRI has enabled recognition of many conditions that used to be missed by CT or myelography investigations performed for back and leg pain. However, even without additional compressive impingement (disc hernia, spondylolisthesis or lumbar canal stenosis) these anomalies can be responsible for sciatica, motor deficit and bladder sphincter dysfunction. Tarlov cysts are perinervous dilatations of the dorsal root ganglion. CT and especially MRI can reveal these cysts and their precise relations with the neighboring structures. Delayed filling of the cysts can be visualized on the myelogram. MRI is more sensitive than CT myelography for a positive diagnosis of nerve root anomalies, a differential diagnosis with disc hernia and classification of these anomalies. Surgical treatment is indicated for symptomatic Tarlov cysts and nerve root anomalies resistant to conservative treatment. Better outcome is observed in patients with an additional compressive impingement component. We report two cases of sciatica: one caused by Tarlov cysts diagnosed by MRI and the other by nerve root anomalies diagnosed by CT myelography. In both cases, conservative treatment was undertaken. The clinical, radiological and therapeutic aspects of these disorders are discussed.     

The value of accurate clinical assessment in the surgical management of the lumbar disc protrusion.

One hundred patients with lumbar disc protrusions were studied. Thirty six "control" patients were admitted in the same time period with low back pain and sciatica but with subsequently "normal" myelograms and no surgery. The aim of this paper was to relate history and clinical signs to the myelograms and surgical findings. Ninety nine per cent of our patients presented with sciatica (controls 94%). The most frequently found sign in patients with a disc protrusion was reduction of ipsilateral straight leg raising (98%). However, 55% of controls also showed this sign. There were three signs that, when present, particularly indicated a disc protrusion; "crossed straight leg raising" (pain on contralateral straight leg raising), measured calf wasting and impaired ankle reflex: the latter being especially indicative of an L5-S1 disc protrusion. There were two further important signs, weakness of dorsiflexion of the foot and scoliosis of the lumbar spine. However, such signs occurred in about half the patients and so clinical diagnosis in the remaining half depended on obtaining a good history of sciatica, and paying due regard to severity of the pain, the mobility of the patient, the ability and desire to work and the overall personality. Satisfactory results of surgery simply depend on finding and removing a definite disc protrusion. Using these methods of selection, 98% have returned to their original employment, 86% within 3 months of the operation. For a patient with no abnormal signs and a normal myelogram, surgical treatment should not be advised.     

Herniated thoracic disks

Thoracic disc herniation is uncommon. An incidence of 0.25 to 0.75 per cent of protruded disks are in the thoracic region. A peak incidence is noted in the fourth decade with 75 per cent of the protruded disks occurring below T8. Pain is the most common initial symptom, present in 57 per cent of the cases, followed by sensory disturbances and motor involvement. By the time of diagnosis, 90 per cent of the patients have signs of spinal-cord compression. Although myelography has been considered the test of choice, 8 per cent false negative results and a correct preoperative diagnosis of 56 per cent has been reported. Now, with CT scanning with and without metrizamide, more accurate diagnoses can be achieved, even with cases in which myelography is negative. There has been a considerable improvement in the surgical treatment of herniated thoracic disks with over an 80 per cent rate of success for surgical approaches other than the posterior approach (decompressive laminectomy). An early and accurate diagnosis, coupled with improvement in the surgical approach, offers a much better prognosis for patients with thoracic disk herniation.     

Paralysis of the foot as the first symptom of a herniated thoracic disc

Herniated thoracic discs are uncommon entities that are difficult to diagnose. They may be associated with a myriad of symptoms, which often delays diagnosis. In general dorsal pain that radiats around the chest or abdomen are found. In case of spinal cord compression signs of thoracal myelopathy are common. This paper describes a patient with a complete paralysis of the left foot as the first symptom of a herniated thoracic disc. After frustrated diagnostic of the lumbar spine, the exact neurological examination showed a sensible cut at the level of D6/7, the MR tomography diagnosed a herniated thoracic disc at the same level. Four months later he was presented again with a plegia of the left foot and a sensible cut at the level D5/6. The MR tomography showed a herniated disc at the level above the spondylodesis. The immediately performed transthoracic disc excision and fusion of D6/7 was followed by complete remission of the plegia and the sensible cut. Four months later we performed a rethoracotomy, disc excision and decompression with a spondylodesis D5/6. The procedure was again followed by complete remission. In case of paralysis of the lower extremities one has to consider a herniated thoracic disc.     

Alternative medicine methods applied in patients before surgical treatment of lumbar discopathy

Case records of 200 patients operated on in 1998/99 for herniated lumbar disc in Neurosurgery Dept. showed that 95 patients (47.5%) had been treated previously by 148 alternative medical or non-medical procedures. The authors discuss the problem of non-conventional treatment methods applied for herniated lumbar disc by professionals or non professionals. The procedures are often dangerous.     

Clinical and Radiological Findings of Nerve Root Herniation after Discectomy of Lumbar Disc Herniation

The authors report 2 cases of nerve root herniation after discectomy of a large lumbar disc herniation caused by an unrecognized dural tear. Patients complained of the abrupt onset of radiating pain after lumbar discectomy. Magnetic resonance imaging showed cerebrospinal fluid signal in the disc space and nerve root displacement into the disc space. Symptoms improved after the herniated nerve root was repositioned. Clinical symptoms and suggestive radiologic image findings are important for early diagnosis and treatment.