CT引导椎间盘造影术在多节段腰椎间盘退变中的临床价值

[目的]探讨CT引导下椎间盘造影术在治疗多节段腰椎间盘退变疾患中的临床价值.[方法]2005年1月～2008年1月对28例多节段腰椎间盘退变疾患行CT引导下椎间盘造影术,其中男12例,女16例;年龄30～56岁,平均38.2岁.腰椎间盘退变节段:L3、4和 L4、5突出9例,L4、5和 L5S1突出15例,L3、4、L4、5和 L5S1三节段突出4例.造影节段:28例共计92个椎间盘,L2、3间隙10例,L3、4间隙28例,L4、5间隙28例,L5S1间隙26例.按照阳性椎间盘造影的诊断标准,筛选出致痛性椎间盘(责任间盘),对这些病变间隙行相应的椎间融合术治疗.[结果]28例患者92个间隙共筛选出32个责任间盘.VAS≥6分组中Ⅱ+Ⅲ级间盘(Dallas分级)和退变间盘(Pearce分级)所占的百分比明显高于VAS<6分组(P<0.05).手术前后ODI指数评分比较有显著性差异(P<0.05).随访12～36个月,平均25.2个月.Charles疗效评定,术后优22例(78.6%),良5例(17.9%),一般1例(3.6%),差0例.所有病例均未发生与椎间盘造影有关的并发症.1例椎间融合器下沉,1例植骨融合不良,1例术后病变侧伸母肌力减退,再次手术行椎弓根螺钉调整术,术后2个月肌力恢复.[结论]CT引导下椎间盘造影术对于多节段腰椎间盘退变疾患中责任间盘的选择具有重要的临床意义.     

The use of single photon emission computed tomography (SPECT) in the diagnosis of low-back pain in young patients

Single photon emission computed tomography (SPECT) is a method of scintigraphy that provides sectional and multi-planar imaging that should improve the sensitivity for diagnosis in remote areas of the spine. To test this hypothesis, the authors reviewed 15 patients with low-back pain and compared the results of the radiographs, planar bone scans (PBS), and SPECT. Four of 15 had normal examinations with all three methods of imaging. The rest had a positive test in at least one of the three methods. Single photon emission computed tomography was positive in eleven, PBS in six, and the radiograph in three of the 11 patients. It appears that the SPECT was the most sensitive method of imaging and greatly enhanced our diagnostic acumen for stress fractures or stress reactions of the spine.     

Pain provocation and disc deterioration by age. A CT/discography study in a low-back pain population

The computed tomography (CT)/discograms and discographic pain provocation reports of 291 clinical patients, 790 discs (mean age, 38; range, 17-79) were collected. The CT/discograms were classified separating anular disruption and degeneration and recording the pain provoked during discography as no pain, dissimilar, similar, or exact reproduction of the patient's clinical pain. Nondegenerated discs usually were found to be painless, and deteriorated discs painful. The proportion of severely degenerated but painless discs increased with age, as did the discs producing dissimilar pain. This may help explain the poor correlation of low-back pain with radiographic degenerative changes reported in previous epidemiologic studies.     

压力控制下椎间盘造影在诊断椎间盘源性疼痛中的应用

目的:评价压力控制下椎间盘造影诊断椎间盘源性疼痛的临床价值.方法:2007年3月-2008年5月,对69例慢性腰痛患者的156个MRI"黑椎间盘"进行压力控制下造影.男26例,女43例;年龄29-48岁,平均39.7岁;病程6-120个月,平均36.1个月.采用椎间盘后外侧人路穿刺,穿刺针针尖到达椎间盘中央后连接压力泵,注射造影剂并连续观察压力变化和患者疼痛反应,记录注射压力和诱发疼痛情况.结果:69例患者156个"黑椎问盘"均完成在压力控制下的造影,同时对73个MRI信号正常的椎间盘造影作为对照.在不设定注射压力限制值情况下,58例(84.06%)共131个(83.97%)"黑椎问盘"造影时出现与平时一致性疼痛,22个出现非一致性疼痛,3个未出现疼痛;4个正常椎间盘出现疼痛.当注射压力≤30psi时,46例(66.67%)共105个(67.31%)"黑椎间盘"有一致性疼痛,未出现非一致疼痛和正常椎间盘疼痛.结论:椎间盘造影是诊断慢性腰痛患者椎间盘源性疼痛的有效方法,但应在较低压下注射和判断阳性结果.     

Postpartum low-back pain.

To determine the prevalence of back pain and its development over the first postpartum period, 817 women who had been followed through pregnancy were studied a minimum of 12 months after delivery. More than 67% of the women experienced back pain directly after delivery, whereas 37% said they had back pain at the follow-up examination. Most of the women who had recovered became pain-free within 6 months. Factors that correlated to persistent postpartum back pain were the presence of back pain before pregnancy, the presence of back pain during pregnancy, physically heavy work, and multipregnancy. Of these four factors, physically heavy work was found to have the strongest association with persistent back pain at 12 months.     

The diagnosis of diastematomyelia by computed tomography

CT scanning has proven efficacy for the demonstration of normal and altered anatomy of the soft tissues of the head, providing information not available with any other modality. The introduction of total body CT has enabled us to study the entire spine and its contents. This new modality is extremely useful in diagnosing a variety of abnormalities of the spine, including diastematomyelia. A case is presented and the application of CT scanning to the spine is discussed.     

Lumbar disc disorders and low-back pain: socioeconomic factors and consequences

Socioeconomic factors are important risk factors for lumbar pain and disability. The total costs of low-back pain in the United States exceed $100 billion per year. Two-thirds of these costs are indirect, due to lost wages and reduced productivity. Each year, the fewer than 5% of the patients who have an episode of low-back pain account for 75% of the total costs. Because indirect costs rely heavily on changes in work status, total costs are difficult to calculate for many women and students as well as elderly and disabled patients. These methodologic challenges notwithstanding, the toll of lumbar disc disorders is enormous, underscoring the critical importance of identifying strategies to prevent these disorders and their consequences.     

Renal cell carcinoma- diagnosis by computed tomography

In approximately 10% of cases, renal cell carcinoma (RCC) could present as a fluid- filled cystic mass. There are three mechanisms by which RCC may become cystic: extensive cystic necrosis, intrinsic cystic growth and origin from the epithelium lining a simple renal cyst. Simple renal cysts are very common. Uncommonly these cysts are complicated by hemorrhage, infection and possibly ischemia. The goal of the radiologist in evaluating these cystic lesions is to distinguish malignant neoplastic cystic masses from non-neoplastic complicated cysts so that appropriate management can be undertaken: RCC is best treated by surgical excision while non-neoplastic complicated cysts do not require surgery. The radiologic findings in these cystic masses which must be carefully evaluated include calcification, abnormal density, septations, nodularity, wall thickening and enhancement.     

Epidural injections for the diagnosis and treatment of low-back pain

Three hundred four consecutive patients with low-back pain were given epidural anesthetic and steroid injections. A prospective study demonstrated that selected patients had 87% short-term success and 34% relief of pain for as long as 6 months. No patient was cured by these injections. Needle placement during epidural injections was incorrect 25% of the time in experienced hands.     

Artificial intelligence in the diagnosis of low-back pain and sciatica

In a prospective trial of 200 patients with low-back pain or sciatica, the diagnostic performance of a computer was compared with that of a clinician in a variety of clinical settings. The results indicate that artificial intelligence techniques can be used for the differential diagnosis of low-back disorders, can outperform clinicians, and can be used to develop better methods of human differential diagnosis.     

Comparison of high-resolution computed tomography with discography in the evaluation of lumbar disc herniations

After failure of conservative treatment, 100 patients with symptoms suggestive of lumbar herniated nucleus pulposus (HNP) but without objective deficits were investigated both by high-resolution CT (without intravenous or intrathecal contrast) and by discography. The L4-L5 and L5-S1 discs were investigated by both techniques in all patients. In addition, the L3-L4 disc was investigated in 20 patients. The 220 investigated discs were sorted out into 6 CT categories according to morphologic and technical criteria. They were also classified into 3 discographic groups according to morphologic and clinical criteria. Based on morphologic considerations alone, the false-negative CT rates varied from 0 to 64% and the false-positive rates varied from 0 to 19%, depending on the category under consideration. Based on both morphologic and clinical consideration, the false-negative CT rates varied from 34 to 57% and the false-positive CT rates varied from 23 to 50%. Thus, high-resolution CT does not constitute an adequate means of investigation for this category of patients and discography appears justified before considering any form of radical therapy.     

The pain of discography

Lumbar discography is a commonly employed diagnostic tool, but important questions about it remain unresolved. Why is an abnormal discogram painful in one patient and not in another? This study was performed to investigate the changes in Substance P (SP) and Vasoactive-Intestinal Peptide (VIP), found in the dorsal root ganglion, following discography in normal and abnormal canine lumber intervertebral discs. The data from this study suggest that dorsal root ganglion SP and VIP are indirectly affected by manipulations of the intervertebral disc. It may be that various neurochemical changes within the intervertebral disc are expressed by sensitized (injured) annular nociceptors, and in part modulated by the dorsal root ganglion. Therefore, the concomitant pain sometimes associated with an abnormal discogram image may in part be related to the chemical environment within the intervertebral disc and the sensitized state of its annular nociceptors.     

Pelvic lipomatosis: diagnosis using computed tomography.

Pelvic lipomatosis is a rare, benign disease in which the characteristic roentgenographic findings may mimic those of pelvic malignancy. In the past more than two-thirds of reported cases have been explored surgically for diagnosis. We present 2 cases to demonstrate how the definitive diagnosis of pelvic lipomatosis can be made with the aid of computed tomography to avoid invasive techniques.     

Popliteal artery entrapment: diagnosis by computed tomography

Popliteal artery entrapment by an anomalous band of the gastrocnemius muscle is uncommon. In cases where popliteal artery occlusion has occurred, the diagnosis is difficult to establish. A case is presented in which computed axial tomography of the popliteal space established the diagnosis of popliteal artery thrombosis caused by entrapment when other diagnostic modalities were inconclusive. Computed axial tomography provides precise anatomic display of the muscle structure of the popliteal fossa and should be an important diagnostic tool in patients suspected to have popliteal artery entrapment.