腰椎神经根冠状位、矢状位和轴位MR扫描定位诊断腰椎椎间孔狭窄症

 目的 探讨腰椎神经根冠状位、矢状位和轴位 MR 扫描定位诊断腰椎椎间孔狭窄症的可行性和有效性。方法回顾性分析 2006 年 6 月至 2011 年 6 月共 21 例腰椎椎间孔狭窄患者的相关资料,男 10 例，女 11 例；年龄 36~65 岁, 平均 45.6 岁。病史 6~36 个月，平均 9.4 个月。5 例表现为腰痛伴单侧下肢痛，16 例为单侧下肢痛。根据腰椎侧位 X 线片测量椎间隙和椎间孔高度并行腰椎神经根冠状位、矢状位和轴位 MR 扫描检查，了解神经根周围组织结构的改变，定位诊断神经根受压部位；并通过手术证实影像学诊断的准确性。结果 21 例患者中 9 例为椎间盘突出导致椎间孔狭窄，12 例为椎间盘弥漫性膨出合并关节突关节增生、肥大导致椎间孔狭窄；21 例均为下腰椎椎间孔横向狭窄，20 例为 L4,5 椎间孔狭窄，造成 L4 神经根受压；1 例为 L5S1 椎间孔狭窄，造成 L5 神经根受压。经手术探查证实与术前定位诊断完全符合，符合率为 100%（21/21）。术后 20 例患者下肢疼痛症状完全缓解，1 例下肢疼痛症状缓解不满意。结论 腰椎神经根冠状位、矢状位和轴位 MRI 扫描方法能准确定位诊断椎间孔狭窄，为确定手术方案提供了准确的影像学依据。

Localization diagnosis of lumbar intervertebral foramen stenosis from multidimensional MRI scans of lumbar nerve roots

Objective To explore the localization diagnosis method of lumbar intervertebral foramen stenosis by multi-dimensional MRI scans of lumbar nerve roots. Methods Twenty-one patients with lumbar intervertebral foramen stenosis were followed up from June 2006 to June 2011 postoperatively, 10 cases of male, 11 cases of female ; 36 to 65 years old, average 45.6 years. The medical history is six to thirty six months, an average of 9.4 years; 5 cases have low back pain with unilateral leg pain and 16 cases showed unilateral leg pain only. The height of intervertebral space and foramen intervertebrale were measured on the X-rays of lumbar lateral position. Lumbar nerve roots MR imaging at the position of axial, coronal and sagittal scan were performed separately to the patients who were clinically suspected to suffer from lumbar intervertebral foramen stenosis. A definitive diagnosis of the location of nerve root compression and structural changes surrounding the nerve root can be obtained. Surgical operation was performed to confirm the accuracy of the MRI imaging diagnosis. Results There were 9 cases of lumbar intervertebral foramen stenosis caused by lumbar disc herniation. The other 12 cases are caused by zygapophyseal joint hyperplasia. All cases of lumbar intervertebral foramen stenosis located at the low back. By comparing MR images of lumbar intervertebral foramen stenosis with surgical procedure，the surgical observation of 21 patients completely coincided with the preoperative localization diagnosis, coincidence rate was 100%(21/21). After surgical treatment, 20 cases achieved a complete remission of leg pain and 1 case was not satisfactory. Conclusion MRI imaging at the position of axial, coronal and sagittal scan for lumbar nerve roots were useful to rigorous localization diagnosis of lumbar intervertebral foramen stenosis, and can provide accurate radiological evidence for surgery program.