间盘造影在近融合椎正常间盘的诊断价值

The Value of Discography in Normal Intervertebral Disc Levels Adjacent to Lumbar Spinal Fusion

目的 采取回顾分析的研究方法，探讨椎间盘造影术在腰椎融合邻近正常椎间盘的诊断应用价值。方法 57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例患者在度过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上专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。

Objective This is a retrospective study to evaluate the value of discography in the diagnosis of lumbar discogenic pain and the normal disc level adjacent to fusion. Methods Fifty-three patients were treated with disc excision and posterior lumbar interbody fusion （PLIF） for painful degenerative disc disease. The normal disc adjacent to fusion was not included in preoperative discography. All patients were followed for an average of 35.6 months （range 24 to 80）. Results The success clinical outcome was achieved at 49 of 53 patients. Of the 53 patients,38 patients became asymptomatic postoperatively. Fifteen patients had a recurrence of pain after an asymptomatic period of average 21 months postoperatively and were evaluated by repeated MRI and discography of the lumbar spine. MRI findings showed that the normal disc adjacent to fusion became abnormal in 8 of these 15 patients. Of these 8 patients ,only one patient （2%） was confirmed to have painful degenerative disc by MRI and discography at the preoperative normal adjacent disc level and was required the extension of fusion because of severe recurrent pain. Conclusion It is highly unlikely that a MRI normal disc adjacent to a pathologicsegment will become symptomatic in the postoperative period after a successful interbody fusion. Therefore,it is unnecessary to routinely include normal adjacent disc levels in preoperative discography in order to rule out inapparent pathology.