椎间盘造影在决定腰椎融合节段中的作用

Value of Magnetic Resonance Imaging and Discography in Determining Level of Lumbar Discetomy and Fusion

目的评估椎间盘造影术在决定选择腰椎间融合节段中的应用价值。方法对17例下腰痛(共56个椎间盘)进行椎间盘造影。根据临床症状、辅助检查、椎间盘造影结果制定手术计划,采用椎间盘切除,腰椎间融合术。术前、术后给予VAS、ODI评分以及影像学评估。结果本组均成功进行了椎间盘造影。椎间盘造影阳性20个,其中MRI显示只有17个为异常椎间盘。在椎间盘造影阴性的36个椎间盘中,18个MRI显示正常。MRI检测症状椎间盘的假阴性率为15%,假阳性率为50%。17例均接受了腰椎间融合术。ODI评分,术前平均51%,术后1周,1、3、6、12个月结果平均为15%,融合率100%,无一例发生并发症。VAS术前平均7分(6～9分),术后平均2分(0～4分),临床效果良好。结论椎间盘造影术可避免不必要的腰椎融合,临床症状、辅助检查结合椎间盘造影可以提供更多的信息以更准确地选择融合节段。

Objective To compare the value of lumbar magnetic resonance imaging versus discography in selecting the level for discectomy and fusion and evaluate the surgical outcome. Methods The magnetic resonance imaging and discography followed by computed tomography in 17 patients with lumbar discogenic pain were evaluated. Surgical plan was based on the complete information of clinical symptoms, magnetic resonance imaging, and dicography as well as computed tomography dicography. Posterior lumbar discetomy and keystone fusion were performed. Postoperative pain relief was assessed by the patients, and the follow- up radiographs were viewed by independent reviewer. The overall surgical outcome was evaluated using ODI. Results There were 56 disc levels that successfully underwent lumbar discography with 20 positive levels. There were 34 abnormal discs on magnetic resonance imaging. Magnetic resonance imaging had a false - positive rate of 47 % and false - negative rate of 20 %. Successful lumbar fusion was achieved in 90 % of patients, and the clinical outcome was good. Conclusion The magnetic resonance imaging can identify most of the painful discs but still has relatively high false - positive and false - negative rates. Discography can save the levels from being unnecessarily fused. The combination of clinical symptoms, magnetic resonance imaging, and dicography provides the most information for decision making and can improve the management of lumbar discogenie pain.