BACKGROUND Chronic neck pain is a common clinical problem.It has long been considered that degenerative cervical disc is an important source of chronic neck pain.In the clinic,cervical discography is thought to be a u...BACKGROUND Chronic neck pain is a common clinical problem.It has long been considered that degenerative cervical disc is an important source of chronic neck pain.In the clinic,cervical discography is thought to be a useful and safe method to distinguish aging discs from pathological discs,and the probability of complications caused by it is really rare.However,once complication occurs,it is likely to cause fatal consequences to patients.Therefore,accurate judgment and effective treatment are crucial.CASE SUMMARY A 45-year-old female was admitted to the department with a 5-year history of severe neck pain,dizziness,and tinnitus.In order to find the diseased disc,analgesic discography was performed on C4/5 and 6/7 discs successively.Unfortunately,Discitis with an epidural abscess was caused during the procedures.With the help of magnetic resonance imaging,an accurate diagnosis was made and an urgent anterior cervical operation was given subsequently.The patient ultimately recovered well.CONCLUSION Discitis with epidural abscess is a rare complication after cervical discography,which needs accurate diagnosis and effective antibiotic treatment.展开更多
Background Discography is a gold standard for the diagnosis of the low back pain （LBP）, but it has potential dangers for the development of discitis, cerebral spinal fluid leakage, retroperitoneal bleeding, acute ne...Background Discography is a gold standard for the diagnosis of the low back pain （LBP）, but it has potential dangers for the development of discitis, cerebral spinal fluid leakage, retroperitoneal bleeding, acute new back pain and the tremendous radiation exposure to the patient. Using ＂evidence-based radiology＂ methods, the comparative roles of high intensity zone （HIZ） in diagnosing discogenic LBP were evaluated. Methods A focused clinical question was designed and a Pubmed and manual search were performed to identify the role of HIZ on MRI T2WI compared with discography. The studies retrieved were assessed for validity and strength. Sensitivity, specificity, likelihood ratios （LRs） and graphs of conditional probability were evaluated from the best current study by evidence-based radiology. Results Best evidence was retrieved in ten articles from 1992 to 2007. The best evidence level was lb and the strength of the evidence included： sensitivity 0.63 （0.51,0.76）, specificity 0.97 （0.92, 1.00）, positive predictive value 0.95, negative predictive value 0.72, positive LRs 18.37 and negative LRs 0.38. The gold standard of discogenic LBP is the provocative discography. Conclusions For suspected discogenic LBP, HIZ is limited for the diagnosis if HIZ is positive, which suggests further discography. In contrast HIZ is a good test for diagnosis if HIZ is negative, which indicates the disease can be excluded.展开更多
基金Supported by Foundation of Capital Medical Development,Beijing,China,No.2010026.
文摘BACKGROUND Chronic neck pain is a common clinical problem.It has long been considered that degenerative cervical disc is an important source of chronic neck pain.In the clinic,cervical discography is thought to be a useful and safe method to distinguish aging discs from pathological discs,and the probability of complications caused by it is really rare.However,once complication occurs,it is likely to cause fatal consequences to patients.Therefore,accurate judgment and effective treatment are crucial.CASE SUMMARY A 45-year-old female was admitted to the department with a 5-year history of severe neck pain,dizziness,and tinnitus.In order to find the diseased disc,analgesic discography was performed on C4/5 and 6/7 discs successively.Unfortunately,Discitis with an epidural abscess was caused during the procedures.With the help of magnetic resonance imaging,an accurate diagnosis was made and an urgent anterior cervical operation was given subsequently.The patient ultimately recovered well.CONCLUSION Discitis with epidural abscess is a rare complication after cervical discography,which needs accurate diagnosis and effective antibiotic treatment.
文摘Background Discography is a gold standard for the diagnosis of the low back pain （LBP）, but it has potential dangers for the development of discitis, cerebral spinal fluid leakage, retroperitoneal bleeding, acute new back pain and the tremendous radiation exposure to the patient. Using ＂evidence-based radiology＂ methods, the comparative roles of high intensity zone （HIZ） in diagnosing discogenic LBP were evaluated. Methods A focused clinical question was designed and a Pubmed and manual search were performed to identify the role of HIZ on MRI T2WI compared with discography. The studies retrieved were assessed for validity and strength. Sensitivity, specificity, likelihood ratios （LRs） and graphs of conditional probability were evaluated from the best current study by evidence-based radiology. Results Best evidence was retrieved in ten articles from 1992 to 2007. The best evidence level was lb and the strength of the evidence included： sensitivity 0.63 （0.51,0.76）, specificity 0.97 （0.92, 1.00）, positive predictive value 0.95, negative predictive value 0.72, positive LRs 18.37 and negative LRs 0.38. The gold standard of discogenic LBP is the provocative discography. Conclusions For suspected discogenic LBP, HIZ is limited for the diagnosis if HIZ is positive, which suggests further discography. In contrast HIZ is a good test for diagnosis if HIZ is negative, which indicates the disease can be excluded.
