[기사]만성 허리통증, 그냥 참는 것이 답일까?

기사출처
: http://www.moneyweek.co.kr/news/mwView.phptype=1&no=2014050911208036036&outlink=1

오랫동안 지속되는 허리통증은 그냥 참는것이 능사는 아니겠죠!
전문가의 정확한 진단에 따라 본인에게 알맞는 치료를 받아야 합니다.

Assessment of Magnetic Resonance Imaging in the diagnosis of lumbar spine foraminal stenosis -A surgeon's perspective

Detailed review

*Title: Assessment of Magnetic Resonance Imaging in the diagnosis of lumbar spine foraminal stenosis -A surgeon's perspective

요추 추간공 협착증 진단에서의 MRI의 측정 -외과의의 관점

*Author: Naftaly Attias, MD, Anne Hayman, MD, John A. Hipp, PhDz Philip Noble, PhD,

and Stephen I. Esses, MD

*Bibliography: J Spinal Disord Tech 2006;19:249-256

Study Design: A 2-part cadaveric study

Introduction:

1. Lumbar spine foraminal stenosis (LSFS) incidence >> 8% ~ 11%

2. Limitations of MRI itself for the diagnosis of LSFS

3. Not well understood about the effect of the variability on assessing LSFS

   1) Various Techniques

   2) Various Observers

4. No control over the final quality, or quantity of images provided to the surgeons

5. Glenn's words for size of a lesion in spine

   >> 1) normal, 2) slight, 3) mild, 4)moderate, 5) sever

6. Wildermuth et al's semi-quantitative classification system for grading LSFS

   1) On the basis of 'Open' MRI findings

   2) Grade 0 >> foramina without pathology

   3) Grade 1 >> slight foraminal stenosis

   4) Grade 2 >> marked foraminal stenosis

   5) Grade 3 >> advanced stenosis

7. About this study

   1) 2-part study to investigate the use of MRI in diagnosing LSFS

     ① Take MRIs of 3 cadavers in 3 centers, 8 spine surgeons to assess

       >> Reliability of Wildermuth semiquantitative classification system

       >> Variability in MRI examinations carried out in different institutions

     ② Compare MRI measurements vs. cadaveric slices to assess

       >> Differences between measurements from MRI vs. cadaveric specimens

Methods:

1. Fresh, frozen human lumbar spines (3 cadavers)

2. Examined with 3 different clinical MRI systems

3. Graded foramina by 8 surgeons on the basis of Wildermuth semiquantitative way

4. MRI measurements

   1) Foraminal height

   2) Superior foraminal width

   3) Middle foraminal width

   4) Posterior disc height

5. Specimen measurements

   1) Foraminal height

   2) Superior foraminal width

   3) Middle foraminal width

Results, Part 1:

1. 9set MRI scan review/total 72 foramina per one observer

2. Grading

   0) Grade 0 >> 222 foramina (39%)

   1) Grade 1 >> 201 foramina (35%)

   2) Grade 2 >> 127 foramina (22%)

   3) Grade 3 >>  26 foramina (04%)

   4) P = 0.15, nearly significant on the basis of paired t-tests

3. Level of interobserver agreement

   0) k grade 0 >> 0.13

   1) k grade 1 >> -0.01

   2) k grade 2 >> 0.06

   3) k grade 3 >> 0.11

   4) combined >> 0.07

   5) Most observers underestimated LSFS grade as compared with grading specimens.

   6) Preferred Method to assess the foramen >> T1 sagittal sequence

Results, Part 2:

1. MRI measurements

   1) Foraminal height >> 14.78mm (SD 4.53)

   2) Superior foraminal width >> 7.73mm (SD 1.77)

   3) Middle foraminal width >> 3.79mm (SD 1.68)

   4) Posterior disc height >> 5.55mm (SD 1.63)

   5) Correlation between MRI measurements and Actual dimensions in specimens >> Poor

2. Specimen measurements

   1) Measured 24 foramina and Graded according to Wildermuth classification

     Grade 0 >> 8 (33%)

     Grade 1 >> 3 (12%)

     Grade 2 >> 10 (42%)

     Grade 3 >> 3 (12%)

   2) Measurments of foraminal size

     Foraminal height >> 16.12mm (SD -3.11)

     Proximal foraminal width >> 8.99mm (SD -2.43)

     Middle foraminal width >> 4.76mm (SD -2.80)

Conclusion:

The parameters associated with the grade of stenosis assigned to the foramen were as follows: 

(1) the observer doing the grading

(2) the place it was imaged

(3) the location of the foramen.

There was poor correlation between measurements of the foramina carried out on MRI and the specimens.

Does the presence of the nerve root sedimentation sign on MRI correlate with the operative level in patients undergoing posterior lumbar decompression for lumbar stenosis?

Brief review 1

*Title: Does the presence of the nerve root sedimentation sign on MRI correlate with the operative level in patients undergoing posterior lumbar decompression for lumbar stenosis?

*Authors: Akil Fazal, MD,  Andrew Yoo, BA,  John A. Bendo, MD

*Bibliography: Spine J. 2013 Aug;13(8):837-42.

BACKGROUND CONTEXT:

-Recent research describes the use of a nerve root sedimentation sign to diagnose lumbar spinal stenosis (LSS).

-The lack of sedimentation of the nerve roots (positive sedimentation sign) to the dorsal part of the dural sac is the characteristic feature of this new radiological parameter.

PURPOSE: To demonstrate how the nerve root sedimentation sign compares with other more traditional radiological parameters in patients who have been operated for LSS.

STUDY DESIGN/SETTING: A retrospective chart and image review.

PATIENT SAMPLE: Preoperative MRI were reviewed from 71 consecutive operative patients who presented with LSS and received spinal decompression surgery (2006-2010).

OUTCOME MEASURES: Preoperative T2-weighted MRIs were reviewed for each patient.

METHODS:

▶Measurements

134 vertebral levels (L1-5) were measured for

1)     sedimentation sign

2)     cross-sectional area (CSA)

3)     anterior/posterior (A/P) diameter of the dural sac

4)     thickness of the ligamentum flavum

5)     Fujiwara grade of facet hypertrophy.

-using Surgimap 1.1.2.169 software (Nemaris, Inc., New York, NY, USA)

-Exclusion criteria: 1) previous spine surgeries 2) absence of MRI on extended dynamic range 3) surgeries for primary diagnosis other than LSS

▶Statistical analyses

-using the SPSS 17.0 statistical software (SPSS Inc., Chicago, IL, USA).

-Significance was demonstrated using unpaired t tests and chi-squared tests.

RESULTS: The measurements are listed below.

CONCLUSIONS:

-The sign is most often present in patients who have clinically significant lumbar stenosis and require surgery.

-The sedimentation sign is a new measurement tool that can enable physicians to objectively assess and quantify spinal stenosis.

*Fujiwara grading system: aim to assess the severity of the facet joint osteoarthritis.

REFERENCE: Fujiwara A, Tamai K, Yamato M, et al. The relationshipbetween facet joint osteoarthritis and disc degeneration of the lumbar spine: anMRI study. Eur Spine J 1999;8:396–401.