| IntroductionLumbar disc herniations have proven resistant to clinical classification and quantification. This has presented a problem in radiograph-ic diagnosis, determination of " normal" disc profiles, and comparing therapeutic trials. In most clinical series, all disc herniations are treated equally, with the Orwellian understanding that some disc herniations are more equal than others. "Bulge," " protrusion," " prolapse ," " extrusion," and " sequestration" have been variously defined, understood, and reported. Even within classes, a protrusion may obliterate nearly all the canal space available, or may be negligible in its compression of the thecal sac. Likewise, an "extruded" fragment may be the size of a small pea or a large grape. With these limitations, the qualitative morphologic features of the spinal canal and the herniated disc as obtained from imaging studies have not proved very helpful in predicting outcomes in patients with sciatica. Small anteroposterior canal diameter and trefoil shape have been loosely associated with unsuccessful conservative treatment. Qualitative " types" of disc herniations have not been found to correlate well withthe success of conservative care or even with the presence of radicular tension signs. A crude index of " disc area" to " canal area" as determined by CT has not developed into a useful tool for clinical prognostication. And, finally, the presence of bulging, protruding, and even extruded discs in people with no back problems at all has confounded the issue. Despite this paucity of data, most surgeons believe larger disc herniations do better after surgery than smaller disc herniations, and small series with very large herniations have been reported to do well compared with others. Attempts to predict successful outcomes early in the clinical course of sciatica have focused mainly on epidemi-ologic variables. Female sex, longer duration of symptoms, litigation or compensation status, poor social/psychological situations, and other parameters have been shown to be associated with poor outcomes. In recent reviews, imaging studies, including magnetic resonance imaging ( MRI) , were thought to have no predictive value in low back pain or sciatica. Higher - quality images of the lumbar spine have been introduced with MRI. From such MR images, the size and shape of disc herniations can be measured accurately, as can the size and proportions of the spinal canal. A comprehensive quantitative measure of symptomatic disc herniations in vivo has not been performed to our knowledge. In this two - part study, we have undertaken the following ; 1) ascertain herniated disc and spinal canal measurements in a group of consecutive patients with sciatica undergoing CT/MRI of the lumbar spine; and 2) correlate these measures and other established clinical predictors with clinical outcomes of 112 patients evaluated with CT/MRI at our institution for herniated lumbar disc with back -leg pain.8MaterialsPart 1: Consecutive 112 surgical treated patients with LDH diagnosed in our hospital were selected from Jan. 1997 to Jan. 2001. Cases , including pre - operation records, CT/MR imaging, and types of herniated disc in intro - operation were collected.Part 2: Measurement InstrumentsUse Math - Physical Platform of standard version 2.5, programmed by Naijing Jinhuake Software Co ltd. , and a computer with scanner.MethodsPart 1; Case and Imaging CollectionConsecutive 112 surgical treated patients with LDH diagnosed in our hospital were randomly selected . Serial numbers of CT/MR imaging scans were registered. ( See Fig. 1) Then CT/MR findings were scanned into computer to form database.Part2: Image MeasurementMeasure the largest axial area of herniated disc on CT/MRJ with Math - Physical Platform, concerned with disc area, spinal canal are-a, Max disc AP length, Max canal AP length, Mid AP disc width, Mid AP canal width, radical canal lamina length ( between posterial vertebral margin and lateral lamina margin at internal foramen) , absolutely disc -fl... |
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