Lumbar Disc Herniation Clinical Symptoms And Prognosis In Patients With Correlation Analysis Of MRI Imaging Findings

ObjectivesTo explore the correlation of MRI images of lumbar disc herniation andclinical symptom severity and treatment prognosis.Materials and MethodsUsing German SIEMENS Avanto1.5T superconducting MR scanner to dolumbar sagittal T1weighted and T2weighted scan.Then select the lumbarprotrusion disc level to do axial T2weighted scanner. From2012January to2012December for lumbocrural pain treated and confirmed by MRI scan in thediagnosis of lumbar disc herniation in120cases. Main outcome measures: thedegree of the prominence, prominent position in the horizontal plane, theincluded angel between prominences and nerve root. According to the area ofthe prominence in the spinal canal,we devide the data into three degrees, onedegrees≤30%,≤30%two degree<60%, three degree≥60%; according to thedifference of the prominent position in the horizontal plane, each group isdivided into a central space, paracentral space, lateral space and ertreme lateralspace.For a case with a plurality of prominence of lumbar intervertebral discprominence, and the heaviest and most consistent with the symptoms and signsof the intervertebral disc was measured. Score criterion of The severity of thesymptoms and signs use Chinese Oswestry disability index (ODI).According to the degree of the nerve root compression, dividing the datainto three groups:group I is not contact group, spacing is always greater than1nerve root diameter (in the same plane on the side of nerve root.), nerve rootsurrounding fat interspace clear; group Ⅱ is compression group, some spacingis less than1nerve root diameter,nerve root become deformed, fat interspace around the nerve root exist partly; group Ⅲ is the adhesion group, spacing isless than1nerve root diameter, root become flat, or fat space disappeared, it isdifficult to identify the nerve root. nerve root is submerged. For a case with aplurality of prominence of lumbar intervertebral disc prominence, and theheaviest and most consistent with the symptoms and signs of the intervertebraldisc was measured. Each group measur the degree of the prominence, and theincluded angel between prominences and nerve root., recording prominentposition in the horizontal plane. Correlation between the clinical severity ofsymptoms before treatment and the therapeutic effect and a prominent position,prominence degtee and AN were observed.Statistic method: SPSS13.0was used to analyze the parameters.Results(1) with the relationship between the prominence and nerve root graduallyclose, the propotion of the mild cases decreas gradually, while the propotion ofthe severe cases increase gradually, so both exist correlation.(2) in the not contact group, clinical symptom severity and the degree ofthe prominence erist correlation. Especially in the central and paracentral space,with increasing the size of prominence, clinical symptom severity graduallyworsened. Clinical symptom severity and prominence in the horizontal positionalso exist correlation, central and paracentral space symptom is lighter, lateralspace and ertreme lateral space symptoms heavier. In the lateral space andertreme lateral space,with AN decreasing, symptoms gradually worsened.In compression group, clinical symptom severity and the degree of theprominence have no correlation; Clinical symptom severity and prominence inthe horizontal position have no correlation. Clinical symptom severity and ANhave correlation, with AN decreasing, symptoms gradually worsened.In the adhesion group, clinical symptom severity and the degtee of theprominence erist correlation. Clinical symptom severity and prominence in thehorizontal position have no correlation,also no correlation with AN.(3) The therapeutic effect and the relationship between the prominence andnerve root exist correlation. The relationship between the prominence and nerveroot become more close, the treatment effect is more poor, and relationshipbetween the prominence and nerve root is more distant, the treatment effect isbetter. (4) in the not contact group, the treatment effect and the degree of theprominence erist correlation. the prominence is smaller, the treatment effect isbetter. the treatment effect and prominence in the horizontal position also existcorrelation, the cases in the central and paracentral space have better treatmenteffect,but In the lateral and ertreme lateral space，the treatment effect is poor.In compression group, there is no correlation between the degree of theprominence and the treatment effect.The treatment effect and prominence in thehorizontal position also have no correlation. There is correlation with AN, withAN decreasing, the more poor treatment effect is.In the adhesion group, the treatment effect and the degree of theprominence erist correlation. the prominence is smaller, the treatment effect isbetter. But have no correlation with the prominence in the horizontal positionand AN.Conclusions(1) in the group that the prominent and nerve root are not contact, theclinical symptom aggravate gradually with the degree of prominence becommingbig, especially in the central and paracentral space, having the higher degree ofcorrelation. There is correlation with the prominent position, and with theposition of the prominence shift outside gradually, the clinical symptomsaggravate.In central and paracentral space, clinical symptom severity isdominated by light and moderate, even in some cases,the area of the prominencein the spinal canal is three degree, the clinical symptoms are moderate, fewreach severe. In the lateral area and ertreme lateral space, the clinical symptomsgradually increase, and the proportion of severe cases increase significantly,even the area of the prominence in the spinal canal is one degree, still canappear severe clinical symptoms.In the non contact group, correlation exist between the therapeutic effectand the measurement index. Prominent in the central and paracentral space, theeffect of treatment is mainly excellence and becoming effective.The effect oftreatment and the choice of treatment method, is closely related with the degreeof promience. The treatment effect of prominnt in one and two degrees is mainlyexcellence.Oniy through conservative treatment, most can have a bettertherapeutic effect. The treatment effect of prominnt in three degrees is mainlyeffective,and the choice of treatment method, some patients need operation treatment to relieve the compression of nerve root. Operation treatment can havegood effect. Prominent in the lateral area and ertreme lateral space, treatmenthave less effective. The treatment effect and the choice of the treatment methodhave relationship with the AN. The smaller The AN,the poorer treatmenteffect,more complex the treatment method is choiced, even the operationtreatment.(2) in the group that the prominence conpress the nerve root, promientmainly in the paracentral and lateral space, and clinical symptom severity mostis moderate and severe. Following its relationship with the measurement index,the smaller the AN, the smaller the size of the promience, the more severe thesymptom; the greater the AN, the greater the size of the promience, the moremild the symptom. The clinical symptom severity have no correlation with thedegree of the prominence and prominence in the horizontal position.The treatment effect in this group is slightly worse than the not contactgroup. The effect of treatment is mainly effective. The effect of treatment andthe choice of treatment method is closely related with AN. The smaller TheAN,the poorer the treatment effect, the more complex the treatment method ischoiced, even the operation treatment. When the AN is greater, the nerve root ieoppressed lighter. The treatment effect ie better, and treatment method isrelatively simple. The treatment effect have no correlation with the degree of theprominence and prominence in the horizontal position.(3) in the group that the prominence adhesion the nerve root, promientmainly in the paracentral and lateral space, and clinical symptom severity mostis severe. clinical symptom severity and the degree of the prominence existcorrelation.The greater the promience,the greater the degree of nerve root iscompressed, the symptom is more serious. No significant correlation with ANand prominence in the horizontal position.If this group arn’t treated by operation treatment, the effect is invalid.thesecases need operation treatment, because operation treatment can relieveadhesion between the prominence and nerve root. Operation treatment can repairthe nerve root, and have a good effect. When the prominence is smaller, theadhesion with the nerve root is more light, the effect of the treatment is better.(4) in short, with the relationship between the prominence and nerve rootcontinuous closely, the more severe symptoms, the worse the symptom, and treatment is more complex. In the not contact group, the clinical symptomseverity and the degree of the prominence、prominence in the horizontal positionand AN exist correlation.in the compression group, the clinical symptomseverity and AN exist correlation.In the adhesion group, the clinical symptomseverity and the degree of the prominence exist correlation. In the not contactgroup, the treatment effect and the degree of the prominence、prominence in thehorizontal position and AN exist correlation.Except some cases in the lateralspace need operation, the other by conservative treatment can have good effect.In the compression group, the treatment effect and AN exist correlation,especially in the lateral space, the cases with smaller AN need operationtreatment.In the adhesion group, the clinical symptom severity and the size ofthe prominence exist correlation. Conservative treatment effect is poor, needoperation treatment.