Bulging lumbar intervertebral disk: myelographic differentiation from herniated disk with nerve root compression.
Bulging lumbar intervertebral disk: myelographic differentiation from herniated disk with nerve root compression.
复制标题
腰椎间盘突出：与神经根受压的椎间盘突出的脊髓造影分化。
DOI：
10.2214/ajr.138.4.709
复制
发表时间：
1982
期刊：
影响因子：
--
通讯作者：
R. B. King
中科院分区：
文献类型：
--
作者：
Stephen A. Kieffer;Richard G. Sherry;David E. Wellenstein;R. B. King
下腰痛患者脊髓造影时，造影剂充盈的腰椎硬膜囊边缘畸形是常见的表现，但并非所有此类畸形都是由于椎间盘突出所致。在Amipaque脊髓造影中，弥漫性椎间盘膨出（不太可能导致神经根压迫）和椎间盘突出（通常导致神经根压迫）之间的区别是基于造影剂填充囊前外侧缘硬膜外畸形的曲率和程度以及受累神经根最远端部分梭形增宽的存在。椎间盘膨出引起的畸形是圆形的，通常是对称的（尽管偶尔一侧更突出），不延伸到椎间盘间隙的上方或下方;神经根口径均匀，大小正常。椎间盘突出引起的畸形呈角度，向头侧和/或尾侧延伸至椎间盘间隙水平;受累神经根通常在其最远可见部分增宽。一个连续系列的33例临床怀疑腰椎间盘突出症，没有以前的历史，背部手术进行椎板切除术。使用上述Amipaque脊髓造影鉴别膨出和椎间盘突出的标准，所有6例经手术证实的膨出椎间盘和27例经手术证实的椎间盘突出中的26例（96%）的脊髓造影诊断是正确的。
Deformities of the margins of the contrast material-filled lumbar thecal sac are common findings at myelography in patients with low back pain, but not all such deformities are due to herniated disks. Differentiation at Amipaque myelography between a diffusely bulging disk (unlikely to cause nerve root compression) and a herniated disk (which typically causes nerve root compression) is based on the curvature and extent of the extradural deformity of the anterolateral margin of the contrast-filled sac and on the presence of fusiform widening of the most distal part of the affected nerve root. The deformity caused by a bulging disk is rounded, usually symmetrical (although occasionally more prominent on one side), and does not extend above or below the disk space; the nerve root is uniform in caliber and normal in size. The deformity caused by a herniated disk is angular and extends cephalad and/or caudal to the level of the disk space; the affected nerve root is usually widened in its most distal visible part. A consecutive series of 33 patients with clinically suspected lumbar disk herniation and no previous history of back surgery underwent laminectomy. Using the criteria listed above for differentiation of bulging from herniated disk on Amipaque myelography, the myelographic diagnosis was correct in all six operatively confirmed bulging disks and in 26 (96%) of 27 operatively verified disk herniations.