LUMBAR DISCOGRAPHY IN NORMAL SUBJECTS - A CONTROLLED, PROSPECTIVE-STUDY
LUMBAR DISCOGRAPHY IN NORMAL SUBJECTS - A CONTROLLED, PROSPECTIVE-STUDY
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DOI：
10.2106/00004623-199072070-00019
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发表时间：
1990-08-01
影响因子：
5.3
通讯作者：
SAYRE, H
中科院分区：
文献类型：
--
作者：
WALSH, TR;WEINSTEIN, JN;SAYRE, H
自1968年以来，椎间盘造影术技术的重大进步，加上近年来在疼痛评估方面的重大进步，促使了一项研究，其中霍尔特·S关于椎间盘造影术特异性的工作被复制和扩展。在本研究中，7名腰痛患者和10名志愿者接受了仔细的筛查，以确保他们没有背部问题的病史，进行了三个水平的注射，并对所有过程进行了录像。每次注射后，参与者都会被问及疼痛的模式和强度，然后用计算机断层扫描对椎间盘进行成像。五名评分员对参与者的情况视而不见，根据注射前的磁共振图像和计算机断层扫描(椎间盘成像)的结果，将每个椎间盘评级为正常或异常。在根据磁共振图像做出的评级和根据视盘图做出的评级之间只有一处不一致。每个参与者的S疼痛相关反应都由两名评分员独立评估，他们查看了椎间盘造影的录像带。在评估疼痛强度、疼痛相关行为以及疼痛与注射前疼痛的相似性方面，评分者之间的可信度分别为0.99、0.93和0.88。在没有症状的个体中，30个椎间盘中有17%(5个)和10个受试者中有5个被解释为椎间盘图异常。然而，当只有在注射时伴有严重疼痛时，才将视盘图定义为阳性，则对无症状个体没有阳性解释(假阳性率为0，特异性为100%)。因此，尽管本研究中无症状受试者的异常率与霍尔特的S研究结果基本一致，但本研究的假阳性率(0%)明显低于霍尔特的S研究(26%)。椎间盘造影术显示有症状个体的20个椎间盘中有13个有异常发现，所有7名患者都有一个或多个节段的异常发现。根据研究标准，有6名患者的椎间盘图呈阳性。结论是，根据目前的技术，结合疼痛评估的标准化方法，腰椎间盘造影术是一种高度可靠和特异的诊断测试。这项研究没有涉及有效性或敏感性，也没有为选择患者进行椎间盘造影术提供指导。当然，椎间盘造影术并不是所有腰痛患者的最佳诊断方法。
Major advances in the techniques of discography since 1968, in conjunction with major strides in the evaluation of pain in recent years, prompted a study in which Holt''s work on the specificity of discography was replicated and extended. For the present study, seven patients who had low-back pain and ten volunteers who had been carefully screened, with a questionnaire and a physical examination, to ensure that they had no history of problems with the back, had an injection at three levels, and all sessions were videotaped. After each injection, the participant was interviewed about the pattern and intensity of the pain, and then the discs were imaged with computed tomography. Five raters, who were blind to the condition of the participant, graded each disc as normal or abnormal on the basis of findings on magnetic resonance images that had been made before the injection and computed tomography (discography) were done. There was only one disagreement between the ratings that were made on the basis of the magnetic resonance images and those that were made on the basis of the discograms. Each participant''s pain-related response was evaluated independently by two raters who reviewed the videotapes of the discography. Inter-rater reliability was 0.99, 0.93, and 0.88 for the evaluation of intensity of the pain, pain-related behavior, and similarity of the pain to pain that the subject had had before the injection. In the asymptomatic individuals, the discogram was interpreted as abnormal for 17 per cent (five) of the thirty discs and for five of the ten subjects. However, when the discogram was defined as positive only when substantial pain had been associated with the injection, there were no positive interpretations for the asymptomatic individuals (a false-positive rate of 0 and a specificity of 100 per cent). Thus, although the prevalence of abnormal discograms in the asymptomatic participants in the present study was generally consistent with Holt''s results, the false-positive rate in this study (0 per cent) was significantly lower than in Holt''s study (26 per cent). Discography revealed abnormal findings in thirteen of the twenty discs in the symptomatic individuals and in all seven patients at one or more levels. Six patients had positive discograms on the basis of the study criteria. It was concluded that, with current techniques and in conjunction with standardized methods for assessment of pain, lumbar discography is a highly reliable and specific diagnostic test. This study did not address the validity or sensitivity or provide guidelines for choosing patients for discography. Certainly, discography is not the best diagnostic test for all patients who have low-back pain.