Lumbar Disk Protrusion Rates of Symptomatic Patients Using Magnetic Resonance Imaging

Gilbert, Jane; Martin, J. Chad; Wheeler, Greg R.; Storey, Benjamin; Mick, Gregory E.; Herder, Stephanie L.; Gyarteng-Dakwa, Kwadwo; Broughton, Patricia G.

doi:10.1016/j.jmpt.2010.08.010

Cited by 20 publications

(11 citation statements)

References 12 publications

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“…Gilbert et al . [ 20 ] noted similar findings, adding that the discrepancy was most prominent at L5-S1 followed by L4-L5 and L3-L4. On the other hand, Zamani et al .…”

Section: Discussionmentioning

confidence: 56%

Upright magnetic resonance imaging of the lumbar spine: Back pain and radiculopathy

Nguyen

Doan

Shabani

et al. 2016

J Craniovert Jun Spine

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Background:Lumbar back pain and radiculopathy are common diagnoses. Unfortunately, conventional magnetic resonance imaging (MRI) findings and clinical symptoms do not necessarily correlate in the lumbar spine. With upright imaging, disc pathologies or foraminal stenosis may become more salient, leading to improvements in diagnosis.Materials and Methods:Seventeen adults (10 asymptomatic and 7 symptomatic volunteers) provided their informed consent and participated in the study. A 0.6T upright MRI scan was performed on each adult in the seated position. Parameters were obtained from the L2/3 level to the L5/S1 level including those pertaining to the foramen [cross-sectional area (CSA), height, mid-disc width, width, thickness of ligamentum flavum], disc (bulge, height, width), vertebral body (height and width), and alignment (lordosis angle, wedge angle, lumbosacral angle). Each parameter was compared based on the spinal level and volunteer group using two-factor analysis of variance (ANOVA). Bonferroni post hoc analysis was used to assess the differences between individual spinal levels.Results:Mid-disc width accounted for 56% of maximum foramen width in symptomatic volunteers and over 63% in asymptomatic volunteers. Disc bulge was 48% greater in symptomatic volunteers compared to asymptomatic volunteers. CSA was generally smaller in symptomatic volunteers compared to asymptomatic volunteers, particularly at the L4-L5 and L5-S1 spinal levels. Thickness of ligamentum flavum (TLF) generally increased from the cranial to caudal spinal levels where the L4-L5 and L5-S1 spinal levels were significantly thicker than the L1-L2 spinal level.Conclusions:The data implied that upright MRI could be a useful diagnostic option, as it can delineate pertinent differences between symptomatic volunteers and asymptomatic volunteers, especially with respect to foraminal geometry.

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“…Gilbert et al . [ 20 ] noted similar findings, adding that the discrepancy was most prominent at L5-S1 followed by L4-L5 and L3-L4. On the other hand, Zamani et al .…”

Section: Discussionmentioning

confidence: 56%

Upright magnetic resonance imaging of the lumbar spine: Back pain and radiculopathy

Nguyen

Doan

Shabani

et al. 2016

J Craniovert Jun Spine

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“… 1 – 3 Numerous studies have attempted to elucidate factors for DDD such as age, body weight, physical job activities, and vertebral motion features. 2 , 18 Although lumbar disc herniation has been reported more often at L5/S1 1 – 6 and lumbar degenerative spondylolisthesis more often at L4/5, 7 – 10 surgical treatments of L4/5 or L5/S1 have also reported segment-dependent clinical outcomes. 11 , 12 Recent in vivo kinematic studies have revealed distinct motion characteristics at the L4/5 and L5/S1 segments.…”

Section: Discussionmentioning

confidence: 99%

“… 1 – 3 Epidemiology studies have suggested a segment-dependent discrepancy in the development of certain pathologies. For example, lumbar disc herniation is found most often at the L5/S1 segment, 1 – 6 whereas lumbar degenerative spondylolisthesis is found most often at L4/5. 7 – 10 Further, segment-dependent clinical outcomes following surgical treatment of L4/5 or L5/S1 have also been reported.…”

Section: Introductionmentioning

confidence: 99%

In Vivo Morphological Features of Human Lumbar Discs

Zhong

Driscoll

et al. 2014

Medicine

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Recent biomechanics studies have revealed distinct kinematic behavior of different lumbar segments. The mechanisms behind these segment-specific biomechanical features are unknown. This study investigated the in vivo geometric characteristics of human lumbar intervertebral discs.Magnetic resonance images of the lumbar spine of 41 young Chinese individuals were acquired. Disc geometry in the sagittal plane was measured for each subject, including the dimensions of the discs, nucleus pulposus (NP), and annulus fibrosus (AF). Segmental lordosis was also measured using the Cobb method.In general, the disc length increased from upper to lower lumbar levels, except that the L4/5 and L5/S1 discs had similar lengths. The L4/5 NP had a height of 8.6 ± 1.3 mm, which was significantly higher than all other levels (P < 0.05). The L5/S1 NP had a length of 21.6 ± 3.1 mm, which was significantly longer than all other levels (P < 0.05). At L4/5, the NP occupied 64.0% of the disc length, which was significantly less than the NP of the L5/S1 segment (72.4%) (P < 0.05). The anterior AF occupied 20.5% of the L4/5 disc length, which was significantly greater than that of the posterior AF (15.6%) (P < 0.05). At the L5/S1 segment, the anterior and posterior AFs were similar in length (14.1% and 13.6% of the disc, respectively). The height to length (H/L) ratio of the L4/5 NP was 0.45 ± 0.06, which was significantly greater than all other segments (P < 0.05). There was no correlation between the NP H/L ratio and lordosis.Although the lengths of the lower lumbar discs were similar, the geometry of the AF and NP showed segment-dependent properties. These data may provide insight into the understanding of segment-specific biomechanics in the lower lumbar spine. The data could also provide baseline knowledge for the development of segment-specific surgical treatments of lumbar diseases.

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“…Moreover, disc herniation without nerve root impingement was demonstrated in 25.9% of the included patients, and in 73.8% of those excluded due to symptoms classified as unspecific low back pain with referred leg pain. This is not surprising, since the prevalence of disc herniation revealed by MRI in the general population is known to be as high as 30% [3,18,41-44]. …”

Section: Discussionmentioning

confidence: 99%

Accuracy of physical examination for chronic lumbar radiculopathy

Iversen

Solberg

Romner

et al. 2013

BMC Musculoskelet Disord

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BackgroundClinical examination of patients with chronic lumbar radiculopathy aims to clarify whether there is nerve root impingement. The aims of this study were to investigate the association between findings at clinical examination and nerve root impingement, to evaluate the accuracy of clinical index tests in a specialised care setting, and to see whether imaging clarifies the cause of chronic radicular pain.MethodsA total of 116 patients referred with symptoms of lumbar radiculopathy lasting more than 12 weeks and at least one positive index test were included. The tests were the straight leg raising test, and tests for motor muscle strength, dermatome sensory loss, and reflex impairment. Magnetic resonance imaging (n = 109) or computer tomography (n = 7) were imaging reference standards. Images were analysed at the level of single nerve root(s), and nerve root impingement was classified as present or absent. Sensitivities, specificities, and positive and negative likelihood ratios (LR) for detection of nerve root impingement were calculated for each individual index test. An overall clinical evaluation, concluding on the level and side of the radiculopathy, was performed.ResultsThe prevalence of disc herniation was 77.8%. The diagnostic accuracy of individual index tests was low with no tests reaching positive LR >4.0 or negative LR <0.4. The overall clinical evaluation was slightly more accurate, with a positive LR of 6.28 (95% CI 1.06–37.21) for L4, 1.74 (95% CI 1.04–2.93) for L5, and 1.29 (95% CI 0.97–1.72) for S1 nerve root impingement. An overall clinical evaluation, concluding on the level and side of the radiculopathy was also performed, and receiver operating characteristic (ROC) analysis with area under the curve (AUC) calculation for diagnostic accuracy of this evaluation was performed.ConclusionsThe accuracy of individual clinical index tests used to predict imaging findings of nerve root impingement in patients with chronic lumbar radiculopathy is low when applied in specialised care, but clinicians’ overall evaluation improves diagnostic accuracy slightly. The tests are not very helpful in clarifying the cause of radicular pain, and are therefore inaccurate for guidance in the diagnostic workup of the patients. The study population was highly selected and therefore the results from this study should not be generalised to unselected patient populations in primary care nor to even more selected surgical populations.

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Lumbar Disk Protrusion Rates of Symptomatic Patients Using Magnetic Resonance Imaging

Cited by 20 publications

References 12 publications

Upright magnetic resonance imaging of the lumbar spine: Back pain and radiculopathy

Upright magnetic resonance imaging of the lumbar spine: Back pain and radiculopathy

In Vivo Morphological Features of Human Lumbar Discs

Accuracy of physical examination for chronic lumbar radiculopathy

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