A Comparison of Computed Tomography-Myelography, Magnetic Resonance Imaging, and Myelography in the Diagnosis of Herniated Nucleus Pulposus and Spinal Stenosis

Bischoff, Robert; Rodriguez, Raoul P.; Gupta, Kundan L.; Righi, A.; Dalton, Jeanette E.; Whitecloud, Thomas S.

doi:10.1097/00002517-199306040-00002

Cited by 79 publications

(49 citation statements)

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“…Both studies with a relatively low prior probability of 49% [26,29] also presented slightly lower sensitivities (0.64 and 0.71 vs. 0.72-0.92) with similar specificities compared to those studies with a higher prior probability. Furthermore the two studies [27,28] subjected to partial verification revealed a slightly higher sensitivity (0.83 and 0.92) compared to studies avoiding partial verification (0.64-0.72).…”

Section: Herniated Nucleus Pulposusmentioning

confidence: 64%

“…The included studies were stratified according to the different pathologies: i.e. lumbar disc herniation [16,[24][25][26][27][28][29] and spinal stenosis [26,30]. Lumbar disc herniation was subdivided into (1) Herniated nucleus pulposus (HNP) and (2) Nerve root compression due to HNP.…”

Section: Resultsmentioning

confidence: 99%

“…Six studies [24][25][26][27][28][29] assessed the diagnostic accuracy of MRI for lumbar disc herniation i.e. HNP including sequestration, extrusion and protrusion or disc bulging.…”

Section: Herniated Nucleus Pulposusmentioning

confidence: 99%

“…One study [27] assessed more than one disc level per patient. The prior probabilities ranged from 49% [26] to 77% [28] with a mean prior probability of 63%. The sensitivity of MRI for HNP ranged from 64 to 92% and the specificity ranged from 55% to even 100% [28].…”

Section: Herniated Nucleus Pulposusmentioning

confidence: 99%

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Magnetic resonance imaging for diagnosing lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review

et al. 2011

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Purpose In about 5% of all cases LBP is associated with serious underlying pathology requiring diagnostic confirmation and directed treatment. Magnetic resonance imaging (MRI) is often used for this diagnostic purpose yet its role remains controversial. Consequently, this review aimed to summarize the available evidence on the diagnostic accuracy of MRI for identifying lumbar spinal pathology in adult low back pain (LPB) or sciatica patients. Methods MEDLINE, EMBASE and CINAHL were searched (until December 2009) for observational studies assessing the diagnostic accuracy of MRI compared to a reference test for the identification of lumbar spinal pathology. Two reviewers independently selected studies for inclusion, extracted data and assessed methodological quality. Pooled summary estimates of sensitivity and specificity with 95% confidence intervals were calculated for homogenous subsets of studies. Results Eight studies were included in this review. Strata were defined for separate pathologies i.e. lumbar disc herniation (HNP) and spinal stenosis. Five studies comparing MRI to findings at the surgery for identifying HNP were included in a meta-analysis. Pooled analysis resulted in a summary estimate of sensitivity of 75% (95% CI 65-83%) and specificity of 77% (95% CI 61-88%). For spinal stenosis pooling was not possible. Conclusions The results suggest that a considerable proportion of patients may be classified incorrectly by MRI for HNP and spinal stenosis. However, the evidence for the diagnostic accuracy of MRI found by this review is not conclusive, since the results could be distorted due to the limited number of studies and large heterogeneity.

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Section: Herniated Nucleus Pulposusmentioning

confidence: 64%

Section: Resultsmentioning

confidence: 99%

“…Six studies [24][25][26][27][28][29] assessed the diagnostic accuracy of MRI for lumbar disc herniation i.e. HNP including sequestration, extrusion and protrusion or disc bulging.…”

Section: Herniated Nucleus Pulposusmentioning

confidence: 99%

Section: Herniated Nucleus Pulposusmentioning

confidence: 99%

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Magnetic resonance imaging for diagnosing lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review

et al. 2011

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“…In a comparison of various imaging modalities, Bischoff et al [1], determined that myelo-CT was the most sensitive and accurate test for diagnosing herniated nucleus pulposus and spinal stenosis, whereas myelography was the most specific. MR imaging provided comparable results in most instances; combined with its noninvasive methods and lack of side effects, it is the procedure of choice for detecting spinal abnormalities.…”

Section: Discussionmentioning

confidence: 99%

A comparison of angled sagittal MRI and conventional MRI in the diagnosis of herniated disc and stenosis in the cervical foramen

et al. 2009

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The object of this study is to demonstrate that angled sagittal magnetic resonance imaging (MRI) enables the precise diagnosis of herniated disc and stenosis in the cervical foramen, which is not available with conventional MRI. Due to both the anatomic features of the cervical foramen and the limitations of conventional MR techniques, it has been difficult to identify disease in the lateral aspects of the spinal canal and foramen using only conventional MRI. Angled sagittal MRI oriented perpendicular to the true course of the foramina facilitates the identification of the lateral disease. A review of 43 patients, who underwent anterior cervical discectomy and interbody fusion, is presented with a herniated disc and/or stenosis in the cervical foramen. They all had undergone conventional MRI and angled sagittal MRI. Fifty levels were surgically explored for evidence of foraminal herniated disc and stenosis. The results of each test were correlated with what was found at each explored surgical level. The sensitivity, specificity, and accuracy of both examinations for making the diagnosis of foraminal herniated disc and stenosis were compared. During the diagnosis of foraminal herniated disc, the sensitivity, specificity, and accuracy of angled sagittal MRI were 96.7, 95.0, and 96.0%, respectively, compared with 56.7, 85.0, and 68.0% for conventional MRI. In making the diagnosis of foraminal stenosis, the sensitivity, specificity, and accuracy of angled sagittal MRI were 96.3, 95.7, and 96.0%, respectively, compared with 40.7, 91.3, and 66.0% for conventional MRI. In the above groups, the difference between the tests for making the diagnosis of both foraminal herniated disc and stenosis was found to be statistically significant in sensitivity and accuracy. Angled sagittal MRI was a more accurate test compared to conventional MRI for making the diagnosis of herniated disc and stenosis in the cervical foramen. It can be utilized for the precise diagnosis of foraminal herniated disc and stenosis difficult or ambiguous in conventional MRI.

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Factory and construction work is associated with an increased risk of severe lumbar spinal stenosis on MRI: A case control analysis within the wakayama spine study

Ishimoto

Cooper

Ntani

et al. 2019

American J Industrial Med

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Background To explore the association of MRI‐diagnosed severe lumbar spinal stenosis with occupation. Methods Occupational data were collected by questionnaire and all participants underwent spine MRI scans using the same protocol. Central lumbar spinal stenosis (LSS) was graded qualitatively. Those with severe LSS (>two‐thirds narrowing) were compared with the controls with lesser degrees of stenosis or no stenosis. Results Data were available for 722 subjects, mean age 70.1 years. 239 (33%) cases with severe LSS were identified. Factory/construction workers had an almost four‐fold increased risk of severe LSS after adjustment for age, sex, smoking, and walking speed amongst those aged <75 years (OR 3.97, 95%CI 1.46‐10.85). Severe LSS was also associated with squatting ≥1 h/day (OR 1.76, 95%CI 1.01‐3.07) but this association became non‐significant after adjustment. Conclusion Further research is needed but this study adds more evidence that occupational factors are associated with an increased risk and/or severity of degenerative disease of the lumbar spine.

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A Comparison of Computed Tomography-Myelography, Magnetic Resonance Imaging, and Myelography in the Diagnosis of Herniated Nucleus Pulposus and Spinal Stenosis

Cited by 79 publications

References 0 publications

Magnetic resonance imaging for diagnosing lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review

Magnetic resonance imaging for diagnosing lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review

A comparison of angled sagittal MRI and conventional MRI in the diagnosis of herniated disc and stenosis in the cervical foramen

Factory and construction work is associated with an increased risk of severe lumbar spinal stenosis on MRI: A case control analysis within the wakayama spine study

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