Disk-caused nerve compression in patients with acute low-back pain: diagnosis with MR, CT myelography, and plain CT.

Abstract

Ninety-five patients with acute low-back and radicular pain underwent magnetic resonance (MR) imaging and either plain computed tomography (CT) (n = 32) or CT myelography (n = 63) for diagnosis of herniated nucleus pulposus-caused nerve compression (HNPNC). Patients were followed up for at least 6-12 months. Fifty-six patients underwent surgery, and 39 received conservative treatment. Receiver operating characteristic (ROC) analysis was performed on correlation of results of blinded image reading with "true" diagnoses determined by an expert panel [corrected]. Results in subgroup analysis for ROC curve areas were MR, 0.84, versus plain CT, 0.86; MR, 0.81, versus CT myelography, 0.83; and MR, 0.82, versus findings with both CT techniques, 0.85. Results indicate no statistically significant difference in diagnostic accuracy of HNPNC among the three modalities. Thus, factors of cost, radiation dose, and invasiveness influence selection of modality. On the basis of accuracy findings, the authors suggest that MR should replace CT myelography because of the invasiveness of myelography but that MR should not replace plain CT because plain CT is equally accurate and much less costly.

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

“…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.…”

“…The diagnostic accuracy of MRI for nerve root compression due to HNP was evaluated in two studies (n = 128) with prior probabilities of 77.9% [16] and 93.9% [27]. The results demonstrated a high sensitivity of 81 and 92% with varying specificity of 52 and 100%.…”

“…However, most studies included patients with a low risk of serious underlying pathology [13][14][15]. Furthermore, studies have not provided conclusive information about the diagnostic accuracy of MRI [16]. This is largely explained by the absence of a 'gold' reference standard for identifying serious underlying spinal pathology in LBP [13,17,18].…”

A 45-Year-Old Man With Low Back Pain and a Numb Left Foot

“…Because findings consistent with herniated disk, disk degeneration, spinal stenosis, and other disorders are often found in people who do not have symptoms (Table 2), valid interpretation of these imaging tests always requires correlation with the history and physical examination. 11,[15][16][17] If we look at the physical examination and the diagnostic test results, we notice these tests are far from perfect. Thus, diagnosis is inherently a probabilistic exercise.…”

Clinical Experience in 2088 Percutaneous Laser Disc Decompression Procedures

“…Free, sequestered disc fragments are missed 20% of the time by the best MRIs. [5][6][7] My theory is that free fragments, missed by the MRI, are the principal cause of PLDD failure. Botsford champions the use of preprocedure discography to identify such patients.…”