Scoring System for Factors Affecting Aggravation of Lumbar Disc Herniation
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: To investigate the various imaging factors associated with aggravation of lumbar disc herniation (LDH) and develop a scoring system for prediction of LDH aggravation. Materials and Methods: From 2015 to 2017, we retrospectively reviewed the magnetic resonance imaging (MRI) findings of 60 patients (30 patients with aggravated LDH and 30 patients without any altered LDH). Imaging factors for MRI evaluation included the level of LDH, disc degeneration, back muscle atrophy, facet joint degeneration, ligamentum flavum thickness and interspinous ligament degeneration. Flexion-extension difference was measured with simple radiography. The scoring system was analyzed using receiver operating characteristic (ROC) analysis. Results: The aggravated group manifested a higher grade of disc degeneration, back muscle atrophy and facet degeneration than the control group. The ligamentum flavum thickness in the aggravated group was thicker than in the group with unaltered LDH. The summation score was defined as the sum of the grade of disc degeneration, back muscle atrophy and facet joint degeneration. The area under the ROC curve showing the threshold value of the summation score for prediction of aggravation of LDH was 0.832 and the threshold value corresponded to 6.5. Conclusion: Disc degeneration, facet degeneration, back muscle atrophy and ligamentum flavum thickness are important factors in predicting aggravation of LDH and may facilitate the determination of treatment strategy in patients with LDH. The summation score is available as supplemental data.
Abstract
Purpose: To investigate the various imaging factors associated with aggravation of lumbar disc herniation (LDH) and develop a scoring system for prediction of LDH aggravation. Materials and Methods: From 2015 to 2017, we retrospectively reviewed the magnetic resonance imaging (MRI) findings of 60 patients (30 patients with aggravated LDH and 30 patients without any altered LDH). Imaging factors for MRI evaluation included the level of LDH, disc degeneration, back muscle atrophy, facet joint degeneration, ligamentum flavum thickness and interspinous ligament degeneration. Flexion-extension difference was measured with simple radiography. The scoring system was analyzed using receiver operating characteristic (ROC) analysis. Results: The aggravated group manifested a higher grade of disc degeneration, back muscle atrophy and facet degeneration than the control group. The ligamentum flavum thickness in the aggravated group was thicker than in the group with unaltered LDH. The summation score was defined as the sum of the grade of disc degeneration, back muscle atrophy and facet joint degeneration. The area under the ROC curve showing the threshold value of the summation score for prediction of aggravation of LDH was 0.832 and the threshold value corresponded to 6.5. Conclusion: Disc degeneration, facet degeneration, back muscle atrophy and ligamentum flavum thickness are important factors in predicting aggravation of LDH and may facilitate the determination of treatment strategy in patients with LDH. The summation score is available as supplemental data.
참고문헌 (22)
- Frymoyer JW, "Lumbar disk disease: epidemiology", Instr Course Lect, 41, pp.217~223 (1992)
- Fager CA, "Observations on spontaneous recovery from intervertebral disc herniation", Surg Neurol, 42, pp.282~286 (1994)
- Weber H. Lumbar disc herniation, "A controlled, prospective study with ten years of observation", Spine (Phila Pa 1976), 8, pp.131~140 (1983)[DOI]
- Weber H, "The natural course of acute sciatica with nerve root symptoms in a double-blind placebo-controlled trial evaluating the effect of piroxicam", Spine (Phila Pa 1976), 18, pp.1433~1438 (1993)[DOI]
- Hofstee DJ, "Westeinde sciatica trial: randomized controlled study of bed rest and physiotherapy for acute sciatica", J Neurosurg, 96, pp.45~49 (2002)
- Peul WC, "Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial", BMJ, 336, pp.1355~1358 (2008)[DOI]
- Fardon DF, "Lumbar disc nomenclature: version 2.0: recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology", Spine J, 14, pp.2525~2545 (2014)[DOI]
- 최수정, "The Use of Magnetic Resonance Imaging to Predict the Clinical Outcome of Non-Surgical Treatment for Lumbar Interverterbal Disc Herniation", Korean Journal of Radiology, 8(2), pp.156~163 (2007), 대한영상의학회
- Pfirrmann CW, "Magnetic resonance classification of lumbar intervertebral disc degeneration", Spine (Phila Pa 1976), 26, pp.1873~1878 (2001)[DOI]
- Pathria M, "Osteoarthritis of the facet joints: accuracy of oblique radiographic assessment", Radiology, 164, pp.227~230 (1987)[DOI]
- Keorochana G, "MRI classification of interspinous ligament degeneration of the lumbar spine: intraobserver and interobserver reliability and the frequency of disagreement", Eur Spine J, 19, pp.1740~1745 (2010)
- Greiner M, "Principles and practical application of the receiver-operating characteristic analysis for diagnostic tests", Prev Vet Med, 45, pp.23~41 (2000)[DOI]
- Haldeman S, "North American Spine Society: failure of the pathology model to predict back pain", Spine (Phila Pa 1976), 15, pp.718~724 (1990)[DOI]
- Boden SD, "Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation", J Bone Joint Surg Am, 72, pp.403~408 (1990)[DOI]
- Rouzbeh Motiei-Langroudi, "Clinical and Magnetic Resonance Imaging Factors Which May Predict the Need for Surgery in Lumbar Disc Herniation", Asian Spine Journal, 8(4), pp.446~452 (2014), 대한척추외과학회
- Berne D, "The aging of the spine: natural evolution", Eur J Orthop Surg Traumatol, 9, pp.125~133 (1999)
- Fujiwara A, "The relationship between disc degeneration, facet joint osteoarthritis, and stability of the degenerative lumbar spine", J Spinal Disord, 13, pp.444~450 (2000)
- Kim KA, "MRI-based morphological predictors of SPECT positive facet arthropathy in patients with axial back pain", Neurosurgery, 59, pp.147~156 (2006)[DOI]
- Leone A, "Lumbar intervertebral instability: a review", Radiology, 245, pp.62~77 (2007)[DOI]
- Tsantrizos A, "Internal strains in healthy and degenerated lumbar intervertebral discs", Spine (Phila Pa 1976), 30, pp.2129~2137 (2005)[DOI]
- 장세연, "Radiographic Parameters of Segmental Instability in Lumbar Spine Using Kinetic MRI", 대한신경외과학회지, 45(1), pp.24~31 (2009), 대한신경외과학회
- Knutsson F, "The instability associated with disc degeneration in the lumbar spine", Acta Radiologica, 25, pp.593~609 (1944)[DOI]