MRI Evaluation of Disc Lesions Causing Lumbar Canal Stenosis and Backache

Degenerative disease of the lumbar spine refers to a syndrome in which an intervertebral disc with adjacent spine structures is compromised, this can be due to aging process associated with pathology. Thirty five percent of asymptomatic individuals may have degenerative spine findings, including: disc degeneration, modic changes, disc bulges, facet joint arthropathy and spinal stenosis. Plain radiography provides only limited diagnostic information. It cannot show the structural morphology of the intervertebral disc. Magnetic resonance imaging (MRI) is helpful in detecting changes like disc displacement (bulge, protrusion, extrusion, sequestration), OPLL, zygapophyseal joint hypertrophy, buckling or hypertrophy of ligaments. Also MRI is helpful in differentiating central canal stenosis from lateral canal stenosis. Study population included all patients above 20 years of age with LBP with/without radiculopathy who were referred for lumbar spine MRI at Radiology Department, SRMCH from August 2011 to September 2013. All consented patients with LBP with/without radiculopathy referred for lumbar MRI were consecutively included in the study. A total of 280 individuals had lumbar MRI scan from August 2011 to September 2013, but only 250 whom fulfilled the study criterion were studied.

Diurnal variation in lumbar MRI: Correlation between signal intensity, disc height, and disc bulge

There have been no reports indicating diurnal variations in MRI at different portions of each lumbar disc. Eight asymptomatic healthy volunteers between 22 and 29 years old had MRI of their lumbar spine, twice on the same day (in the morning and evening). Forty lumbar discs were studied and the signal intensity change was measured from three portions of each disc (a total of 120 portions). No visible changes could be detected between scans by blinded observers. However, the calculated signal intensity changes showed an average loss of -20.0% (ant., 5 cases), -19.0% (mid, 2 cases), and -17.5% (post., 1 case). Height loss of the disc showed an average loss of -9.9% (ant., 4 cases), -8.3% (mid., 2 cases), and -10.4% (post., 2 cases). An increase of disc bulge at L4-5 level (18.3%) was pronounced, but L5-S1 level was less than others. Loss of body height averaged a loss of 7 mm (0.39% of body height). There was no correlation between reduced signal intensity and height loss at the ant./post. portion (p = 0.42), but there was a close relation at the mid. portion (p = 0.008). Diurnal change of the disc bulge was not correlated with reduced signal intensity (p = 0.48) or height loss (p = 0.16). Intradiscal fluid change was not necessarily influenced by the disc height loss, and height loss did not necessarily have an effect on disc bulge. But diurnal change showed a trend that was reflected in reduced signal intensity, height loss, and an increase of disc bulge which was more apparent from the ant. portion to the post, portion on moving down to the lower levels. Loss of disc height was one factor in the reduction of body height. These changes occurred randomly throughout 5 lumbar disc levels in each case.

CT Analysis of 809 Cases with Degenerative Lumbar Intervertebral Disc / 实用放射学杂志

Objective To discuss the diagnostic value of the lumbar intervertebral disc degeneration by CT scanning.Methods The clinical representation and CT view of 809 cases with degenerative lumbar intervertebral disc were retrospectively analyzed.Results According to the different CT representation character,the degenerative lumbar intervertebral disc may be divided into the lumbar intervertebral disc denaturation bulge in 96 cases and the lumbar intervertebral disc herniation in 713 cases.Conclusion CT scanning is a value method to diagnosing degenerative lumbar intervertebral disc.