PRACA POGLĄDOWA
Badania obrazowe w diagnostyce bólów dolnego odcinka kręgosłupa
 
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Ukryj
1
Z Kliniki Rehabilitacji Warszawskiego Uniwersytetu Medycznego Centrum Rehabilitacji w Konstancinie
 
Med Og. 2010;16(2):117–130
SŁOWA KLUCZOWE
STRESZCZENIE ARTYKUŁU
Metody obrazowania kręgosłupa są waŜnym narzędziem pomocniczym w ustalaniu rozpoznania, monitorowaniu przebiegu choroby i leczenia u osób zgłaszających się z bólami dolnego odcinka kręgosłupa. Nieprawidłowo zlecone badanie lub źle zinterpretowany jego wynik moŜe być przyczyną pomyłki diagnostycznej lub błędu w leczeniu. Artykuł analizuje przydatność najczęściej zlecanych w praktyce lekarza rodzinnego badań obrazowych.

Diagnostic work-up of low back pain (LBP) is often characterized by overimaging. Abundance of information retrieved from images may sometimes be misleading and result in diagnostic pitfalls. The purpose of this review is to describe sensitivity and specificity of most often prescribed non-invasive imaging studies – plain radiography (PL) (static and dynamic), computed tomography (CT), magnetic resonance imaging (MRI) and bone scyntygraphy (BS). PL is sensitive and specific as a diagnostic tool in cases of advanced deformities related to ankylosing spondylitis, selected congenital and developmental malformations, but lack appropriate sensititvity in detecting early stages of tumor or infection. Due to low specificity PL is of limited value in diagnostics of spondylo-atrhrotic cause of LBP in older patients. Dynamic radiography is crucial in diagnostics of spinal instabilities. CT is useful in diagnostics of lumbar stenosis, as well as disc extrusion; however abnormalities may be detected in asymptomatic individuals. MRI is sensitive in diagnostics of tumor, infection, and disc pathologies; however, significant rate of asymptomatic disc deformities is reported. MRI is sensitive in the detection of tumors and foci of infection, and is characterised by high sensitivity with respect to intervertebral disc pathology, nevertheless a positive result is observed among a considerable percentage of people without LBP. BS is helpful in detection of regions of increased bone metabolism, but lacks cause specificity. Some authors recommend BS in children suspected of organic cause of LBP. Each referral for imaging examination in the case of LBP should be preceded by a thorough patient examination and the analysis of the role of the information anticipated in the diagnostictherapeutic process. The image description is not a diagnosis and does not seem to be useful and appropriate information for the patient.
 
REFERENCJE (40)
1.
Ash LM, Modic MT, Obuchowski NA, Ross JS, Brant-Zawadzki MN, Grooff PN. Effects of Diagnostic Information, Per Se, on Patient Outcomes in Acute Radiculopathy and Low Back Pain. AJNR 2008, 29, 1098-103.
 
2.
Auerbach JD, Ahn J, Miltiadis H i wsp. Streamlining the evaluation of low back pain in children. Clin Orthop Relat Res 2008, 466, 1971–1977.
 
3.
Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 1990, 72, 403-408.
 
4.
Borejko M. Dziak A. Badanie Radiologiczne w Ortopedii. PZWL Warszawa 1988.
 
5.
Bigos S, Bowyer O, Braen G, i wsp. Acute Low Back Problems in Adults. Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Healthand Human Services. Clinical Practice Guideline No. 14. Report No. 95-0642, 1994.
 
6.
Carroll KW, Feller JF, Tirman PF. Useful internal standards for distinguishing infiltrative marrow pathology from hematopoietic marrow at MRI. J Magn Reson Imaging 1997, 7, 394-398.
 
7.
de Maesneer M, Lenchik L, Everaert H i wsp. Evluation of lower back pain with bone scintigraphy and SPECT. Radiographics 1999, 19, 901-912.
 
8.
Deyo RA, Diehl AK. Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies. J Gen Intern Med 1988, 3, 230-238.
 
9.
Hayes MA, Howard TC, Gruel CR, Kopta JA. Roentgenographic evaluation of lumbar spine flexion-extension in asymptomatic individuals. Spine 1989, 14, 327–331.
 
10.
Hicks GE, Morone N, Weiner DK. Degenerative lumbar disc and facet disease in older adults: prevalence and clinical correlates. Spine (Phila Pa 1976) 2009, 34 (12), 1301–1306.
 
11.
Jackson RP, Cain JE Jr, Jacobs RR, Cooper BR, Mc Manus GE. The neuroradiographic diagnosis of lumbar herniated nucleus pulposus: II. A comparison of computed tomography (CT), myelography, CT-myelography, and magnetic resonance imaging. Spine 1989, 14, 1362-1367.
 
12.
Jarvik JG, Deyo RA. Diagnostic Evaluation of Low Back Pain with Emphasis on Imaging. Ann Intern Med 2002, 137, 586-597.
 
13.
Joines JD, Mc Nutt RA, Carey TS, DeyoR A, Rouhani R. Finding cancer in primary care outpatients with low back pain: a comparison of diagnostic strategies. J Gen Intern Med. 2001, 16, 14-23.
 
14.
Kent DL, Haynor DR, Larson EB, DeyoRA. Diagnosis of lumbar spinal stenosis in adults: a metaanalysis of the accuracy of CT, MR, and myelography. AJR 1992, 158, 1135-1144.
 
15.
Kikkawa I, Sugimoto H, Saita K, Ookami H, Nakama S, Hoshino Y. The role of Gd-enhanced three-dimensional MRI fast low-angle shot (FLASH) in the evaluation of symptomatic lumbosacral nerve roots. J Orthop Sci 2001, 6, 101-109.
 
16.
Konferencja prasowa Polskiego Towarzystwa Rehabilitacji zainicjowania z okazji społecznego programu edukacyjnego „Ruch na rzecz zdrowych pleców”, Materiały prasowe; Centrum Prasowe PAI, Warszawa, 10.09.2002 r.
 
17.
Kopec J A . Measuring functional outcomes in persons with back pain: a review of back-specific questionnaires. Spine (Phila Pa 1976). 2000, 25 (24), 3110-3114.
 
18.
Kosuda S, Kaji T, Yokoyama H, i wsp. Does bone SPECT actually have lower sensitivity for detecting vertebral metastasis than MRI? J Nucl Med. 1996, 37, 975-978.
 
19.
Krasuski M. Algorytm postępowania diagnostyczno-leczniczego w zespołach bólowych kręgosłupa. Rehabilitacja Medyczna 2005, 9 (3), 19-25.
 
20.
Krasuski M. Postępowanie diagnostyczno-lecznicze w zespołach bólowych kręgosłupa. w: Pop T, Obodyński K. (red.) Fascynacje Rehabilitacją , Wyd. Uniwersytetu Rzeszowskiego, Rzeszów, 2010, 165-80.
 
21.
Lateef H, Patel D. What is the role of imaging in acute low back pain? Curr Rev Musculoskelet Med 2009, 2, 69–73.
 
22.
Maigne J, Lapeyre E, Morvan G, i wsp. Pain immediately upon sitting down and relieved by standing up is often associated with radiologic lumbar instability or marked anterior loss of disc space. Spine 2003, 28, 1327-1334.
 
23.
Manchikanti L, Helm S, Singh V, i wsp. An Algorithmic Approach for Clinical Management of Chronic Spinal Pain. Pain Phys 2009, 12, E225-E264.
 
24.
Manchikanti L, Singh V, Datta S, Cohen SP, Hirsh JA. Comprehensive review of epidemiology, scope, and impact of spinal pain. Pain Phys 2009, 12, E35-70.
 
25.
Marc V, Dromer C, Le Guennec P, Manelfe C, Fournie B. Magnetic resonance imaging and axial involvement in spondylarthropathies. Delineation of the spinal entheses. Rev Rheum Engl Ed 1997, 64, 465-473.
 
26.
Modic MT, Feiglin DH, Piraino DW, i wsp. Vertebral osteomyelitis: assessment using MR. Radiology 1985, 157, 157-166.
 
27.
Moon ES, Kim HS, Park JO i wsp. Comparison of the predictive value of myelography, computed tomography and MRI on the treadmill test in lumbar spinal stenosis. Yonsei Med J 2005, 46 (6), 806-811.
 
28.
O ’Neill C, Kurgansky M, Kaiser J, Lau W. Accuracy of MRI for diagnosis of discogenic pain. Pain Phys 2008, 11 (3), 311-326.
 
29.
Porter RW, Bewley B. A ten-year prospective study of vertebral canal size as a predictor of back pain. Spine 1994, 19, 173-175.
 
30.
Rojas-Vargas M, Munoz-Gomariz E, Escudero A i wsp. First signs and symptoms of spondyloarthritis—data from an inception cohort with a disease course of two years or less (REGISPONSEREarly). Rheumatology 2009, 48, 404–409.
 
31.
Sartoris DJ, Clopton P, Nemcek A, Dowd C, Resnick D. Vertebral-body collapse in focal and diffuse disease: patterns of pathologic processes. Radiology 1986, 160, 479-483.
 
32.
Savelli G, Chiti A, Grasselli G, Maccauro M, Rodari M, Bombardieri E. The role of bone SPET study in diagnosis of single vertebral metastases. Anticancer Res 2000, 20, 1115-1120.
 
33.
Sharma A, Pilgram T, Wippold FJ 2n d. Association between annular tears and disk degeneration : a longitudinal study. AJNR Am J Neuroradiol 2009, 30, 500-506.
 
34.
Schwartz E.D., Flanders A.E.: Spinal Trauma, Lippincott Williams&Wilkins, Philadelphia, 2007.
 
35.
Swanson D, Blecker I, Gahbauer H, Caride VJ. Diagnosis of discitis by SPECT technetium-99m MDP scintigram. A case report. Clin Nucl Med. 1987, 21, 210-211.
 
36.
Syrmou E, Tsitsopoulos PP, Marinopoulos D, Tsonidis C, Anagnostopoulos I, Tsitsopoulos PD. Spondylolysis: A review and reappraisal. Hippokratia 2010, 14 (1), 17-21.
 
37.
van Rijn JC, Klemetso N, Reitsma J B i wsp. Observer variation in the evaluation of lumbar herniated discs and root compression: spiral CT compared with MRI.B J Radiol 2006, 79, 372-377.
 
38.
van Tulder MW, Assendelft WJ, Koes BW, Bouter LM. Spinal radiographic findings and nonspecific low back pain. A systematic review of observational studies. Spine 1997, 22, 427-434.
 
39.
White AA, Panjabi MM. The problem of clinical instability in the human spine: a systematic approach, part 4: the lumbar and lumbosacral spine. W: White AA, Panjabi MM, eds. Clinical Biomechanics of the Spine. 2 wyd. New York, JB Lippincott Co, 1990, 342-361.
 
40.
Zhang YH, Zhao CQ, Jiang LS, Chen XD, Dai LY. Modic changes: a systematic review of the literature. Eur Spine J 2008, 17, 1289–1299.
 
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