Potentialities of spiral CT in diagnosis of degenerative-dystrophic lesions of lumbar spine causing chronic pain

Anosov N.A., Parfionov V.E., Toptygin S.V.

Chair of Rentgenology and Radiology, Clinic of Neurosurgery Medicomilitary Academy, St.Petersburg, Russia

Introduction

Degenerative-dystrophic lesions are the most frequent disease of the spine [3, 5, 11]. The last 15 years were characterized by a growth of morbidity. This makes the problem of diagnosis, treatment and prevention of degenerative-dystrophic lesions of the spine a national task [4].

Radiation methods and MRI play an important part in diagnosis of diseases of the spine [1, 2, 5, 6, 7, 8, 10]. Spiral CT has been used in clinical practice since 1989 [9].

The goal of the present work is generalization of experience of using spiral CT (SCT) in diagnosis of degenerative-dystrophic lesions of lumbar spine, causing chronic pain.

Material and Methods

Examination of 752 patients with chronic pain of lumbar localization was carried out. Obtained data were analyzed. X-ray, CT and MRI examinations showed, that degenerative-dystrophic lesions of lumbar spine were typical of all patients; 503 of them (75,9%) had this or that degree of intervertebral disk prolapse; 59 cases underwent subsequent surgical intervention. A mean age of patients was 44.4±0.4 years.

Examination was carried out with the help of Somatom Plus 4 computer tomograph (120 kV, 206 mAs, 0.75-1.0 s), using layer-by-layer and or spiral modes. When the first mode was used, a slice thickness and a step were equal to 2 mm in a plane parallel to a disk under examination. In spiral mode one or 2-3 vertebral segments (a "block") were scanned. In this case a slice thickness could reach 2, 3, 5 mm with a step of 3, 4.5 and 7.5 mm respectively. An examined area varied from 5 up to 35 cm, depending on a slice thickness, speed of scanning and current intensity. When some spinal segment were examined in "block", additional information on structures of the vertebral column, paravertebral tissues was obtained from high-quality MPR (multi-planar volume reformating), i.e. multi-planar (including curvilinear) reconstructions, and SSD (shaded surface display), i.e. three-dimentional surface reconstructions.

Results and Discussion

Tomograms of the whole population of patients with chronic pain syndrome of lumbar localization were analyzed. The results were as follows:

As for localization, there were: