RU2371096C1 - Ultrasonic diagnostic technique for dorsal paramedial lumbar disk herniation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to neurology, and can be used for diagnostics of dorsal paramedian lumbar disk herniation. Real-time multiple view supersonic scanning is performed. Anteroposterior size of chord of spinal canal circle is determined. Said chord passes through a point that corresponds 1/2 radiuses of spinal canal circle to the right and to the left. Asymmetry is calculated. If it exceeds 4.36±0.44 mm, related dorsal paramedian lumbar disk herniation is diagnosed.

EFFECT: method allows providing objective diagnostics of dorsal paramedian lumbar disk herniation, establishing exact localisation of pathological process representing paramedian lumbar disk herniation, improving examination quality, and also ensuring possibility to control the results of treatment if dorsal paramedian lumbar disk herniation is observed.

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Description

The invention relates to medicine, namely to neurology, vertebrology, ultrasound diagnostics, and can be used to diagnose dorsal paramedian hernias of the lumbar intervertebral discs.

A known method for the diagnosis of dorsal paramedian hernias of the intervertebral discs of the lumbar using the method of computed tomography (Vasiliev A.Yu. X-ray computed tomography in the diagnosis of degenerative changes in the spine and in the treatment by laser vaporization. - M .: GOU VUNMTS, 2005. - P.43- 45.). Using this method, the image obtained by computed tomography is analyzed, and the degree of protrusion of the intervertebral disc is evaluated. The main disadvantages of the above method are:

- radiation exposure (irradiation of the investigated x-ray radiation), the creation of a series of x-ray images;

- the high cost of the study, since when applying the phlebography method, expensive equipment is used - a computer tomograph and the use of consumables (x-ray film, chemical reagents);

- the presence of a large number of contraindications for computed tomography (pregnancy, claustrophobia, early childhood, the patient's body weight exceeding the permissible values for specific models of computed tomography);

- lack of objective diagnosis of paramedian herniated disc

The prototype is a method for ultrasound diagnosis of herniated discs of the lumbar intervertebral disc (RU 2250076 C2, 2003.03.05). The implementation of this method is achieved by the fact that when conducting ultrasound scanning that is harmless to the body in real time, the fibrous ring of the intervertebral disc is broken and thinned to 1 mm, the anteroposterior size of the canal is reduced by more than 4 mm due to the "hernial sac", "vacuum phenomenon "- gas in the disk and compression of the roots of the nerves (asymmetry up to 2 mm at a rate of 5 mm). However, the implementation of this method does not allow to diagnose dorsal paramedian hernia of the lumbar intervertebral discs. Conducting diagnostic studies in accordance with this method involves the measurement of the fibrous ring of the intervertebral disc, the anteroposterior size of the channel and the roots of the nerves. Analysis of the results of these measurements does not allow the diagnosis of dorsal paramedian hernias of the intervertebral discs.

The essence of the invention lies in the fact that when polypositional ultrasound scanning in real time determines the anteroposterior size of the chord of the circumference of the spinal canal drawn through a point corresponding to ^1/2 _{of the} radius of the circumference of the spinal canal on the right and left, the asymmetry value is calculated, if the asymmetry value exceeds 4 , 36 ± 0.44 mm, diagnose a dorsal paramedian hernia on the side of a smaller chord value.

The technical result is to provide objective diagnosis of dorsal paramedian hernias of the lumbar intervertebral discs, to establish the exact localization of the pathological process in the form of dorsal paramedian hernias of the lumbar intervertebral discs, to improve the quality of the study, as well as to provide the possibility of establishing control of treatment results in the presence of dorsal paramedian hernias of the lumbar intervertebral discs.

An objective diagnosis of dorsal paramedian hernias of the lumbar intervertebral discs is provided by analyzing the ultrasound image of the spinal canal at the level of the lumbar spine, measuring the anteroposterior size of the chord of the circumference of the spinal canal drawn through a point corresponding to ^1/2 _{of the} radius of the circumference of the spinal canal to the right and left, calculate the asymmetry value, if the asymmetry value exceeds 4.36 ± 0.44 mm, a dorsal paramedian hernia is diagnosed on the side e chord smaller value.

The establishment of the exact localization of the pathological process in the form of dorsal paramedian hernias of the lumbar intervertebral discs is ensured by accurate visual determination of the spinal canal at the level of the lumbar spine, as well as accurate measurements of the chords of the circumference of the spinal canal in accordance with the claimed method.

Improving the quality of research is provided by the ability to diagnose dorsal paramedian hernias of the lumbar intervertebral discs by polyposition ultrasound scanning in real time.

Ensuring the possibility of establishing control of treatment results in the presence of dorsal paramedian hernias of the lumbar intervertebral discs is achieved by conducting multiple determinations of the presence of dorsal paramedian hernias of the lumbar intervertebral discs.

The asymmetry value of 4.36 ± 0.44 mm, beyond which a dorsal paramedian hernia is diagnosed on the side of a smaller chord value, is optimal based on experimental data on multiple measurements of the anteroposterior size of the spinal cord chord drawn through a point corresponding to ^1/2 _{of the} radius the circumference of the spinal canal in healthy patients on the right and left and in patients with dorsal paramedian hernias of the lumbar intervertebral discs on the side of the presence of a hernia and on the ozhnoy (contralateral) side (see. the clinical examples).

The present invention is illustrated by drawings, where figure 1 shows a General diagram for the diagnosis of dorsal paramedian hernias of the lumbar intervertebral discs, which implements a method for the diagnosis of dorsal paramedian hernias of the lumbar intervertebral discs; figure 2 - scheme for determining the chord of the circumference of the spinal canal drawn through a point corresponding to ^1/2 _{of the} radius of the circumference of the spinal canal; figure 3 is an ultrasound image of the spinal canal at the level of the intervertebral disc L4-L5 in a healthy patient; figure 4 is an ultrasound image of the spinal canal at the level of the intervertebral disc L4-L5 in a patient with a left-sided dorsal paramedian hernia of the disc L4-L5; figure 5 presents a table that shows the measurement parameters of the spinal canal (anteroposterior size of the chord of the circumference of the spinal canal drawn through a point corresponding to ^1/2 _{of the} radius of the circumference of the spinal canal) at the level of the lumbar spine in healthy and patients with dorsal paramedian hernias of the intervertebral lumbar discs.

Figure 1 is additionally indicated: 1 - ultrasonic scanner; 2 - electronic convex sensor. Figure 2 is additionally indicated: 3 - lumbar vertebra; 4 - intervertebral disc; 5 - spinal canal; 6 - the center of the spinal canal; 7 - horizontal diameter of the spinal canal; 8 - chords of the circumference of the spinal canal, drawn through points corresponding to ^1/2 _{of the} radius of the circumference of the spinal canal) on the right and left. Figure 4 is additionally indicated: 9 - left-sided dorsal paramedian hernia of the intervertebral disc L4-L5. Figure 5 is additionally indicated: M - arithmetic mean; m is the standard error; n is the number of patients in the study group; an asterisk (*) -differences in healthy and sick, as well as in patients on the side of hernia presence and the opposite side are significant (P <0.05; P-significance of differences with the group of healthy individuals or the contralateral side in patients).

The method of ultrasound diagnosis of dorsal paramedian hernias of the lumbar intervertebral discs is as follows. Perform real-time polypositional ultrasound scanning, determining the anteroposterior size of the spinal canal by determining the size of the chord of the circumference of the spinal canal drawn through a point corresponding to ^1/2 _{of the} radius of the circumference of the spinal canal on the right and left, calculate the asymmetry value, while if the asymmetry value exceeds 4, 36 ± 0.44 mm, a dorsal paramedian hernia is diagnosed on the side of a smaller chord value.

An example of a specific implementation of the method. The proposed method for diagnosing varicose anterior radicular veins of the lumbar spine (Fig. 1) is implemented on an ultrasound scanner 1, for example, Aloka 4000 from Aloka, Japan, having an electronic convex sensor 2, for example, with a varying operating frequency of 2-6 MHz. The electronic convex sensor 2 is connected to the ultrasound scanner 1. The ultrasound scanner 1 allows you to get an image of the spinal canal, intervertebral disc. During the study, the patient should be supine. An ultrasonic gel is applied to the scanning surface of the electronic convex sensor 2, and then it is placed on the patient’s skin in the suprapubic region along the midline of the abdomen. In this case, the scanning plane is perpendicular to the longitudinal axis of the spinal column. The spinal canal 5 of the lumbar is visualized at the level of the intervertebral discs 4. The image is fixed. Through the center of the spinal canal 6 carried horizontal diameter of the spinal canal 7. After a point corresponding to _^half the radius of the circumference of the spinal canal (or the _^fourth diameter of the spinal canal 7) carried chords of the spinal canal 8 in the anteroposterior direction. Measure the chords of the circumference of the spinal canal 8 on the right and left. Analyze the obtained measurement results, calculate the magnitude of the asymmetry. If the asymmetry value exceeds 4.36 ± 0.44 mm, a dorsal paramedian hernia is diagnosed on the side of a smaller chord value.

Clinical examples

1. Study of healthy patients on the possible presence of dorsal paramedian hernias of the lumbar intervertebral discs

In accordance with the claimed method, a group of practically healthy patients (38 people) aged 18 to 32 years was investigated. When examining the claimed method of a group of healthy patients, the spinal canal 5 on the monitor of the ultrasound scanner 1 was visualized in the form of a circle. Signs of prolapse (protrusion) of the vertebral intervertebral discs 4 were not determined. A typical image of the spinal canal 5 at the level of the intervertebral disc L4-L5 in a healthy patient is presented in Fig.3. When determining the anteroposterior size of the chord of the circumference of the spinal canal drawn through a point corresponding to ^1/2 _{of the} radius of the circumference of the spinal canal 8, it was 12.8 mm on the right and 12.8 mm on the left, without asymmetry. The results of the study of a group of healthy patients are presented in the table in figure 5.

2. Diagnosis of dorsal paramedian hernias of the lumbar intervertebral discs in patients with osteochondrosis complicated by hernias of the lumbar intervertebral discs.

Patient L., 36 years old, diagnosis: osteochondrosis of the lumbar spine, disc herniation L4-L5. The patient underwent a study of the lumbar spine by magnetic resonance imaging (MRI). Conclusion - left-sided paramedian disc herniation L4-L5 5 mm. In the study of this patient by the claimed method, the anteroposterior dimensions of the chords of the circumference of the spinal canal are drawn through points corresponding to ^1/2 _{of the} radius of the circumference of the spinal canal 8. These measurements were 8.9 mm on the right, 5.2 mm on the left, asymmetry - 3.7 mm These indicators make it possible to diagnose the presence of a patient with left-sided dorsal paramedian hernia of the L4-L5 disk. In addition, the results of measurements of the right chord are less than those obtained in healthy patients. This indicates a protrusion of the posterior part of the intervertebral disc L4-L5.

We studied a group of patients consisting of 29 people aged 19 to 46 years, 25-49 years old) with previously installed dorsal paramedian hernias of the lumbar intervertebral discs (mainly at the level of L4-L5 or L5-S1) using MRI. The results of these studies are presented in the table in figure 5.

The application of the proposed method was effective in the study of 27 people (93.1%). The size of hernial protrusion determined using MRI and the proposed method was comparable. The strangeness revealed by various methods of hernias was appropriate. In two patients, the presence of hernial protrusion at the level of the L5-S1 intervertebral disc was accompanied by spondylosis. The phenomena of spondylosis, characterized, in particular, by a decrease in the height of the intervertebral disc, significantly impede the ultrasound diagnosis of the condition of the intervertebral discs and the spinal canal.

Thus, the use of the present invention allows for the objective diagnosis of dorsal paramedian hernias of the lumbar intervertebral discs, to establish the exact localization of the pathological process in the form of dorsal paramedian hernias of the lumbar intervertebral discs, to improve the quality of the study, and also to enable the monitoring of treatment results in the presence of dorsal paramedian hernias of the lumbar intervertebral discs drives.

The inventive method can be applied in departments of ultrasound diagnostics, specialized cabinets of ultrasound diagnostics, for the diagnosis of dorsal paramedian hernias of the lumbar intervertebral discs. A method for the diagnosis of dorsal paramedian hernias of the lumbar intervertebral discs provides a small investment of time for its implementation.

Claims (1)

The ultrasonic diagnostic dorsal paramedian herniation lumbar intervertebral disc comprising polypositional ultrasound in real time, determining the anterior-posterior size of the spinal canal, characterized in that the determined anteroposterior size chord spinal canal circle drawn through the point corresponding to _^half the radius of the circumference of the spinal canal right and on the left, the asymmetry value is calculated, while if the asymmetry value exceeds 4.36 ± 0.44 mm, d rzalnuyu paramedian hernia smaller value on the side of the chord.

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