RU2421142C1 - Method of diagnosing dorsal reducable hernia of lumbar intervertebral discs - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to medicine, namely to neurology, vertebrology, ultrasonic diagnostics and can be used for diagnostics of dorsal reducible hernia of lumbar intervertebral discs. By polypositional ultrasonic scanning in real time mode anterior-posterior size of vertebral canal is determined at the level of hernial protrusion of intervertebral disc at rest and when carrying out lumbar traction. Obtained values are compared. If size of vertebral canal at the background of lumbar traction increases by 3.840.50 mm and more, dorsal reducible hernia of lumbar intervertebral disc is diagnosed. ^ EFFECT: method makes it possible to ensure objective diagnostics of dorsal reducible hernia of lumbar intervertebral disc, detect precise localisation of pathological process in form of reducible hernia of lumbar intervertebral disc, increase quality of examination, as well as provide possibility to realise control of treatment results in case if dorsal reducible hernia of lumbar intervertebral disc is present. ^ 3 ex, 5 dwg

Description

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

A known method for the diagnosis of osteochondrosis of the spine (RU 2099010 C1, 1997.12.20) using the method of x-ray. The method is as follows. A lateral radiograph of the spine is carried out after puncture injection of an radiopaque substance (discography) into the cavity of the intervertebral disc (discography), and then, against the background of stretching of the investigated spine, a control lateral radiograph is performed and a correct protrusion is established in the vertebral canal to reduce the amount of protrusion of the disc, and when the protrusion is stable, partial protrusion is established. hernias of the intervertebral disc.

The main disadvantages of the above method are:

- radiation exposure, since the implementation of this method is accompanied by the production of a series of x-ray images (in this case, the patient is exposed to multiple x-rays);

- lengthening the time of diagnosis, since the implementation of this method requires the sequential implementation of a number of operations: preparing a patient, producing radiographs, introducing a radiopaque substance into the cavity of the intervertebral disc, stretching the investigated spine, re-manufacturing the radiographs, developing, fixing and drying the obtained x-ray images, Description of roentgenograms;

- the invasiveness of the method, as for the introduction of contrast medium into the vertebrae, surgical technique is used, including puncture of the skin, vertebra with a needle and the subsequent administration of an radiopaque substance;

- medical manipulation, since a necessary condition for carrying out this method is the introduction of a radiopaque substance directly into the patient’s vertebra. In this case, contrast agents can cause undesirable complications associated with the local effect of the drug-contrast on the bone structures, the vascular bed and the general effect of the drug-contrast on the patient’s body as a whole;

- an increase in the cost of research, since when applying the method of discography, consumables are attracted (contrast, X-ray film, chemical reagents for its processing);

- the presence of a large number of contraindications for carrying out radiopaque studies (including individual intolerance to radiopaque substances, primarily preparations containing iodine);

- in some cases, the lack of objective diagnosis of a correctable hernia of the lumbar intervertebral discs, since in practice the filling of the intervertebral disc with radiopaque material is uneven (especially if the patient has a long degenerative-dystrophic process at the level of the intervertebral disc, one of the manifestations of which is the presence of hernial protrusion )

The prototype is a method of ultrasound diagnosis of herniated discs of the lumbar intervertebral disc (RU 2250076 C2, 2003.03.05). The implementation of the method of ultrasound diagnosis of hernias of the intervertebral discs of the lumbar is achieved by the fact that when conducting an ultrasound scan 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 more than 4 mm due to the "hernial bag "," vacuum phenomenon "- gas in the disk and compression of the nerve roots (asymmetry up to 2 mm at a rate of 5 mm).

However, the implementation of this method does not allow to diagnose correctable hernias 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 to diagnose dorsal adjustable hernias of the lumbar 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 spinal canal at the level of hernial protrusion of the intervertebral disc at rest, and when lumbar traction is performed, the obtained values are compared, while if the size of the spinal canal against the background of lumbar traction increases 3.84 ± 0.50 mm and more diagnose a dorsal adjustable hernia of the lumbar intervertebral disc.

The technical result is to provide objective diagnosis of a dorsal adjustable hernia of the lumbar intervertebral disc, establishing the exact localization of the pathological process in the form of a correctable hernia of the lumbar intervertebral disc, improving the quality of the study, as well as providing the possibility of establishing control of treatment results in the presence of a dorsal hernia of the lumbar intervertebral disc.

An objective diagnosis of correctable hernia of the lumbar intervertebral disc is provided by analyzing the ultrasound image of the spinal canal obtained by real-time polypositional ultrasound scanning, determining the anteroposterior size of the spinal canal at the level of hernial protrusion of the lumbar intervertebral disc at rest and when performing lumbar traction by comparing the obtained values, this, if the size of the spinal canal against the background of lumbar traction increases by 3.84 ± 0.50 mm or more, a dorsal adjustable hernia of the lumbar intervertebral disc is diagnosed.

Establishing the exact localization of the pathological process in the form of a correctable hernia of the lumbar intervertebral disc is ensured by accurate visual determination of the spinal canal at the level of the lumbar spine, as well as accurate measurements of the anteroposterior size of the spinal canal at the level of hernial protrusion of the intervertebral disc at rest and during lumbar traction.

Improving the quality of the study is provided by the ability to diagnose a dorsal adjustable hernia of the lumbar intervertebral disc by accurately quantifying the anteroposterior size of the spinal canal at the level of the dorsal hernial protrusion of the intervertebral disc at rest and during lumbar traction

Ensuring the possibility of establishing control of treatment results in the presence of a hernia of the lumbar intervertebral disc is achieved by conducting multiple determinations of the presence of a dorsal correctable hernia of the lumbar intervertebral disc.

The magnitude of the change in the magnitude of the anteroposterior size of the spinal canal at rest and during lumbar traction, equal to 3.84 ± 0.50 mm, above which a dorsal right hernia of the lumbar intervertebral disc is diagnosed, is optimal based on experimental data on multiple measurements of the anteroposterior size of the spinal canal in patients with dorsal hernia of the lumbar intervertebral disc (see clinical examples).

The invention is illustrated by drawings, where figure 1 shows a General diagram of the diagnosis of dorsal correctable hernia of the lumbar intervertebral disc; figure 2 - scheme for measuring the anteroposterior size 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 patient with a dorsal compressible hernia of the lumbar intervertebral disc at rest; figure 4 is an ultrasound image of the spinal canal at the level of the intervertebral disc L4-L5 in the same patient with the presence of an adjustable hernia of the lumbar intervertebral disc with lumbar traction; figure 5 presents a table that shows the measurement parameters of the spinal canal (anteroposterior size) at the level of the lumbar spine in healthy and patients with dorsal hernias of the intervertebral discs of the lumbar spine at rest and during lumbar traction.

Figure 1 is additionally indicated: 1 - ultrasonic scanner; 2 - electronic convex sensor; 3 - traction table; 4 - belts for fastening the traction table; arrows indicate the direction of traction load. Figure 2 is additionally indicated: 5 - lumbar vertebra; 6 - intervertebral disc; 7 - spinal canal; 8 - anteroposterior size of the spinal canal; 9 - dorsal hernia of the lumbar intervertebral disc.

Figure 5 is additionally indicated: M - arithmetic mean; m is the standard error; n is the number of patients in the study group; asterisk (*) - differences in similar parameters in healthy and sick people, as well as in patients in different groups, are significant (P <0.05; P - significance of differences).

A method for the diagnosis of dorsal adjustable hernia of the lumbar intervertebral disc is as follows. A real-time polypositional ultrasound scan is performed, determining the anteroposterior size of the spinal canal at the level of hernial protrusion of the intervertebral disc, determining the anteroposterior size of the spinal canal at rest, and when lumbar traction is performed, the obtained values are compared, if the size of the spinal canal against the background of lumbar traction increases 3.84 ± 0.50 mm and more diagnose a dorsal adjustable hernia of the lumbar intervertebral disc.

An example of a specific implementation of the method.

The proposed method for the diagnosis of dorsal adjustable hernia of the lumbar intervertebral discs (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 receive an image of the spinal canal, intervertebral disc. During the study, the patient should be in a supine position, on traction table 3, for example ANATOMOTOR from Hill Laboratories Co., USA, having fastening belts 4 connected to the traction mechanism. 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 7 is visualized at the level of the dorsal hernia 9 of the lumbar intervertebral disc 6. The image is fixed. The anteroposterior size of the spinal canal 8 is determined at the level of the dorsal hernia of the lumbar intervertebral disc 9 at rest. Then carry out lumbar traction. The direction of the traction load is from the center of the patient's body to the periphery. Then, an ultrasonic gel is re-applied onto the scanning surface of the electronic convex sensor 2, and 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 7 is visualized at the level of the dorsal hernia 9 of the lumbar intervertebral disc 6. The image is fixed. The anteroposterior size of the spinal canal 8 is determined at the level of the dorsal hernia of the lumbar intervertebral disc 9 during traction. End the process of lumbar traction. Analyze the obtained measurement results, calculate the magnitude of the change in the anteroposterior size of the spinal canal (during lumbar traction). Moreover, if the size of the spinal canal against the background of lumbar traction increases by 3.84 ± 0.50 mm or more, a dorsal adjustable hernia of the lumbar intervertebral disc is diagnosed more.

Clinical examples

1. The study of healthy patients to determine the anteroposterior size of the spinal canal of the lumbar is normal. 34 clinically healthy patients aged 19 to 36 years were examined. When examining the claimed group of healthy patients, the spinal canal 7 on the monitor of the ultrasound scanner 1 was visualized in the form of a circle. Signs of the presence of a dorsal hernia 9 of the lumbar intervertebral disc 6 were not determined. The results of the study of a group of healthy patients are presented in the table in figure 5. The table shows that the anteroposterior size of the spinal canal at the level of the lumbar spine in healthy individuals averaged 15.21 ± 0.89 mm. These data correspond to previously obtained literature. So, according to A.Yu. Kinzersky, D.V. Medvedev and A.L. Buruleva (2001) average dimensions of the lumbar spinal canal L1-L2 - 14.46 ± 0.28 mm, L2-L3 - 14.45 ± 0.25 mm, L3-L4 - 14.91 ± 0.27 mm, L4 -L5 - 14.89 ± 0.26 mm, L5-S1 - 14.61 ± 0.29 mm (Kinzersky A.Yu., Medvedev D.V., Burulev A.L. Ultrasonography of the spine. - Chelyabinsk: “Hieroglyph ", 2001. - P.66. ISBN 5-900094-02-2.)

2. Diagnosis of a dorsal adjustable hernia of the lumbar intervertebral disc. A typical image of the spinal canal 7 at the level of the L4-L5 intervertebral disc in a patient with dorsal hernia 9 of the lumbar intervertebral disc 6 is shown in FIG. 3. The anteroposterior size of the spinal canal is 5.7 mm. Against the background of lumbar traction (standard traction in accordance with the recommendations of such medical procedures), another image of the spinal canal 7 was obtained (shown in Fig. 4). The anteroposterior size of the spinal canal during lumbar traction was 11.7 mm. There was a change in the anteroposterior size of the spinal canal (during lumbar traction) - an increase of 6 mm. In this case, it is possible to diagnose a dorsal adjustable hernia of the lumbar intervertebral disc. We studied a group of patients consisting of 31 people aged 18 to 44 years) with previously installed dorsal 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. In patients of this group, as a result of lumbar traction, an increase in the size of the spinal canal by an average of 3.84 ± 0.50 mm occurred.

3. In addition, we examined a group of patients (30 patients aged 21 to 47 years) with previously installed dorsal 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. In patients of this group, as a result of lumbar traction, an increase in the size of the spinal canal by an average of 0.75 ± 0.74 mm occurred. In this case, it is impossible to diagnose a dorsal correctable hernia of the lumbar intervertebral disc, or to diagnose a dorsal irreducible hernia of the lumbar intervertebral disc.

The inventive method can be applied in departments of ultrasound diagnostics, specialized cabinets of ultrasound diagnostics, for the diagnosis of dorsal correctable hernias of the lumbar intervertebral disc. 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)

A method for diagnosing a dorsal correctable hernia of the lumbar intervertebral discs, including real-time polypositional ultrasound scanning, determining the anteroposterior size of the spinal canal at the level of hernial protrusion of the intervertebral disc, characterized in that the anteroposterior size of the spinal canal at rest is determined and the values obtained are compared when lumbar traction is performed, if the size of the spinal canal against the background of lumbar traction increases by 3.84 ± 0.50 mm or more, the diagnosis dorsal adjustable hernia of the lumbar intervertebral disc.

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