Ultrasonic diagnosis method for diagnosing hernia of intervertebral disks in lumbar segment

FIELD: medicine.

SUBSTANCE: method involves applying polypositional ultrasonic scanning techniques in real time mode. Echo pattern of thinned fibrous ring to 1 mm or its rupture or anteroposterior vertebral canal size reduction by more than 4 mm, vacuum phenomenon, nerve radix compression with asymmetry more than 2 mm is to be recognized.

EFFECT: high accuracy of non-invasive, non-ionizing primary diagnosis method.

1 dwg

 

The invention relates to medicine, in particular to x-ray diagnostics, and can be used for early diagnosis of intervertebral disk.

There is a method of radiographic diagnosis of herniated intervertebral discs of the lumbar spine (Helly R.L., spit D.U., Simon P.P. Emergency orthopedics. - M.: Medicine, 1995. - S-396). In this way reveals a decrease in the height of the intervertebral space, sclerosis, deformation, and probabaly closing plates of the vertebral bodies, the presence of osteophytes. The disadvantages of this method is the lack of objectivity of the presence of the hernia, the inability deivatives contrasting intervertebral discs, compression of spinal roots and the exposure of patients to x-ray radiation.

The prototype is a method of magnetic resonance imaging of intervertebral discs of the lumbar spine (Choline A.V., Makarov, A., Mazurkiewicz E. Magnetic resonance imaging of the spine and spinal cord. - SPb.: LLC Olga, 1995. - 132 C.), which is harmless to the patient, but not always available for General use and is a costly procedure.

The disadvantages of both methods is a long examination time is from 0.5 to 1.5 hours.

The invention is aimed at early diagnosis of hernias of intervertebral disks, eliminating the beam is o loads, reducing the time of examination of the patients and its cost. Is achieved by the fact that when conducting harmless to the body ultrasound scanning in real-time to detect rupture of the fibrous ring of an intervertebral disc and its thinning to 1 mm, the reduction of the anteroposterior size of the channel by more than 4 mm due to the hernial bag”, "vacuum phenomenon" - the gas in the disk and compression of nerve roots (asymmetry up to 2 mm at a rate of 5 mm).

This technique allows a primary non-invasive and non-ionizing dorentinahetemi diagnosis of early signs of herniation of intervertebral disk at the prehospital stage.

Ultrasound studies of the vertebral body, pedicles of the bodies and the processes are transparent to ultrasonic waves in adults, however, the intervertebral discs and vertebral canal well-conducted ultrasonic waves due to the content of water in their composition and clear the border reflective environments (e.g., bone and liquor).

For studies used the anterior transabdominal method of imaging of the lumbar spine. With this access not only the analysis of intervertebral disk, but the study of the linear dimensions of the spinal canal and to assess its echogenicity as the “acoustic window”.

Studies were performed on ultratv the same scanners “Justvision 400” SSA 325 (Toshiba), Capasee 2” A220 (Toshiba), using convex transducer with a frequency of from 2.0 to 3.75 MHz for the study of the lumbar spine.

Electronic convex probe with an operating frequency of 3.5-3.75 MHz was installed in the sagittal plane above the umbilicus in the midline of the abdomen to visualize the contour images of the front surfaces of the vertebral bodies. In obese patients for the study used electronic sensors with a frequency of 2.0 MHz. Ultrasound guidance for identifying vertebrae was the disk L3-L4is projected onto the navel and the isthmus of the pancreas, the corresponding projection of the body L1vertebra. Loss of imaging in the scanning plane in the suprapubic area corresponded to the disk L5-S1. Further study was conducted in a horizontal plane, visualizing while the fibrous ring and the pulpous nucleus, determining their linear dimensions.

The main hallmark of protrusion from other changes in prepositional the survey was the lack of structural changes of the annulus in the area of the protrusion without local deformation of the Dura.

When the intervertebral disk was detected cleavage of linear structures in the rear contour of the disk with explicit arcuate protrusion of the rear sheet into the spinal canal with astalnim the presence of a hernia gate and directly hernial focus.

As an example, here is a clinical observation.

Sick askin I.D., born in 1972, engineer, turned on outpatient reception in February 2002 about pulling pain in the lumbar-sacral region, worse after exercise. Injury notes. Considers himself ill for 1.5 months, when after the hockey game was a pain in the lumbosacral region. Treated independently (rubbing Fastum-gel without much positive dynamics. Upon examination of the lumbosacral region is not changed. Palpation of the spinous processes moderately painful. Other neurological symptoms are not identified. On the radiograph of the lumbosacral region in two projections was the initial manifestations of osteochondrosis, manifested in the form of sclerosis, reflex records, the inhomogeneity of the vertebral bodies, small marginal osteophytes. Ultrasound scan revealed the cleavage structures of the rear contour of the disk with the arcuate protrusion into the spinal canal for 4 mm and the presence of hernia gate and hyperechoic inclusions (Fig 1, A).

Diagnosed with intervertebral hernia at the level of L4-L5. Patients received a comprehensive course of conservative treatment with pronounced positive effect. Re ultrasound scan in 3 months. otricatelniy dynamics have been identified (figure 1, B).

The method of ultrasonic diagnosis of herniated intervertebral discs of the lumbar spine, wherein at prepositional ultrasound scanning in real-time detect echocardio thinning to 1 mm or rupture of the fibrous ring, the reduction of the anteroposterior size of the spinal canal more than 4 mm “vacuum phenomenon”, the compression of the nerve roots with the asymmetry of more than 2 mm.



 

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