A Comparative Study of Neurologic Characteristics and Surgical Findings in Lumbar Disc Hernia

Abstract

The purpose of this study is to determine the diagnostic value of various methods used in the present-day diagnosis of lumbar disc hernias (myelography, computer tomography and intrathecal contrast computer tomography (myelo-computertomography or myelo-T) by comparison with surgical findings and to correlate retrospectively the most practical and beneficial methods with the result of surgery and, consequently, compare them with the findings in patients who have lower back pain and who are diagnosed as suffering from lumbar disc hernias. We have compared retrospectively the result of myelography, computer tomography, and myelocomputer tomography with the result of surgical intervention, in 130 patients who were diagnosed as suffering from lumbar disc hernias and who were operated between January 1985 and December 1987. We observed that the results were not consistent with those found at surgery in 5 out of 27 cases where CT and myelo-CT were compared, in 20 out of 109 cases where myelography and CT were compared, and in 9 out of 48 cases where myelography and myelo-CT were compared. We have established that the correct diagnosis was obtained by myelography in 87% of the cases, by CT in 89% of the cases and by myelo-CT in 91.6% of the cases and in cases where there was no likelihood of error. However, the results we obtained were not statistically significant. We have concluded that, in cases where bulging is observed, and in which CT is proved inefficient (in cases of spondylolystesis, degenerative disc disorder, and calcified disc disease), myelography and myelo-CT should be performed together as a complementary method. We believe that direct surgical intervention should be adopted for patients who are diagnosed clinically as suffering from lumbar disc hernia, and in whom protruded disc is visualized in CT, and that, in suspected cases, these three examinations should be carried out together before making a decision as to the surgical intervention.