Validity of Repeated MRI in Degenerative Lumbar Disease with Conservative Management

Ju-Oh Kim; Bong-Ju Park; Byung-Wan Choi; Kyung-Jin Song; Byung-Ryeul Choi; Yun-Hyeok Yang

doi:10.4055/jkoa.2009.44.6.604

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Kim, Park, Choi, Song, Choi, and Yang: Validity of Repeated MRI in Degenerative Lumbar Disease with Conservative Management

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2009; 44(6): 604-612.

Published online: 21 December 2009

DOI: https://doi.org/10.4055/jkoa.2009.44.6.604

Validity of Repeated MRI in Degenerative Lumbar Disease with Conservative Management

Ju-Oh Kim, M.D., Bong-Ju Park, M.D., Byung-Wan Choi, M.D., Kyung-Jin Song, M.D.^*, Byung-Ryeul Choi, M.D.^*, Yun-Hyeok Yang, M.D.

Department of Orthopedic Surgery, Gwang-Ju Veterans Hospital, Gwangju, Korea.

^*Department of Orthopedic Surgery, College of Medicine, Institute for Medical Sciences, Chonbuk National University Hospital, Jeonju, Korea.

Correspondence to Byung-Wan Choi, M.D. Department of Orthopaedic Surgery, Gwang-Ju Veterans Hospital, 887-1, Sanwoldong, Gwangju 506-705, Korea. Tel: +82.62-602-6162, Fax: +82.62-602-6989, alla1013@naver.com

Received 15 June 2009 Accepted 1 October 2009

Abstract

Purpose

This study examined the value and indications of repeated MRI in degenerative lumbar diseases under conservative management by comparing the primary MR and repeated MR images with respect to the symptomatic and radiological changes.

Materials and Methods

Seventy patients with degenerative lumbar disease under conservative management underwent repeat MRI. Five MRI findings, including disc, foramen, facet joint, nerve root, and ligamentum flavum, were used to examine the difference between the initial and repeat MRI. The severity was graded using a four-point scale for each item. The patients were divided into 3 groups in order to compare the radiological changes and symptomatic changes, as follows; Group I no change from the initial symptoms (38 cases), Group II aggravation of the initial pain (18 cases), and Group III aggravation of the initial neurology or the development of a new neurology (14 cases).

Results

The mean scores of each item the disc, foramen, facet joint, nerve root and ligamentum flavum increased from 1.76, 1.31-1.79, 1.71, and 1.47, respectively, to 1.90, 1.47, 1.80, 1.79, and 1.53, respectively. Group III showed the greatest proportion of cases with an increasing grading score (78%, 11 cases) only the disc was significant.

Conclusion

Repeat MRI in degenerative lumbar disease under conservative management was found to be valuable only in cases with aggravated neurological symptoms, and was not relevant in cases with persistent symptoms or aggravated pain alone.

Keywords: Degenerative lumbar disease, Repeat MRI, Validity

Figures and Tables

Fig. 1

The seventy-three year old male performed repeat MRI on 7 months interval due to Rt. sciatic symptom and motor weakness aggravation (Group III). The grading scores of each parameter were increased from disk 2, foramen 2, facet joint 2, and nerve root 2, ligamentum flavum 1 (A, B) to 3, 3, 2, 3, 1 (C, D) respectively.

Fig. 2

The fifty-nine year old male performed repeat MRI on 14 months interval due to the symptom persistent (Group I). The grading scores of each parameter were decreased from disk 3, foramen 1, facet joint 1, and nerve root 3, ligamentum flavum 1 (A, B) to 2, 1, 1, 2, 1 (C, D) respectively.

Table 1

Demographic Data of the Patients

^*Lower Back Pain; ^†ANOVA test; ^‡chi-square test.

Table 2

Assessment Scale and Grading

Table 3

Number of Cases that Showed Increased Grading Score according to Symptom Change

^*some cases showed increased grading scale in more than one item.

Table 4

Change of the MRI Grading according to Symptom Change

^*analysed using the data of (B-A).

Table 5

Number of Cases that Showed Increased Grading Score according to Diagnosis

^*some cases showed increased grading scale in more than one item.

Table 6

Change of the MRI Grading according to Diagnosis

^*analysed using the data of (B-A).

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