The research was carried out in Clinical Diagnostic Centre and included 25 patients from 25 to 35 years old with degenerative-dystrophic lumbar vertebral changes (stages III,
IV,
V,
according to Pfirrmann classification).
The patients had long-lasting,
over four months,
intractable or relapsing pain syndrome.
In 10 cases it was caused by foraminal and paramedian hernias,
in 15 cases - by protrusions of 4-5mm.
All the patients had their lumbar spines MRT-scanned in standard regime and MSCT-scanned in DE regime before surgical intervention and 6 months after the rigid or dynamic fixing constructions having been implanted.
Correspondingly,
the patients were divided into 2 groups.
The 1st group included 13 patients with dynamic fixation of VMS L4-L5,
L5-S1 and L4-L5-S1.
The 2nd group included 12 patients with TLIF and rigid fixation of VMS L4-L5,
L5-S1 and L4-L5-S1.
The degenerative-dystrophic changes (DDC) of facet joints,
disks and vertebral bodies were analyzed and compared including anatomic structure data before and after VMS having been fixed.
Before and after surgical intervention MSCT was made in DE regime on the apparatus GE Discovery 750HD with submillisecond switching voltage 80kV-120kV,
by means of 0,625mm slices. The DDC were measured according to the classic X-ray pictures of VMS during the DE scanning.
MSCT saw the following typical DDC symptoms in VMS:
- Density and thickness,
thickness evenness of adjacent VB closing plates; presence and evidence of regional osteophytes.
- Presence of subchondral nodes (Schmorl’s nodes).
- Height of intervertebral space (disc),
disk tissue density,
partials (calcification,
vacuum-effect).
- Density,
thickness and its evenness of facet joint cortical layer.
- Density and structure of facet joint spongy bone,
cyst changes.
- Height of facet joint space.
- Presence and size of bone excrescence in facet boundaries.
- Spondylosis signs within front and back longitudinal ligament.
Disk dehydration and changes in spongy bone of vertebral bodies and facet joints are the most difficult-to-find indexes of VMS degenerative- dystrophic affection,
only defined by the way of DE scanning.
There were estimated such quantity indexes as:
- H2O quantity in disk structures as the index of dehydration and evident degenerative changes of intervertebral disk
- Ca and adipose tissue quantity within spongy bone of vertebral body
- Ca and adipose tissue quantity within spongy bone of facet joint
- Ca and adipose tissue quantity in spine longitudinal muscles
Statistical data were processed with the applied Microsoft Excel,
Statistica 10,0.