Lumbar disc herniation? Check CT is not necessarily accurate!

In the minds of many patients with low back pain, CT examinations are higher, larger, and higher than X-rays. A CT scan of the lumbar spine can confirm the presence or absence of lumbar disc herniation and the severity. In fact, it may not be. Professor Liang De of the Department of Spine, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine pointed out that the symptoms of patients with low back and leg pain are different, the length of the disease is different, and the choice of examination methods is different. Choosing “right” is conducive to the accurate diagnosis of the disease. In most cases, lumbar CT is not recommended as the preferred method of examination for patients with low back pain.

Lumbar disc herniation? Check CT is not necessarily accurate!

CT should not be the first choice for low back pain

Liang De does not recommend lumbar CT as the preferred method of examination for patients with low back pain. However, contrary to this, most patients who are initially seen often carry a CT scan of the lumbar spine. The reason may be that the patient's visiting department is not a spine specialist, and the attending physician is not a spine specialist. Due to the limitations of the specialist knowledge, the understanding of the imaging examination of the spinal disease is not clear, comprehensive and accurate. It is mistaken that the CT examination of the lumbar spine is clear. Diagnostic examination "gold standard".

In addition, there are also reasons for misleading information. Many patients were influenced by some kind of herd mentality, or some unscientific reports from the media, so that the CT examination was the way to find out the diagnosis of the root cause.

There are still quite a few hospitals, there is no MRI equipment, only CT examinations can be provided. Some of the CTs are misdiagnosed or missed due to the aging of the machine and the quality of the image after the filming. Many of the above factors have caused many patients to see the doctor for the first time. Only when doing CT examinations, to some extent, bring some interference to clinical diagnosis and treatment.

Professor Liang De does not advocate lumbar CT as the preferred method of examination for lumbar disc herniation. Because the advantage of lumbar CT examination is to distinguish the lumbar vertebral body, pedicle, joint protrusion and other bone tissue lesions, but the lesions of soft tissue such as intervertebral disc or nerve root can not clearly show the extent of the lesion, and even can not prompt the lesion, For example, intraspinal tumors, etc., resulting in misdiagnosis and missed diagnosis, so patients with low back and leg pain for the initial visit do not advocate too aggressive CT examination of the lumbar spine.

Low back pain, short time, no need to film

Which type of examination should I choose for patients with lumbar disc herniation? Liang De said that it should be determined in light of the specific circumstances of the patient's morbidity, and the method of examination should also be personalized. For example, patients with mild symptoms and low back pain, after treatment, specialists believe that the medical history is clear, the diagnosis is clear, and those who do not need imaging examination can directly perform functional exercise, physical therapy, internal or external medication, and reduce radiation damage. To reduce the economic burden of patients, and at the same time achieve the effect of treating diseases.

MRI can be performed if the symptoms are severe or the course of the disease is long. Long course of disease, typical symptoms, such as low back pain with lower extremity radiation pain, numbness, muscle atrophy, etc. After the treatment, the specialist believes that there is nerve root compression, it is recommended to do lumbar X-ray (positive lateral position, overextension and flexion) and nuclear magnetic Resonance imaging (MRI) examination can evaluate the stability of the lumbar spine structure and clearly show the degree of nerve compression.

Part of the back pain, combined with fatigue of both lower limbs, pain and numbness, difficulty walking, chest and abdomen belt sensation, "walking cotton sensation" when walking, and symptoms quickly aggravated in the short term, should be highly vigilant. Because these symptoms are not caused by simple lumbar disc herniation, but may be due to compression of high nerves above the waist, such as cerebral infarction, cervical and thoracic disc herniation, posterior longitudinal ligament calcification or spinal canal occupying the spinal cord. The above-mentioned symptoms suggest that the preferred MRI examination can clearly show the degree of compression of the spinal nerves and confirm the diagnosis.

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