Diskojenik bel ağrısında diskografinin tanısal değeri

Amaç: Lomber diskografi dejeneratif disk hastalığının tanısında popüler hale gelmiştir. Diskografi temelde dejeneratif disk hastalığına bağlı semptomatik disk seviyesini göstermek için kullanılmaktadır. Bu çalışmanın amacı diskojenik bel ağrılarının tanısında diskografinin etkinliğini ortaya koymaktır. Gereç ve Yöntem: Diskojenik bel ağrısı olan 42 olguda 61 seviyeye diskografi yapılmıştır. Diskografinin sonucu Modifiye Dallas Sınıflamasına göre, ağrının şiddeti ise VAS ölçeğine göre incelenmiştir. Bulgular: Olguların 31ʼinde (% 74) diskografi pozitif, 11ʼinde (% 26) negatif olarak değerlendirilmiştir. Diskografi iki seviyede (% 3,2) I. derece, dokuz seviyede (% 14,7) II. derece, beş seviyede (% 8,1) III. derece, 15 seviyede (% 24,5) IV. derece ve 30 seviyede (% 49,1) V. derece olarak değerlendirilmiştir. Diskografi 32 seviyede (% 52,4) ağrıya neden olmuştur. Diskografi pozitif olarak değerlendirilen 18 hasta opere edilmiştir. 17 (% 94,4) olguda VAS ölçeklemesine göre bel ağrısında düzelme azalma belirlenmişken, bir olguda (% 5,6) ağrıda değişiklik olmamıştır (p0.05). Diskografisi negatif olan 11 olgunun (% 26.2) tümünde konservatif tedavi uygulanmıştır. Konservatif tedavi ile hastaların ağrı düzeylerinde 6 hastada (% 53) artış, 3 hastada (% 27) azalma ve 2 hastada (%20) ise aynı düzeyde kalmıştır (p>0.05). Sonuç: Çalışmamız diskografinin diskojenik bel ağrılarının tanısında etkin olduğunu ortaya koymaktadır

The roleof discography in diagnosis of discogenic low back pain

Objective: Lumbar discography has been popular diagnostic tool in degenerative disc disease. It is mainly used to identify symptomatic disk level in discogenic low back pain. The aim of this study is to study diagnostic value of discography in patients with discogenic lower back pain. Materials and Methods: 61 levels lumbar discographies were performed in 42 cases with discogenic low back pain. Results of discography were graded according to Modified Dallas Classification. Pain severity was assessed using VAS score. Results: Discography was evaluated as positive in 31 cases (74 %), and negative in 11 cases (26 %). Discography was assessed as grade I two levels (3.2 %), grade II in nine levels (14.7 %), grade III in five levels (8.1 %), grade IV in 15 levels (24.5 %), and grade V in 30 levels (49.1 %). Discography provoked pain in 32 levels (52.4 %). Eighteen patients with positive discography were operated. While improvement/reducing of the low back pain VAS score was observed in 17 cases (94.4 %), no change was observed in one case (5.6 %) (p<0.05). When 13 patients who were not operated despite the positive discography are considered, three (23 %) of these experienced worsening of the low back pain VAS, six (46 %) had no change in VAS score, and four (31 %) had improvement in the low back pain VAS (p>0.05). Conservative therapy was administered to all the 11 cases (26.2%) with negative discography results. With the conservative therapy, increases in pain level were observed in 6 patients (53%), reducing of the pain was observed in 3 patients (27%), and level remained the same in 2 patients (20%). Conclusion: Discography was found to be effective in diagnosis of discogenic low back pain.

Kaynakça

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