Prediction of the Development of Neurogenic Bladder in Patients with Lumbar Disc Herniation.
10.4055/jkoa.2006.41.3.495
- Author:
Jung Sub LEE
1
;
Hyun Jun PARK
;
Won Chul SHIN
;
Kuen Tak SUH
Author Information
1. Department of Orthopaedic Surgery, College of Medicine, Pusan National University, Busan, Korea. kuentak@pusan.ac.kr
- Publication Type:Original Article
- Keywords:
Lumbar spine;
Disc herniation;
Neurogenic bladder;
Anteroposterior diameter of the dural sac;
Saddle anesthesia
- MeSH:
Anesthesia;
Asian Continental Ancestry Group;
Humans;
Intervertebral Disc Displacement;
Low Back Pain;
Lower Extremity;
Magnetic Resonance Imaging;
Sensitivity and Specificity;
Urinary Bladder;
Urinary Bladder, Neurogenic*;
Urodynamics
- From:The Journal of the Korean Orthopaedic Association
2006;41(3):495-503
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: To predict the development of a neurogenic bladder based on an analysis of the clinical and radiological findings in patients with lumbar disc herniations. MATERIALS AND METHODS: Twenty-six patients, who were suspected of having neurogenic bladders, underwent urodynamic testing. The anteroposterior diameters and the cross-sectional areas of the dural sacs at the herniated disc levels were measured by magnetic resonance imaging. Clinically, we evaluated lower back pain, radiating pain, saddle anesthesia, bladder function, motor weakness of the lower limbs, and the Japanese Orthopaedic Association (JOA) score. RESULTS: Thirteen (50%) of the 26 patients were diagnosed with positive neurogenic bladders. The average anteroposterior diameters of the dural sacs in group I (13 cases) with positive neurogenic bladders and in group II (13 cases) with negative neurogenic bladders, were 6.8 (range, 4-9) mm and 9.0 (range, 8-10) mm, respectively (p<0.001). When an anteroposterior diameter of 7 mm was used as the threshold value for differentiation between the anteroposterior diameter of the dural sac and a neurogenic bladder, the sensitivity and specificity were 61.5% and 100%, respectively. The average cross-sectional areas of the dural sacs in group I and group II were 74.9 (range 50-96) mm(2) and 86.2 (range 60-103) mm(2), respectively (p=0.069). When a cross-sectional area of 77 mm2 was used as the threshold value for differentiation between the cross-sectional area of the dural sac and a neurogenic bladder, the sensitivity and specificity were 61.5% and 84.6%, respectively. All 9 patients who had saddle anesthesia were diagnosed with positive neurogenic bladders. However, there was no statistical significance between the preoperative JOA score and the development of a neurogenic bladder. CONCLUSION: The anteroposterior diameter of the dural sac and saddle anesthesia might be important factors in predicting the presence of a neurogenic bladder in patients with lumbar disc herniation.
