Myelographic differentiation of bulging disk from herniated disk
10.3348/jkrs.1986.22.5.722
- Author:
In Sup SONG
;
In Dong SEUNG
;
Kun Sang KIM
- Publication Type:Original Article
- MeSH:
Clothing;
Congenital Abnormalities;
Humans;
Intervertebral Disc Displacement;
Laminectomy;
Low Back Pain;
Metrizamide;
Myelography;
Spine
- From:Journal of the Korean Radiological Society
1986;22(5):722-732
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Among the many causes producing lower back pain herniated nucleus pulposus and bulging disk have occupiedlarge percentaages and uniformly showed defect on lateral aspect of contrast filled thecal sac. But it isessential to differentiate each conditions from the other because of their different treatment methods.differentiation at metrizamide myelography between a diffusely bullging disk(unlikely to cause nerve rootcompression) and a herniated disk is based on the curature, extent, and multipllicity of the extradural deformityof the anterolateral margin of the contrast filled sac and o hte presence of fusiform widening of the most distalpart of the affected nerve root. The deformities caused by a bullging disk are round, usually symmetrical(aothoughoccasionally more prominent on one side), do not extend above or below the disk space, and can show multiple levelinvolvement; the nerve root is uniform in caliber and normal in size(although some of severe bulging show fusiformwidening of the most distal part of the affected nerve root). The deformities caused by a herniated disk isangular and extends cephalad and/or caudal to the level of the disk space; the affected nerve root is usuallywidened in its most distal visible part. A consecutive series of 50 patients with low back pain and no pasthistory of back surgery who did metrizamide myelography underwent spine CT and /or laminectomy. Using the criterialisted above for differentiation of bulging from herniated disk on metrizamide myelography, the myelographicdiagnosis was correct in 32(22 patients) of 34(24 patients) (95%) surgically and/or computed tomographicallyconfirmed bulging disks and in all 26 (100%) surgically and/or computed tomographically confirmed herniated disks.
