Lumbar disk herniation and canal stenosis: value of intraoperative sonography in diagnosis and surgical management.

Full Abstract

One hundred four patients with preoperative diagnoses of lumbar canal stenosis, disk herniation, or a combination of both were evaluated with intraoperative sonography with the intent of (1) describing the sonographic characteristics of herniated disks and distinguishing these from bulging anuli, epidural fat, scar tissue, and spondylolisthesis; (2) establishing criteria for adequate decompression of canal stenosis; and (3) determining the usefulness of sonography in monitoring disk removal. Disk material demonstrates medium echogenicity, different in its sonographic features from bone, epidural fat, scar tissue, and epidural veins. A sonographic diagnosis of disk herniation was made in 43 cases, 41 of which were confirmed during surgery. Sonography established the presence or absence of disk herniation (confirmed by surgery) in 14 of 19 patients who had equivocal preoperative findings. After routine diskectomy, residual disk material was found in 17 (41%) of 41 patients, which led to further surgery in 16 patients with removal of the additional disk fragments. In 84 patients undergoing decompressive surgery for canal stenosis, sonography detected residual canal compression in 19 (23%), which led to a widened decompression in 15 of these patients. Sonography can differentiate disk material from other normal or abnormal structures in the canal; therefore, sonographic monitoring helps to ensure adequate bony decompression and complete diskectomy. We conclude that intraoperative sonography is an important tool in the surgical management of lumbar disk disease and stenosis.

Author information

Author/s: Montalvo, B M (BM); Quencer, R M (RM); Brown, M D (MD); Sklar, E (E); Post, M J (MJ); Eismont, F (F); Green, B A (BA);

Affiliation: Department of Radiology, University of Miami School of Medicine/Jackson Memorial Medical Center, FL 33101.

Journal and publication information

Publication Type: Journal Article

Journal: AJR. American journal of roentgenology (AJR Am J Roentgenol), published in UNITED STATES. (Language: eng)

Reference: 1990-Apr; vol 154 (issue 4) : pp 821-30

Dates: Created 1990/04/18; Completed 1990/04/18; Revised 2008/02/15;

PMID: 2107683, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

External Links for this article
(including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.