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  • 1
    ISSN: 1432-0932
    Keywords: Discographie ; Discomanométrie ; Disque intervertébral. Rachis lombaire ; Key words ; Discography ; Discomanometry ; Intervertebral disc ; Lumbar spine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary A new discomanometry system was developed and evaluated for application in the lumbar spine. The diagnostic reliability of discography, manometry and discomanometry (a combination of both methods) was assessed in 20 lumbar cadaver spines (95 intervertebral discs) with regard to the diagnosis of non-contained intervertebral discs. The sensitivity was 92% for manometry and 78% for discography. This indicates that 22% of the non-contained discs could not be correctly identified with common discography. The specificity was 98% for manometry and 100% for discography, indicating that contained discs could be easily identified with both methods. A combination of manometry and discography provides a high sensitivity (98%) as well as high specificity (98%). It is concluded that discomanometry is a simple, cost-effective and reliable diagnostic procedure which can precede percutaneous nucleotomy without additional risks or relevant efforts. It allows the differentiation between contained and non-contained intervertrebral discs with a high degree of diagnostic reliability in an experimental setting, which justifies its further application in patients.
    Notes: Résumé Un nouveau système de discomanométrie a été développé et évalué afin d'être appliqué au rachis lombaire. La fiabilité diagnostique de la discographie, de la manométrie et de la discomanométrie (combinaison des deux méthodes) en matière de hernie discale, a été évaluée sur 20 rachis lombaires de cadavres (95 disques intervertébraux). La sensibilité était de 92% pour la manométrie et 78% pour la discographie. Cela indique que 22% des disques présentant une hernie ne pouvaient pas être identifiés par la discographie de routine. La spécificité était de 98% pour la manométrie et 100% pour la discographie, indiquant que les disques intacts pouvaient être aisément identifiés par les deux méthodes. Une combinaison de la manométrie et de la discographie assure une grande sensibilité (98%) ainsi qu'une haute spécificité (98%). En conclusion, la discomanométrie est un procédé diagnostique simple, économique et fiable que l'on peut pratiquer avant la nucléotomie percutanée sans risques ni efforts supplémentaires importants. Elle permet de distinguer les disques intervertébraux intacts des disques rompus avec une grande fiabilité diagnostique expérimentale, ce qui justifie son utilisation chez les patients.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-0932
    Keywords: Diagnostic imaging ; Lumbar spine ; Bias ; Efficacy ; Technology assessment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This review provides methodological background and some guidelines for the evaluation of imaging modalities for the lumbar spine and reviews the current literature on the basis of different levels of efficacy which consider standards beyond technical quality or diagnostic accurracy. From a MEDLINE search, 672 articles (1985–1995) were retrieved which focused on the development or application of imaging modalities for lumbar spinal disorders. The papers were categorized according to different efficacy levels at which the imaging modalities were assessed. This review has demonstrated that the vast majority of reports evaluate imaging studies for the lumbar spine only at the technical efficacy level. A minor proportion of the articles focus on the evaluation at the level of diagnostic accuracy. Articles which assess imaging studies on a higher level of efficacy (e.g., diagnostic and therapeutic impact, patient outcome and costbenefit analysis) are sparse. This review has outlined frequent methodological flaws in patient selection and design of imaging studies for the lumbar spine. The spine specialist should therefore become very critical in the interpretation of those studies and pay attention to patient selection and spectrum, choice of the reference standard, sample size, various forms of biases, and the reasoning behind clinical recommendations in order to improve his patient care.
    Type of Medium: Electronic Resource
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