Author/Editor		Zidar, Janez; Knific, Jernej
Title		Sodobne diagnostične preiskave pri bolniku z radikulopatijo
Translated title		Diagnostic tests for assessing patients with radiculopathies
Type		članek
Source		Zdrav Vars
Vol. and No.		Letnik 39, št. 7-8
Publication year		2000
Volume		str. 160-4
Language		slo
Abstract		Radicular pain characteristically radiates from the involved spinal region into the corresponding sensory dermatome and is aggracated by manoeuvres that increase the intraspinal pressure and strech the affected root. It is ususally accompanied by objective demonstration of sensory loss and the presence of motor weakness. Diagnosis is largely clinical. Laboratory methods (neuroimaging, electrophysiology) that confirm the clinical impression are applied when surgery is planned or in cases when other causes of pain are to be ruled out. Basic radiograms are rarely helpful and are in practice overused. In our hospital computerised tomographic (CT) myelography is still the most frequently utilised, while in recent years, magnetic resonance imaging (MRI), which is not painful, is becoming more prevalent. It is, however, inferior to CT scans. Most recently, MRI with myelography has gained importance and, in the developed countries, it already represents the first and often the only test to confirm clinical diagnosis. At presebt, the most sensitive test for substantiating possible root affection is contrast enhanced MRI. Classifical MRI scans are unfortunately not specific and detect abnormalities also in 33-52% of asymptomatic subjects. On the other hand, MRI cannot confirm all types of radiculopathies (e.g. diabetic, inflammatory, paraneoplastic). Because of these MRI limitations there is a definite role of needle electromyography (EMG) in the work-up of radiculopathy. In contrast to MRI which reveals structural abnormalities, EMG identifies physiological abnormalities. It is indicated in cases when MRI is unrevealing, when there is a discrepancy between the MRI and clinical findings, and in cases when radiculopathy cannot be differentiated clinically from plexopathy or mononeuropathy. And, of course, when neuroimaging is not available.
Summary		Na radikulopatijo pomislimo pri bolečini, ki s hrbta seva v ustrezen dermatom, se poslabša s postopki, ki zvušajo intraspinalni tlak ali nategnejo živčno korenino, in jo spremljajo motnje občutkov ter oslabelost tistih mišic, ki jih oživčuje prizadeta korenina. Klinična diagnoza je pogosto prepričljiva. Preden začneno diferentnejše (operativno) zdravljenje in v vseh dvomljivih primerih primerih pa je diagnozo prizadetosti živčnih korenin treba preveriti z dodatnimi laboratorijskimi preiskavami. V ta namen so uporabne predvsem slikovne in elektrofiziološke preiskave. Med slikovnimi preiskavami velja omeniti rentgenogram hrbtenice, predvsem zato, ker je ta preiskava mnogokrat napovedna in zato prepogosto uporabljena. Pri nas sta najpogosteje uporabljeni preiskavi lumbosakralna radikulografija in mielografija - obe s računalniško tomografijo. V zadnjih letih vse pogosteje uporabljamo nebolečo konvencionalno magnetno resonanco (MR), ki ao mielografiji ni povsem enakovredna; novejši magnetnoresonančni tomografi omogočajo mielografijo z MR. V bogatejših državah je to prva in lahko edina preiskava, s katero potrdijo klinično diagnozo. Prizadetost korenin najzanesljiveje pokažemo z MR s kontrastom. S konvencionalno MR pogosto odkrijemo degenerativne spremembe na hrbtenici in na medvretenčnih diskih tudi pri asimptomatskih preiskovancih (33-52%), nekaterih vrst radikulopatij (npr. vnetnih, diabetičnih ali paraneoplastičnih) pa, nasprotno, ne zaznamo. V takih primerih je koristna elektromiografija (EMG). V nasprotju z MR, ki zazna strukturne, EMG zazna fiziološke okvare. Indiciran je, kadar je izvid MR normalen, kadar so med kliničnim in inzvidom MR razlike in kadar radikulopatije klinično ne moremo razlikovati od pleksopatije ali mononevropatije. Seveda pa tudi vedno, ko MR ni na voljo.
Descriptors		RADICULITIS SPINE MYELOGRAPHY MAGNETIC RESONANCE IMAGING TOMOGRAPHY, X-RAY COMPUTED ELECTROMYOGRAPHY