Saturday, February 14, 2009

The place of Physioanatomic Imaging Approach in treatment of LS spine disorders:

The following should be an algorithmic approach of clinicians working with LS spine disorders.

1. Patient symptoms and history must be evaluated by use of a pain drawing and information sheet.
2. The patient's pain pattern is categorized into a nonspecific pattern or into one of four recognizable pathway patterns (radicular, dorsal ramus, polyneuropathy, and sympathetic). Because each spinal lesion is typically manifested primarily via one of the four symptom pathways, the distribution of expected symptoms from each pathologic feature can be compared with the patient's pain drawing.
3. The patient's presenting symptoms are also used to determine the most cost-effective and efficacious use of initial diagnostic imaging evaluation.
4. In a minority of patients the findings on noninvasive imaging either will not correlate with the patient's symptoms or will demonstrate multiple abnormalities that could account for the patient's symptoms. In these patients, invasive techniques are extremely helpful in defining a pain generator or pain generators.
5. Finally an assessment of the significance of imaged lesions can be made.
What is Physioanatomic (noninvasive and invasive) imaging evaluation?
The goal of physioanatomic (both noninvasive and invasive) imaging evaluation is to increase specificity by differentiating pain generators from asymptomatic underlying pathologic conditions.
Noninvasive Physioanatomic imaging:
1. computed tomography,
2. single-photon emission-computed tomographic bone scan, and
3. magnetic resonance imaging
The above said 3 tests have sigificant diagnostic accuracy in detecting pathologic conditions.
Invasive Physioanatomic imaging:
1. diskography-enhanced computed tomography
2. nerve root block
3. facet block
The physioanatomic imaging approach:
The physioanatomic imaging approach attempts to correlate pathologic changes demonstrated by noninvasive imaging modalities or invasive modalities with the patient's symptoms to evaluate whether the symptoms and the pathologic lesion are concordant or discordant.
The outcome of physioanatomic imaging approach
When used with intensive conservative management and psychologic testing, this physioanatomic approach has been reported to result in much better treatment outcomes.
Impact on disease detection physioanatomic imaging approach:
1. Identification of a 50% prevalence of underlying abnormalities in patients between 20 and 60 years old who have no symptoms.
2. When such patients (as above) have a back injury, subsequent imaging show 50% of population studied abnormalities that are not related to an acute injury.
3. Degeneration of the spine progresses in all patients throughout their lifetime, and nearly all of the population will have back discomfort at some time.
Luers PR; Curr Probl Diagn Radiol. 1992 Sep-Oct;21(5):151-213. Lumbosacral spine imaging: physioanatomic method.

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