Abstract
OBJECTIVE: Early detection of degenerative changes in lumbar intervertebral disc by magnetic resonance imaging in a semiautomatic classifier for prevention of degenerative disease. METHOD: MRIs were selected with a diagnosis of degenerative disc disease or back pain from January to May 2014, with a sample of 23 patients and a total of 170 disks evaluated by sagittal T2 MRI image, first evaluated by a specialist physician in training and them were introduced into the software, being the results compared. RESULTS: One hundred and fifteen discs were evaluated by a programmed semiautomatic classifier to identify MODIC changes and hernia, which produced results "normal or MODIC" and "normal or abnormal", respectively. With a total of 230 readings, of which 141 were correct, 84 were reading errors and 10 readings were undiagnosed, the semiautomatic classifier is a useful tool for early diagnosis or established disease and is easy to apply because of the speed and ease of use; however, at this early stage of development, software is inferior to clinical observations and the results were from around 65% to 60% certainty for MODIC rating and 61% to 58% for disc herniation, compared with clinical evaluations. CONCLUSION: The comparative results between the two doctors were 94 consistent results and only 21 errors, which represents 81% certainty.
Highlights
Until the late twentieth century, it was believed that low back pain was mostly due to overexertion of the muscles and organic changes such as arthrosis, scoliosis, and disc herniation, but scientific studies conducted over the last twenty years have shown that most organic changes of the spine are irrelevant, and do not correlate with the presence of pain, and 80-85% of cases of low back pain are diagnosed as unspecific pathologies due to the absence of any relationship between the results of complementary examinations and the patient’s clinical history.[1]
Degenerative intervertebral disc disease is a common cause of low back pain among spine pathologies, and can be classified into three types based on its duration: Acute, if the symptoms last less than six weeks; Subacute, if they last between six and twelve weeks; and Chronic, when the profile persists for more than 12 weeks.[2]
The readings of a total of 115 discs, previously classified by an orthopedic doctor in training, were compared with readings made by the semiautomatic classifier both for disk disease, using classifications of MODIC or Normal, and for disc herniation, using classifications of either Normal or Abnormal
Summary
The origin of diseases of the lumbar spine, and herniated discs in particular, is still a matter of debate in the scientific world, a multifactorial etiology that includes genetic, degenerative, biochemical, medical, traumatic, and psychosocial factors is accepted.[1]Until the late twentieth century, it was believed that low back pain was mostly due to overexertion of the muscles and organic changes such as arthrosis, scoliosis, and disc herniation, but scientific studies conducted over the last twenty years have shown that most organic changes of the spine are irrelevant, and do not correlate with the presence of pain, and 80-85% of cases of low back pain are diagnosed as unspecific pathologies due to the absence of any relationship between the results of complementary examinations and the patient’s clinical history.[1]Degenerative intervertebral disc disease is a common cause of low back pain among spine pathologies, and can be classified into three types based on its duration: Acute, if the symptoms last less than six weeks; Subacute, if they last between six and twelve weeks; and Chronic, when the profile persists for more than 12 weeks.[2]. Physical inactivity results in a loss of muscle coordination and strength and, in the medium term, the appearance of atrophy and worsening of the initial clinical profile.[1] Subsequent physical disability can sometimes be totally debilitating because it can lead to neurological impairment in our experience, which leads to problems of absenteeism or permanent inability to perform daily activities This is because the diagnosis is based on two-dimensional images and even today remains very subjective, depending on the evaluator, which could lead to its diagnosis being made only in an advanced phase of the disease, when the only treatment is sometimes extraction of the disc and intervertebral fusion as a palliative analgesic measure. We try to identify degenerative changes in the intervertebral disc early, in order to carry out conservative therapeutic intervention that can prolong the functional life of the degenerating disc
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