Further Observations on the Radiological Diagnosis of Lumbar Intervertebral Disc Lesions

Abstract

The X-ray diagnosis of lumbar disc lesions has lately attracted a good deal of attention and numerous papers on this subject have appeared. The contributions fall into two categories. There are those papers which deal with myelography, and there are the communications such as Dandy (1942–1944) and Gillespie (1946) which regard the use of myelography as unnecessary in the diagnosis of a prolapsed disc. The present studies permit deductions concerning some of the factors on which a reliable straight X-ray diagnosis will depend. The importance of a detailed examination with accurate centring needs stressing, as in the majority of patients three to eight different views are necessary before reliable information can be gained. Without a detailed examination under supervision of the radiologist, the radiologist's opinion will be of limited value to the clinical examiner, and the orthopædic surgeon may well interpret the films more accurately than the radiologist. The two principal findings in straight radiography of lumbar disc lesions are decreased intervertebral space and hypertrophic fringe formation. Dandy (1942–1944) came to the conclusion that over 50 per cent. of his cases can be diagnosed on straight radiography. Similar results were obtained by Gillespie (1946). The study of further cases confirms findings such as the frequency of hypertrophic fringe formation. The 31·2 per cent. of cases showing evidence of decreased intervertebral space can be regarded as a conservative figure and this sign alone may be observed in up to 45 per cent. of all cases with prolapsed disc.