, Jong Oh Kim In order to evaluate clinical significance of MR signal change within vertebral body marrow, we investigated the relationship between signal change of marrow and duration of low back pain, hight of disc, segmental hypermobility, disc degeneration and degree of disc herniation.
We reviewed retrospectively simple radiograph, flexion-extension dynamic radiograph and MR images of the lumber spines(L3-S1) of 100 patients, who underwent discectomy at Ewha Womans University Mokdong Hospital from September 1993 to October 1996.
1) There were Modic type 2 changes in 36 patients of 100 patients(36%) and in 52 segments of 300 segments(17.3%). 2) Average was older in the group with signal change in marrow than in that without signal change. 3) Signal change of vertebral body marrow was not significantly related to duration of low back pain. 4) Decreased disc heght was more frequently found in segments with signal change in marrow than in those without signal chagne. 5) Modic type 2 changes was not related to lumbar segmental hypermobility. 6) Degeneration of disc was more frequently found in segments with signal change in marrow than in those without signal change. 7) Signal change of vertebral body marrow was not directly related to degree of disc herniation.
Signal change of vertebral body marrow in MRI was significantly related to age, disc height and degree of disc degeneration, and it suggests that the marrow change can be induced by response of vertebral body to the changed mechanical environment, which is due to long-standing disc degeneration.
Spinal stenosis is one of the degenerative diseases of spine, and frequently involves several segments. However, symptom may be provided by pathology in only one or two segments. Therefore, it is very important to select symptomatic segments when we treat patients with multilevel stenosis surgically. Decompression may be done limitedly to prevent high morbidity and complications associated with extensive decompression and posterolateral fusion. The purpose of this study is to evaluate the effectiveness of limited decompression of selective segments in spinal stenosis. From September, 1993 to August, 1996, 21 patients who underwent limited decompression of only symptomatic segments, were followed up for more than 1 ysar, and the results were assessed according to the criteria of Kim & Kim. The indications of surgery were definite neurologic symptoms, failure of conservative treatments, and no instability. The segments for operation were chosen by symptom, physical examination and radiographic study, and sometimes root block or electromyography were done in case of necessity. The results were followed as: 4 excellent(19%), 13 good(62%), 3 fair(14%), and 1 poor(5%). 1 superficial wound infection developed and was treated without suquelae. Conclusively, limited decompression of selective segments in multilevel spinal stenosis is considered to be useful if selection of level and extent of decomperssion are carefully determined.
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