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Minerva Medica 2005 February;96(1):41-60


language: English, Italian

The value of computed tomography in the diagnosis of low back pain. A review of 2012 cases

Scutellari P. N., Rizzati R., Antinolfi G., Malfaccini F., Leprotti S., Campanati P.


Aim. The aim of this study was to establish the effective role of CT in the diagnosis of low back pain, and whether CT features correlate with clinical signs and symptoms.
Methods. Two thousand and twelve consecutive patients, of which 866 males and 1 146 females, aged 22 to 91 years, affected by generic painful back, have been studied in the period between January 2000 and October 2002. Volumetric CT of the lumbo-sacral column was performed on all the patients, employing a Philips Tomoscan SR 7000 (Eindhoven, The Netherlands). Sections of 3 mm in thickness were obtained, employing window and level of window both for bone and soft tissues. Contrast medium was not injected.
Results. Regarding the distribution of lesions, 172 males were affected by one, 586 from 2 to 4, 102 more than 4 lesions; 6 subjects were without. On the contrary, 196 females had a single lesion, 611 from 2 to 4, 331 more than 4 and 8 did not have any one. In females, the age group most involved is encompassed between 51 and 80 years; the more frequent alterations, in decreasing order, were: bulging disc, synovial facet syndrome, disc herniation and vacuum phenomenon. In males incidence age related and frequency of various pathologies were overlapped to that observed in females; however the incidence of disc herniation in males is greatest between 41 to 50 years.
Conclusion. Low back pain, with or without radiation to the sciatic and femoral nerves, is one of the most common diseases, involving approximately 2/3 of the adult population sooner or later in life. Anatomically the center of pain is the lumbar column (from L3 to L5), the lumbo-sacral junction, the sacrum, the sacro-iliac joints, and the sacral-coccygeal region. Generally, it is a benign syndrome; however, since a pathologic condition is recognized in 15% of cases, then this condition must always be diagnosed. The list of events producing lumbar pain seems to be endless: therefore differential diagnosis must be based on appropriate anatomic and etiologic factors, also considering that pathogenesis (due to mechanical, compression, inflammatory, and neuropathic factors) is directly influenced by social and psychologic factors. Initially a conventional X-ray was used for the diagnosis of images, subsequently, arthrography and myelography were used; today CT is useful in the detection of bone and soft tissue structures, especially using multiplanar reformatted images. It is a noninvasive procedure that usually reveals the cause of radicular compression and demonstrates lateral and intraforaminal pathologic condition well. MRI represents the last technical development. The characteristics of all these techniques are such as to achieve a full diagnosis. Their reconciled use is in relation to the current clinical question, and it also depends on various considerations, not only technical matters, but availability of equipment and costs too, even if conventional radiography must always precede every other survey.

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