Lumbar disk herniation: diagnosis with CT or myelography

Area of Science:

• Radiology
• Neurosurgery
• Orthopedics

Background:

• Computed tomography (CT) and myelography are established diagnostic tools for radiating leg pain due to lumbar disk herniation (LDH).
• Uncertainty remains regarding the optimal use of CT versus myelography, including their combination and sequence in diagnostic workups.

Purpose of the Study:

• To compare the diagnostic performance of CT and myelography in patients with suspected lumbar disk herniation (LDH).
• To establish an evidence-based sequential diagnostic workup for radiating leg pain.

Main Methods:

• Retrospective evaluation of CT scans and myelograms from 461 patients with symptoms of lumbar root compression.
• Comparison of imaging results with surgical findings when available.
• Analysis of sensitivity, specificity, and positive predictive values for both imaging modalities.

Main Results:

• Myelography demonstrated higher sensitivity (82%) than CT (73%) for detecting lumbar disk herniation (LDH).
• CT exhibited superior specificity (77%) compared to myelography (67%).
• Positive predictive values were comparable, with CT at 94% and myelography at 93%.

Conclusions:

• CT is a highly specific imaging technique for lumbar disk herniation (LDH), comparable to myelography in positive predictive value.
• A diagnostic workup prioritizing CT could significantly reduce the number of myelographic procedures required.
• CT can serve as an effective initial investigation for patients with radiating leg pain suspected to be caused by lumbar disk herniation (LDH).