Diagnostic Paraspinal Musculoskeletal Ultrasonography

Pain Cure: Diagnostic Testing

Page 2

Debate has developed with respect to the use of diagnostic musculoskeletal ultrasound for inflammatory disorders of the nerve root or spinal facets. This discussion has shifted the focus from less controversial aspects of spinal diagnostic ultrasonography including measurement of spinal canal diameter, paraspinal muscle evaluation, and monitoring of intraoperative spinal decompression. This paper will review the literature with respect to the above, and present a supporting argument for the use of diagnostic musculoskeletal ultrasonography in the evaluation of paraspinal conditions involving ligamentous or muscular strain. A clinical study will be presented where images are correlated to magnetic resonance imaging (MRI), and a case report will be presented.

Keywords: Spine, ultrasonography, muscles, ultrasonography, soft tissues, ultrasonography

1. INTRODUCTION:

Diagnostic musculoskeletal ultrasonography has been in use for medical purposes since the 1940’s when B-mode (brightness mode) introduction allowed for two dimensional representation of the examined tissue to occur. Shades of gray are visualized in a linear gray scale. With digitalization by computers, image quality has improved and soft tissue applications have grown in popularity (1).

*Address correspondence: to Robert G. Schwartz, M.D., Tel.: +1 864 235 1834; Fax: +1 864 235 2486; E-mail: RSDHEAL@aol.com

Journal of Back and Musculoskeletal Rehabilitation 12 (1999) 25-23 ISSN 1053/$8.00 Copyright 1999, IOS Press. All Rights Reserved

There are numerous articles supporting diagnostic musculoskeletal the use of ultrasonography to evaluate and diagnose muscular pathology (2-8). When confined to muscular conditions there is no reason to believe that efficacy would be different paraspinal assessment, and there are references that support this presumption (9-13). Some authors have also successfully utilized ultrasonography to measure spinal canal diameter and for the monitoring of intraoperative spinal decompression (14-22). Congenital anomalies in children, extradural space depth and lumbar disc degeneration, herniation, and annular tears have also been successfully evaluated with ultrasonography (23-30). Claims as to the ability of diagnostic musculoskeletal ultrasonography to objectively measure inflammatory disorders of the nerve root or spinal facets (31,32) have met considerable resistance however (33,34). This is largely due to problems with artifact, high false positive rates, and intra-operator variability (33,34). As a result of these claims, additional correlation of previously on controversial paraspinal and spinal image acquisition has become needed. While there is literature that suggests that MRI is less than perfect for assessment of incomplete paraspinal soft tissue injuries (35-38), special attention has been given in this article to the evaluation of paraspinal muscles and posterior spinous ligaments via the use of STIR (short time inversion recovery) sequence (39) imaging in an effort to correlate ultrasonographically obtained findings. In order to further enhance the utility of diagnostic ultrasound for paraspinal musculoskeletal conditions, identification of the pitfalls in interpretation and a grading scale for the severity of finding is required. In this paper, a case report confirming the correlation of ultrasound findings to MRI are presented, some of the pitfalls encountered in interpretation will be reviewed, and a grading scale based upon echo texture is proposed.

Diagnostic Paraspinal Musculoskeletal Ultrasonography

Journal Of Back And Musculoskeletal Rehabilitation, IOS Press, vol.12, no.1, pg.25-33, 1999, Robert G. Schwartz, M.D.