Correlación radiográfica y resonancia magnética para el diagnóstico de discopatía degenerativa en lumbalgia crónica
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2021
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
El dolor lumbar es una de las causas más comunes de discapacidad para las personas en edad laboral en los países industrializados afectando hasta dos tercios de los adultos en algún momento de su vida, una situación que constituye gran preocupación para los sistemas de salud, debido a que su padecimiento está asociado con altos costos de atención médica, además de producir consecuencias económicas sustanciales debido a la pérdida de productividad por la discapacidad asociada con este síntoma (Benneker, Heini, Anderson, Alini y Ito, 2004; Brinjikji et al., 2014; Haaga, 2011).
Hay muchas causas de lumbalgia, pero la Discopatía Degenerativa (DD) es generalmente la causa más probable. Aunque los mecanismos por los cuales esta enfermedad puede causar dolor lumbar no están claros, si lo está el hecho de que la gravedad de la DD tiene relación con la intensidad de este síntoma. Esta gravedad a su vez se asocia con el grado de degeneración del disco intervertebral (DDI) y este a su vez se relaciona con cambios progresivos de las estructuras vertebrales, tanto en la composición de la matriz como en la morfología. Por este motivo se ha aceptado que el diagnóstico de la DD es patomorfológico a partir de muestra de tejidos, sobre todo porque es un método fiable y repetible y esta identificación es mucho más precisa si se combina con métodos bioquímicos (Benneker et al., 2004).
Sin embargo, debido a que estas características hacen que este método de diagnóstico tenga una utilidad clínica limitada, se ha buscado métodos no invasivos para clasificar la gravedad de la DD como el diagnóstico por imágenes ya que los cambios en la morfología del DDI y la composición de la matriz se pueden observar con diversas modalidades de imagen. Particularmente la Resonancia Magnética (RM) se considera actualmente el método estándar de oro para el diagnóstico, precisamente por la precisión con la que puede identificar estos cambios, pero su uso no siempre está disponible y su realización incrementa los costos en salud. Desde años atrás, se ha sugerido (Benneker et al., 2004) que incluso algunos de los parámetros utilizados por la RM
Low back pain is one of the most common causes of disability for people of working age in industrialized countries, affecting up to two-thirds of adults at some point in their lives, a situation that is of great concern to health systems, due to that their condition is associated with high health care costs, in addition to producing substantial economic consequences due to the loss of productivity due to the disability associated with this symptom (Benneker, Heini, Anderson, Alini, & Ito, 2004; Brinjikji et al., 2014 ; Haaga, 2011). There are many causes of low back pain, but Degenerative Disc Disease (DD) is usually the most likely cause. Although the mechanisms by which this disease can cause low back pain are not clear, the fact that the severity of DD is related to the intensity of this symptom is. This severity in turn is associated with the degree of intervertebral disc degeneration (IDD) and this in turn is related to progressive changes in the vertebral structures, both in the composition of the matrix and in morphology. For this reason, it has been accepted that the diagnosis of DD is pathomorphological from tissue samples, above all because it is a reliable and repeatable method and this identification is much more precise if it is combined with biochemical methods (Benneker et al., 2004 ). However, because these characteristics make this diagnostic method of limited clinical utility, non-invasive methods of classifying DD severity such as diagnostic imaging have been sought since changes in IDD morphology and composition of the matrix can be observed with various imaging modalities. In particular, Magnetic Resonance Imaging (MRI) is currently considered the gold standard method for diagnosis, precisely because of the precision with which it can identify these changes, but its use is not always available and its use increases health costs. For years, it has been suggested (Benneker et al., 2004) that even some of the parameters used by MRI
Low back pain is one of the most common causes of disability for people of working age in industrialized countries, affecting up to two-thirds of adults at some point in their lives, a situation that is of great concern to health systems, due to that their condition is associated with high health care costs, in addition to producing substantial economic consequences due to the loss of productivity due to the disability associated with this symptom (Benneker, Heini, Anderson, Alini, & Ito, 2004; Brinjikji et al., 2014 ; Haaga, 2011). There are many causes of low back pain, but Degenerative Disc Disease (DD) is usually the most likely cause. Although the mechanisms by which this disease can cause low back pain are not clear, the fact that the severity of DD is related to the intensity of this symptom is. This severity in turn is associated with the degree of intervertebral disc degeneration (IDD) and this in turn is related to progressive changes in the vertebral structures, both in the composition of the matrix and in morphology. For this reason, it has been accepted that the diagnosis of DD is pathomorphological from tissue samples, above all because it is a reliable and repeatable method and this identification is much more precise if it is combined with biochemical methods (Benneker et al., 2004 ). However, because these characteristics make this diagnostic method of limited clinical utility, non-invasive methods of classifying DD severity such as diagnostic imaging have been sought since changes in IDD morphology and composition of the matrix can be observed with various imaging modalities. In particular, Magnetic Resonance Imaging (MRI) is currently considered the gold standard method for diagnosis, precisely because of the precision with which it can identify these changes, but its use is not always available and its use increases health costs. For years, it has been suggested (Benneker et al., 2004) that even some of the parameters used by MRI
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DIAGNOSTICO POR IMAGENES, RESONANCIA MAGNETICA, LUMBALGIA CRONICA, HOSPITAL DE ESPECIALIDADES DR. TEODORO MALDONADO CARBO, CANTON GUAYAQUIL, ECUADOR