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<meta name="DC.Title" content="Comparison of MR Imaging Findings between Extraligamentous and Subligamentous Disk Herniations in the Lumbar Spine" />
<meta name="DC.Identifier" content="10.3174/ajnr.A3258" />
<meta name="DC.Date" content="2013-03-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: The method of treating an HIVD in the lumbar spine may depend on the integrity of the PLL. The purpose of this study was to analyze and compare the MR imaging findings of extraligamentous and subligamentous HIVDs in the lumbar spine.

MATERIAL AND METHODS: One hundred seventeen patients (M/F = 71:46; mean age, 47 years; age range, 15–79 years) underwent lumbar spine MR imaging and disk surgery (extraligamentous/subligamentous = 66:51) from May 2003 to November 2006. Two radiologists in consensus retrospectively reviewed all MR images, focusing on 10 criteria.

RESULTS: The following 5 criteria are suggestive of extraligamentous HIVD in the lumbar spine: 1) spinal canal compromised for more than half its dimension, 2) internal signal difference in the HIVD, 3) an ill-defined margin of the HIVD, 4) disruption of the continuous low-signal-intensity line covering the HIVD, and 5) the presence of an internal dark line in the HIVD ( P &lt; .05). When we combined these 5 MR imaging criteria, the sensitivity, specificity, accuracy, and odds ratio were 77.3%, 74.5%, 76.1%, and 9.93 ( P &lt; .0001).

CONCLUSIONS: Our proposed 5 MR imaging criteria will be helpful in differentiating extraligamentous and subligamentous HIVDs in the lumbar spine.

BM
:   bone marrow
HIVD
:   herniated intervertebral disk
NPV
:   negative predictive value
PLL
:   posterior longitudinal ligament
PPV
:   positive predictive value" />
<meta name="DC.Contributor" content="K.-J. Oh" />
<meta name="DC.Contributor" content="J.W. Lee" />
<meta name="DC.Contributor" content="B.L. Yun" />
<meta name="DC.Contributor" content="S.T. Kwon" />
<meta name="DC.Contributor" content="K.-W. Park" />
<meta name="DC.Contributor" content="J.S. Yeom" />
<meta name="DC.Contributor" content="H.S. Kang" />
<meta name="article:published_time" content="2013-03-01" />
<meta name="article:section" content="Spine" />
<meta name="citation_title" content="Comparison of MR Imaging Findings between Extraligamentous and Subligamentous Disk Herniations in the Lumbar Spine" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;The method of treating an HIVD in the lumbar spine may depend on the integrity of the PLL. The purpose of this study was to analyze and compare the MR imaging findings of extraligamentous and subligamentous HIVDs in the lumbar spine.&lt;/p&gt;&lt;h3&gt;MATERIAL AND METHODS:&lt;/h3&gt;
&lt;p&gt;One hundred seventeen patients (M/F = 71:46; mean age, 47 years; age range, 15–79 years) underwent lumbar spine MR imaging and disk surgery (extraligamentous/subligamentous = 66:51) from May 2003 to November 2006. Two radiologists in consensus retrospectively reviewed all MR images, focusing on 10 criteria.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;The following 5 criteria are suggestive of extraligamentous HIVD in the lumbar spine: 1) spinal canal compromised for more than half its dimension, 2) internal signal difference in the HIVD, 3) an ill-defined margin of the HIVD, 4) disruption of the continuous low-signal-intensity line covering the HIVD, and 5) the presence of an internal dark line in the HIVD (&lt;i&gt;P&lt;/i&gt; &amp;lt; .05). When we combined these 5 MR imaging criteria, the sensitivity, specificity, accuracy, and odds ratio were 77.3%, 74.5%, 76.1%, and 9.93 (&lt;i&gt;P&lt;/i&gt; &amp;lt; .0001).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Our proposed 5 MR imaging criteria will be helpful in differentiating extraligamentous and subligamentous HIVDs in the lumbar spine.&lt;/p&gt;" />
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<meta name="citation_reference" content="citation_journal_title=Spine (Phila Pa 1976);citation_author=D. Fardon;citation_author=P. Milette;citation_title=Nomenclature and classification of lumbar disc pathology: recommendations of the combined task forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology;citation_pages=93E-113;citation_volume=26;citation_year=2001;citation_doi=10.1097/00007632-200103010-00006" />
<meta name="twitter:title" content="Comparison of MR Imaging Findings between Extraligamentous and Subligamentous Disk Herniations in the Lumbar Spine" />
<meta name="twitter:card" content="summary_large_image" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: The method of treating an HIVD in the lumbar spine may depend on the integrity of the PLL. The purpose of this study was to analyze and compare the MR imaging findings of extraligamentous and subligamentous HIVDs in the lumbar spine.

MATERIAL AND METHODS: One hundred seventeen patients (M/F = 71:46; mean age, 47 years; age range, 15–79 years) underwent lumbar spine MR imaging and disk surgery (extraligamentous/subligamentous = 66:51) from May 2003 to November 2006. Two radiologists in consensus retrospectively reviewed all MR images, focusing on 10 criteria.

RESULTS: The following 5 criteria are suggestive of extraligamentous HIVD in the lumbar spine: 1) spinal canal compromised for more than half its dimension, 2) internal signal difference in the HIVD, 3) an ill-defined margin of the HIVD, 4) disruption of the continuous low-signal-intensity line covering the HIVD, and 5) the presence of an internal dark line in the HIVD ( P &lt; .05). When we combined these 5 MR imaging criteria, the sensitivity, specificity, accuracy, and odds ratio were 77.3%, 74.5%, 76.1%, and 9.93 ( P &lt; .0001).

CONCLUSIONS: Our proposed 5 MR imaging criteria will be helpful in differentiating extraligamentous and subligamentous HIVDs in the lumbar spine.

BM
:   bone marrow
HIVD
:   herniated intervertebral disk
NPV
:   negative predictive value
PLL
:   posterior longitudinal ligament
PPV
:   positive predictive value" />
<meta name="og-title" property="og:title" content="Comparison of MR Imaging Findings between Extraligamentous and Subligamentous Disk Herniations in the Lumbar Spine" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/34/3/683" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: The method of treating an HIVD in the lumbar spine may depend on the integrity of the PLL. The purpose of this study was to analyze and compare the MR imaging findings of extraligamentous and subligamentous HIVDs in the lumbar spine.

MATERIAL AND METHODS: One hundred seventeen patients (M/F = 71:46; mean age, 47 years; age range, 15–79 years) underwent lumbar spine MR imaging and disk surgery (extraligamentous/subligamentous = 66:51) from May 2003 to November 2006. Two radiologists in consensus retrospectively reviewed all MR images, focusing on 10 criteria.

RESULTS: The following 5 criteria are suggestive of extraligamentous HIVD in the lumbar spine: 1) spinal canal compromised for more than half its dimension, 2) internal signal difference in the HIVD, 3) an ill-defined margin of the HIVD, 4) disruption of the continuous low-signal-intensity line covering the HIVD, and 5) the presence of an internal dark line in the HIVD ( P &lt; .05). When we combined these 5 MR imaging criteria, the sensitivity, specificity, accuracy, and odds ratio were 77.3%, 74.5%, 76.1%, and 9.93 ( P &lt; .0001).

CONCLUSIONS: Our proposed 5 MR imaging criteria will be helpful in differentiating extraligamentous and subligamentous HIVDs in the lumbar spine.

BM
:   bone marrow
HIVD
:   herniated intervertebral disk
NPV
:   negative predictive value
PLL
:   posterior longitudinal ligament
PPV
:   positive predictive value" />
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      <h1 class="highwire-cite-title" id="page-title">Comparison of MR Imaging Findings between Extraligamentous and Subligamentous Disk Herniations in the Lumbar Spine</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">K.-J. Oh</span>, <span class="highwire-citation-author" data-delta="1">J.W. Lee</span>, <span class="highwire-citation-author" data-delta="2">B.L. Yun</span>, <span class="highwire-citation-author" data-delta="3">S.T. Kwon</span>, <span class="highwire-citation-author" data-delta="4">K.-W. Park</span>, <span class="highwire-citation-author" data-delta="5">J.S. Yeom</span> and <span class="highwire-citation-author" data-delta="6">H.S. Kang</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">March 2013,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">34 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">683-687; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A3258 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-12291--61461832533" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">K.-J. Oh </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (K.-J.O., J.W.L., B.L.Y., H.S.K.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Radiology (K.-J.O., S.T.K.), Chungnam National University (Graduate School) College of Medicine, Daejeon, South Korea.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=K.-J.%2BOh%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Oh%20K&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AK.-J.%2BOh%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">J.W. Lee </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (K.-J.O., J.W.L., B.L.Y., H.S.K.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.W.%2BLee%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lee%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJ.W.%2BLee%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">B.L. Yun </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (K.-J.O., J.W.L., B.L.Y., H.S.K.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=B.L.%2BYun%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Yun%20B&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AB.L.%2BYun%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">S.T. Kwon </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Radiology (K.-J.O., S.T.K.), Chungnam National University (Graduate School) College of Medicine, Daejeon, South Korea.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.T.%2BKwon%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kwon%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.T.%2BKwon%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">K.-W. Park </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Orthopedic Surgery (K.-W.P., J.S.Y.), Seoul National University Bundang Hospital, Gyeongi-Do, South Korea</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=K.-W.%2BPark%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Park%20K&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AK.-W.%2BPark%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">J.S. Yeom </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Orthopedic Surgery (K.-W.P., J.S.Y.), Seoul National University Bundang Hospital, Gyeongi-Do, South Korea</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.S.%2BYeom%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Yeom%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJ.S.%2BYeom%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">H.S. Kang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (K.-J.O., J.W.L., B.L.Y., H.S.K.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=H.S.%2BKang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kang%20H&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AH.S.%2BKang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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<p id="p-2"><strong>BACKGROUND AND PURPOSE:</strong> The method of treating an HIVD in the lumbar spine may depend on the integrity of the PLL. The purpose of this study was to analyze and compare the MR imaging findings of extraligamentous and subligamentous HIVDs in the lumbar spine.</p>
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<p id="p-3"><strong>MATERIAL AND METHODS:</strong> One hundred seventeen patients (M/F = 71:46; mean age, 47 years; age range, 15–79 years) underwent lumbar spine MR imaging and disk surgery (extraligamentous/subligamentous = 66:51) from May 2003 to November 2006. Two radiologists in consensus retrospectively reviewed all MR images, focusing on 10 criteria.</p>
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<p id="p-4"><strong>RESULTS:</strong> The following 5 criteria are suggestive of extraligamentous HIVD in the lumbar spine: 1) spinal canal compromised for more than half its dimension, 2) internal signal difference in the HIVD, 3) an ill-defined margin of the HIVD, 4) disruption of the continuous low-signal-intensity line covering the HIVD, and 5) the presence of an internal dark line in the HIVD (<em>P</em> &lt; .05). When we combined these 5 MR imaging criteria, the sensitivity, specificity, accuracy, and odds ratio were 77.3%, 74.5%, 76.1%, and 9.93 (<em>P</em> &lt; .0001).</p>
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<p id="p-5"><strong>CONCLUSIONS:</strong> Our proposed 5 MR imaging criteria will be helpful in differentiating extraligamentous and subligamentous HIVDs in the lumbar spine.</p>
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</div><div class="section glossary" id="glossary-1"><h2>ABBREVIATIONS:</h2>
<dl id="def-list-1"><dt id="def-item-1">BM<span class="def-item-dt-sep"></span></dt><dd>bone marrow<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">HIVD<span class="def-item-dt-sep"></span></dt><dd>herniated intervertebral disk<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">NPV<span class="def-item-dt-sep"></span></dt><dd>negative predictive value<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">PLL<span class="def-item-dt-sep"></span></dt><dd>posterior longitudinal ligament<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">PPV<span class="def-item-dt-sep"></span></dt><dd>positive predictive value</dd></dl>
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      <div class="highwire-cite-title">Comparison of MR Imaging Findings between Extraligamentous and Subligamentous Disk Herniations in the Lumbar Spine</div>  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Mar 2013, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">34 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">683-687; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3258 </span></div>
  
  
  
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      <div class="highwire-cite-title">Comparison of MR Imaging Findings between Extraligamentous and Subligamentous Disk Herniations in the Lumbar Spine</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">K.-J.</span> <span class="nlm-surname">Oh</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">J.W.</span> <span class="nlm-surname">Lee</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">B.L.</span> <span class="nlm-surname">Yun</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">S.T.</span> <span class="nlm-surname">Kwon</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">K.-W.</span> <span class="nlm-surname">Park</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">J.S.</span> <span class="nlm-surname">Yeom</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">H.S.</span> <span class="nlm-surname">Kang</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Mar 2013, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">34 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">683-687; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3258 </span></div>
  
  
  
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