Magnetic resonance imaging predictors of surgical outcome in patients with lumbar intervertebral disc herniation

Jon D. Lurie, Rachel A. Moses, Anna N A Tosteson, Tor D. Tosteson, Eugene J. Carragee, John A. Carrino, Jay A. Kaiser, Richard J. Herzog

Research output: Contribution to journalArticle

Abstract

Study Design. A retrospective cohort design. Objective. To determine whether baseline magnetic resonance imaging findings, including central/foraminal stenosis, Modic change, disc morphology, facet arthropathy, disc degeneration, nerve root impingement, and thecal sac compression, are associated with differential surgical treatment effect. Summary of Background Data. Intervertebral disc herniation remains the most common source of lumbar radiculopathy treated either with discectomy or nonoperative intervention. Although magnetic resonance imaging remains the reliable "gold standard" for diagnosis, uncertainty surrounds the relationship between magnetic resonance imaging fi ndings and treatment outcomes. Methods. Three hundred seven "complete" images from patients enrolled in a previous trial were de-identified and evaluated by 1 of 4 independent readers. Findings were compared with outcome measures including the Oswestry Disability Index. Differences in surgery and nonoperative treatment outcomes were evaluated between image characteristic subgroups and TE determined by the difference in Oswestry Disability Index scores. Results. The cohort comprised 40% females with an average age of 41.5 ( ?± 11.6) years, 61% of whom underwent discectomy for intervertebral disc herniation. Patients undergoing surgery with Modic type I endplate changes had worse outcomes ( - 26.4 vs . - 39.7 for none and - 39.2 for type 2, P = 0.002) and smaller treatment effect ( - 3.5 vs . - 19.3 for none and - 15.7 for type 2, P = 0.003). Those with compression of ≥ 1/3 showed the greatest improvement within the surgical group ( - 41.9 for ≥ 1/3 vs . - 31.6 for none and - 38.1 for <1/3, P = 0.007) and the highest TE ( - 23 compared with - 11.7 for none and - 15.2 for <1/3, P = 0.015). Furthermore, patients with minimal nerve root impingement demonstrated worse surgical outcomes ( - 26.5 vs . - 41.1 for "displaced" and - 38.9 for "compressed," P = 0.016). Conclusion. Among patients with intervertebral disc herniation, those with thecal sac compression of 1/3 or more had greater surgical treatment effect than those with small disc herniations and Modic type I changes. In addition, patients with nerve root "compression" and "displacement" benefi t more from surgery than those with minimal nerve root impingement.

Original languageEnglish (US)
Pages (from-to)1216-1225
Number of pages10
JournalSpine
Volume38
Issue number14
DOIs
StatePublished - Jun 15 2013

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Intervertebral Disc
Magnetic Resonance Imaging
Diskectomy
Radiculopathy
Intervertebral Disc Degeneration
Joint Diseases
Uncertainty
Pathologic Constriction
Therapeutics
Outcome Assessment (Health Care)

Keywords

  • Intervertebral disc herniation
  • Lumbar
  • Magnetic resonance imaging
  • Modic change
  • Surgical outcome
  • Thecal sac compression

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Lurie, J. D., Moses, R. A., Tosteson, A. N. A., Tosteson, T. D., Carragee, E. J., Carrino, J. A., ... Herzog, R. J. (2013). Magnetic resonance imaging predictors of surgical outcome in patients with lumbar intervertebral disc herniation. Spine, 38(14), 1216-1225. https://doi.org/10.1097/BRS.0b013e31828ce66d

Magnetic resonance imaging predictors of surgical outcome in patients with lumbar intervertebral disc herniation. / Lurie, Jon D.; Moses, Rachel A.; Tosteson, Anna N A; Tosteson, Tor D.; Carragee, Eugene J.; Carrino, John A.; Kaiser, Jay A.; Herzog, Richard J.

In: Spine, Vol. 38, No. 14, 15.06.2013, p. 1216-1225.

Research output: Contribution to journalArticle

Lurie, JD, Moses, RA, Tosteson, ANA, Tosteson, TD, Carragee, EJ, Carrino, JA, Kaiser, JA & Herzog, RJ 2013, 'Magnetic resonance imaging predictors of surgical outcome in patients with lumbar intervertebral disc herniation', Spine, vol. 38, no. 14, pp. 1216-1225. https://doi.org/10.1097/BRS.0b013e31828ce66d
Lurie JD, Moses RA, Tosteson ANA, Tosteson TD, Carragee EJ, Carrino JA et al. Magnetic resonance imaging predictors of surgical outcome in patients with lumbar intervertebral disc herniation. Spine. 2013 Jun 15;38(14):1216-1225. https://doi.org/10.1097/BRS.0b013e31828ce66d
Lurie, Jon D. ; Moses, Rachel A. ; Tosteson, Anna N A ; Tosteson, Tor D. ; Carragee, Eugene J. ; Carrino, John A. ; Kaiser, Jay A. ; Herzog, Richard J. / Magnetic resonance imaging predictors of surgical outcome in patients with lumbar intervertebral disc herniation. In: Spine. 2013 ; Vol. 38, No. 14. pp. 1216-1225.
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abstract = "Study Design. A retrospective cohort design. Objective. To determine whether baseline magnetic resonance imaging findings, including central/foraminal stenosis, Modic change, disc morphology, facet arthropathy, disc degeneration, nerve root impingement, and thecal sac compression, are associated with differential surgical treatment effect. Summary of Background Data. Intervertebral disc herniation remains the most common source of lumbar radiculopathy treated either with discectomy or nonoperative intervention. Although magnetic resonance imaging remains the reliable {"}gold standard{"} for diagnosis, uncertainty surrounds the relationship between magnetic resonance imaging fi ndings and treatment outcomes. Methods. Three hundred seven {"}complete{"} images from patients enrolled in a previous trial were de-identified and evaluated by 1 of 4 independent readers. Findings were compared with outcome measures including the Oswestry Disability Index. Differences in surgery and nonoperative treatment outcomes were evaluated between image characteristic subgroups and TE determined by the difference in Oswestry Disability Index scores. Results. The cohort comprised 40{\%} females with an average age of 41.5 ( ?± 11.6) years, 61{\%} of whom underwent discectomy for intervertebral disc herniation. Patients undergoing surgery with Modic type I endplate changes had worse outcomes ( - 26.4 vs . - 39.7 for none and - 39.2 for type 2, P = 0.002) and smaller treatment effect ( - 3.5 vs . - 19.3 for none and - 15.7 for type 2, P = 0.003). Those with compression of ≥ 1/3 showed the greatest improvement within the surgical group ( - 41.9 for ≥ 1/3 vs . - 31.6 for none and - 38.1 for <1/3, P = 0.007) and the highest TE ( - 23 compared with - 11.7 for none and - 15.2 for <1/3, P = 0.015). Furthermore, patients with minimal nerve root impingement demonstrated worse surgical outcomes ( - 26.5 vs . - 41.1 for {"}displaced{"} and - 38.9 for {"}compressed,{"} P = 0.016). Conclusion. Among patients with intervertebral disc herniation, those with thecal sac compression of 1/3 or more had greater surgical treatment effect than those with small disc herniations and Modic type I changes. In addition, patients with nerve root {"}compression{"} and {"}displacement{"} benefi t more from surgery than those with minimal nerve root impingement.",
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AU - Lurie, Jon D.

AU - Moses, Rachel A.

AU - Tosteson, Anna N A

AU - Tosteson, Tor D.

AU - Carragee, Eugene J.

AU - Carrino, John A.

AU - Kaiser, Jay A.

AU - Herzog, Richard J.

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N2 - Study Design. A retrospective cohort design. Objective. To determine whether baseline magnetic resonance imaging findings, including central/foraminal stenosis, Modic change, disc morphology, facet arthropathy, disc degeneration, nerve root impingement, and thecal sac compression, are associated with differential surgical treatment effect. Summary of Background Data. Intervertebral disc herniation remains the most common source of lumbar radiculopathy treated either with discectomy or nonoperative intervention. Although magnetic resonance imaging remains the reliable "gold standard" for diagnosis, uncertainty surrounds the relationship between magnetic resonance imaging fi ndings and treatment outcomes. Methods. Three hundred seven "complete" images from patients enrolled in a previous trial were de-identified and evaluated by 1 of 4 independent readers. Findings were compared with outcome measures including the Oswestry Disability Index. Differences in surgery and nonoperative treatment outcomes were evaluated between image characteristic subgroups and TE determined by the difference in Oswestry Disability Index scores. Results. The cohort comprised 40% females with an average age of 41.5 ( ?± 11.6) years, 61% of whom underwent discectomy for intervertebral disc herniation. Patients undergoing surgery with Modic type I endplate changes had worse outcomes ( - 26.4 vs . - 39.7 for none and - 39.2 for type 2, P = 0.002) and smaller treatment effect ( - 3.5 vs . - 19.3 for none and - 15.7 for type 2, P = 0.003). Those with compression of ≥ 1/3 showed the greatest improvement within the surgical group ( - 41.9 for ≥ 1/3 vs . - 31.6 for none and - 38.1 for <1/3, P = 0.007) and the highest TE ( - 23 compared with - 11.7 for none and - 15.2 for <1/3, P = 0.015). Furthermore, patients with minimal nerve root impingement demonstrated worse surgical outcomes ( - 26.5 vs . - 41.1 for "displaced" and - 38.9 for "compressed," P = 0.016). Conclusion. Among patients with intervertebral disc herniation, those with thecal sac compression of 1/3 or more had greater surgical treatment effect than those with small disc herniations and Modic type I changes. In addition, patients with nerve root "compression" and "displacement" benefi t more from surgery than those with minimal nerve root impingement.

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KW - Intervertebral disc herniation

KW - Lumbar

KW - Magnetic resonance imaging

KW - Modic change

KW - Surgical outcome

KW - Thecal sac compression

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