TY - JOUR
T1 - Magnetic resonance imaging predictors of surgical outcome in patients with lumbar intervertebral disc herniation
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.
PY - 2013/6/15
Y1 - 2013/6/15
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.
AB - 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.
KW - Intervertebral disc herniation
KW - Lumbar
KW - Magnetic resonance imaging
KW - Modic change
KW - Surgical outcome
KW - Thecal sac compression
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UR - http://www.scopus.com/inward/citedby.url?scp=84880059033&partnerID=8YFLogxK
U2 - 10.1097/BRS.0b013e31828ce66d
DO - 10.1097/BRS.0b013e31828ce66d
M3 - Article
C2 - 23429684
AN - SCOPUS:84880059033
SN - 0362-2436
VL - 38
SP - 1216
EP - 1225
JO - Spine
JF - Spine
IS - 14
ER -