J Korean Soc Spine Surg.  2014 Mar;21(1):24-29. 10.4184/jkss.2014.21.1.24.

The Relationship Between Preoperative MRI Findings and Clinical Outcomes in Surgical Treatment of Lumbar Disc Herniation

• Lee SH
• Kwon HM
• Yoon TH
• Moon SH
• Lee HM

• KMID: 1840413
• DOI: http://doi.org/10.4184/jkss.2014.21.1.24

Abstract

STUDY DESIGN: A retrospective study.
OBJECTIVES
To assess the relationship between surgical outcomes and preoperative MRI findings, a retrospective review was conducted on the surgical outcomes depending on the preoperative MRI findings including type of herniation and Modic changes. SUMMARY OF LITERATURE REVIEW: In most reports, the patients that have large disc herniation were expected to have improved surgical outcomes. However, there have been controversies regarding the outcomes and Modic changes.
MATERIALS AND METHODS
The retrospective review was conducted in 82 patients who underwent a discectomy for single level lumbar disc herniation. The average follow-up period was 34.2 months. Among their preoperative baseline MRI measurements, the stage of disc herniation, degree of nerve root compression, degree of dural sac compression, and Modic change of vertebral endplate were evaluated for the subsequent comparison between the preoperative and postoperative changes and ODI score.
RESULTS
Patients with extrusion or sequestration type showed significant improvements compared to the patients with protrusion type disc herniation. By degree of nerve root compression, patients with root compression showed significant improvements compared to the patients who had contact type. The degree of dural sac compression revealed no correlation with changes in the ODI score. 23 of the 82 patients, the preoperative MRI showed a Modic change. Compared to the group who did not show such a Modic change, they turned out to be unrelated to the preoperative and postoperative changes in the ODI score.
CONCLUSIONS
Patients who had extrusion or sequestration type disc herniation showed a better clinical improvement than protrusion type. Patients with compression type root lesion showed better clinical improvement than contact type root lesion. No correlation was noted regarding the outcomes of the surgical treatment and degree of dural sac compression or Modic changes.

Keyword

Lumbar disc herniation; MRI; Discectomy; Clinical outcome

MeSH Terms

Diskectomy
Follow-Up Studies
Humans
Magnetic Resonance Imaging*
Radiculopathy
Retrospective Studies

Figure

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  Fig. 1. Disc Morphology and Clinical Outcome.

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  Fig. 2. Nerve Root Compromise and Clinical Outcome.

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  Fig. 3. Degree of Dural Sac Compression and Clinical Outcome.

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  Fig. 4. Modic Change and Clinical Outcome.

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