J Korean Soc Magn Reson Med.  2011 Aug;15(2):123-129. 10.13104/jksmrm.2011.15.2.123.

Follow-Up MR Imaging Assessment of Natural History of Lumbar Disc Herniation in Patients with Recurred Low Back Pain

• Lee KM
• Park JS
• Ryu KN
• Park SY
• Jin W

• KMID: 2000060
• DOI: http://doi.org/10.13104/jksmrm.2011.15.2.123

Abstract

PURPOSE
To compare lumbar disc changes between initial lumbar spine (L-spine) MRI and follow-up (f/u) MRI that were performed due to recurred backaches.
MATERIALS AND METHODS
A total 50 patients who had undergone f/u L-spine MRI were retrospectively reviewed. Five discs (L1-S1) were surveyed in each f/u MRI. Lumbar disc changes were defined as no change, aggravations, or improvements compared to initial disc states. These states were defined on the basis of morphologic status and disc levels.
RESULTS
In a total of 250 discs in 50 patients, 31 discs (12.4%) showed morphologic changes of disc lesions, whereas 219 discs (87.6 %) showed no changes. Among the 31 disc lesions, 24 were aggravated and 7 were partially improved. And on the basis of disc status, initially abnormal discs revealed any morphologic changes of the degree of disc herniation. A total of 33.3% of the morphologic changes are noted in initially extruded discs. Fifteen morphologic changes of disc lesions were located at the L4-5 level.
CONCLUSION
Our results suggest that correlations between lumbar disc herniations and back pain symptoms are limited, and that evaluations of extra disc lesions are required.

Keyword

Magnetic resonance imaging (MRI); Spine; Intervertebral disc; Natural history

MeSH Terms

Back Pain
Follow-Up Studies
Humans
Intervertebral Disc
Low Back Pain
Natural History
Retrospective Studies
Spine

Figure

• 

  Fig. 1 A 29-year-old female underwent follow-up 47 months after initial presentation. Initial sagittal and axial T2-weighted images of the lumbar spine MRI show bulging of the L4-5 disc with an annular tear of the cental zone (a and c). In a follow-up lumbar spine MRI after 47 months, the extent of disc bulging and signal intensity of L4-5 have not changed (b and d).

• 

  Fig. 2 A 56-year-old female underwent follow-up 18 months after initial presentation. Initial sagittal T2-weighted image of the lumbar spine MRI shows herniated L4-5 disc material (a). In a follow-up lumbar spine MRI after 18 months, the extent of disc herniation was aggravated (extrusion and inferior extension) and the thecal sac was compressed by the aggravated disc lesion (b).

• 

  Fig. 3 A 46-year-old female underwent follow-up 6 months after initial presentation. Initial sagittal and axial T2-weighted images of the lumbar spine MRI show left central extrusion and decreased signal intensity of the L4-5 disc and adjacent bone marrow changes (a and c). In a follow-up lumbar spine MRI after 6 months, the disc lesion was markedly improved (b and d). The patient received only conservative treatment.

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