Investig Magn Reson Imaging.  2018 Mar;22(1):18-25. 10.13104/imri.2018.22.1.18.

Scoring System for Factors Affecting Aggravation of Lumbar Disc Herniation

• Lee SW
• Kim SY
• Lee JY

• KMID: 2408814
• DOI: http://doi.org/10.13104/imri.2018.22.1.18

Abstract

PURPOSE
To investigate the various imaging factors associated with aggravation of lumbar disc herniation (LDH) and develop a scoring system for prediction of LDH aggravation.
MATERIALS AND METHODS
From 2015 to 2017, we retrospectively reviewed the magnetic resonance imaging (MRI) findings of 60 patients (30 patients with aggravated LDH and 30 patients without any altered LDH). Imaging factors for MRI evaluation included the level of LDH, disc degeneration, back muscle atrophy, facet joint degeneration, ligamentum flavum thickness and interspinous ligament degeneration. Flexion-extension difference was measured with simple radiography. The scoring system was analyzed using receiver operating characteristic (ROC) analysis.
RESULTS
The aggravated group manifested a higher grade of disc degeneration, back muscle atrophy and facet degeneration than the control group. The ligamentum flavum thickness in the aggravated group was thicker than in the group with unaltered LDH. The summation score was defined as the sum of the grade of disc degeneration, back muscle atrophy and facet joint degeneration. The area under the ROC curve showing the threshold value of the summation score for prediction of aggravation of LDH was 0.832 and the threshold value corresponded to 6.5.
CONCLUSION
Disc degeneration, facet degeneration, back muscle atrophy and ligamentum flavum thickness are important factors in predicting aggravation of LDH and may facilitate the determination of treatment strategy in patients with LDH. The summation score is available as supplemental data.

Keyword

Lumbar disc herniation; Disc degeneration; Back muscle atrophy; Facet joint degeneration; Aggravation; Magnetic resonance imaging

MeSH Terms

Atrophy
Back Muscles
Humans
Intervertebral Disc Degeneration
Ligaments
Ligamentum Flavum
Magnetic Resonance Imaging
Radiography
Retrospective Studies
ROC Curve
Zygapophyseal Joint

Figure

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  Fig. 1. Measurement perpendicular to the thickest portion of ligamentum flavum at the herniated disc level on T2-weighted image axial scan.

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  Fig. 2. The flexion-extension difference was measured on lateral simple radiograph.

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  Fig. 3. The graph showing the number of patients for each summation score of the Pfirrmann disc degeneration grade, back muscle atrophy, and facet joint degeneration.

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  Fig. 4. Receiver operating characteristic curve showing the threshold value of the summation score of the Pfirrmann disc degeneration grade, back muscle atrophy, and facet joint degeneration to predict the aggravation of lumbar disc herniation.

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  Fig. 5. A 63-year-old woman with right subarticular disc extrusion, L5-S1. (a) Initial sagittal T2-weighted image shows disc degeneration grade 4. (b) Sagittal T2-weighted image shows lumbar disc herniation aggravation after 58 months. (c) Initial axial T2-weighted image shows back muscle atrophy grade 3, facet joint degeneration grade 1 and ligamentum flavum thickness 2.2 mm. The summation score is 8.

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  Fig. 6. A 58-year-old woman with right central disc protrusion, L5-S1. (a) Initial sagittal T2-weighted image shows disc degeneration grade 2. (b) Sagittal T2-weighted image shows no significant change in lumbar disc herniation after 47 months. (c) Initial axial T2-weighted image shows grade 1 back muscle atrophy, facet joint degeneration grade 1 and ligamentum flavum thickness 1.9 mm. The summation score is 4.

Reference

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