Abstract

Study Design: A retrospective cohort designObjective: To determine if baseline MRI 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 (IDH) remains the most common source of lumbar radiculopathy treated either with discectomy or non-operative intervention. Although MRI remains the reliable gold standard for diagnosis, uncertainty surrounds the relationship between MRI findings and treatment outcomes.Methods: Three-hundred-and-seven "complete" images from patients enrolled in a previous trial were de-identified and evaluated by one of 4 independent readers. Findings were compared to outcome measures including the Oswestry Disability Index. Differences in surgery and non-operative treatment outcomes were evaluated between image characteristic subgroups and TE determined by the difference in ODI scores.Results: The cohort was comprised of 40% females with an average age of 41.5 (±11.6), 61% of which underwent discectomy for IDH. Patients undergoing surgery with Modic type I endplate changes had worse outcomes (-26.4 versus -39.7 for none and -39.2 for type 2, p = 0.002) and smaller treatment effect (-3.5 versus -19.3 for none and -15.7 for type 2, p = 0.003). Those with compression > = 1/3 showed the greatest improvement within the surgical group (-41.9 for > = 1/3 versus -31.6 for none and -38.1 for <1/3, p = 0.007), and the highest TE (-23 compared to -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 versus -41.1 for "displaced" and -38.9 for "compressed", p = 0.016).Conclusion: Among patients with IDH, those with thecal sac compression > = 1/3 had greater surgical treatment effect than those with small disc herniations and Modic type I changes. Additionally, patients with nerve root "compression" and "displacement" benefit more from surgery than those with minimal nerve-root impingement.

View details for DOI 10.1097/BRS.0b013e31828ce66d

View details for PubMedID 23429684