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

Seung-Hwan Lee; Hyuck-Min Kwon; Tae-Hwan Yoon; Seong-Hwan Moon; Hwan-Mo Lee

doi:10.4184/jkss.2014.21.1.24

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Lee, Kwon, Yoon, Moon, and Lee: The Relationship Between Preoperative MRI Findings and Clinical Outcomes in Surgical Treatment of Lumbar Disc Herniation

Original Article

Journal of Korean Spine Surg 2014;21(1):24-29.

Published online: 21 March 2014

DOI: https://doi.org/10.4184/jkss.2014.21.1.24

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

Seung-Hwan Lee, M.D.^∗, Hyuck-Min Kwon, M.D., Tae-Hwan Yoon, M.D., Seong-Hwan Moon, M.D., Hwan-Mo Lee, M.D.

Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea

^∗Department of Orthopaedic Surgery, Kwangmyeong Sung-Ae Hospital, Kwangmyeong, Korea

Corresponding author: Hwan-Mo Lee, M.D. Department of Orthopedic Surgery, Yonsei University College of Medicine 50 Yonsero, Seodaemun-ku, Seoul, 120-752, Korea TEL: 82-2-2228-2191, FAX: 82-2-363-1139 E-mail: hwanlee@yuhs.ac

Received 31 May 2013 Revised 2 July 2013 Accepted 7 March 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 followup 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.

Conclusion

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.

Keywords: Lumbar disc herniation, MRI, Discectomy, Clinical outcome

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Figures and Tables%

Fig. 1.

Disc Morphology and Clinical Outcome.

Fig. 2.

Nerve Root Compromise and Clinical Outcome.

Fig. 3.

Degree of Dural Sac Compression and Clinical Outcome.

Fig. 4.

Modic Change and Clinical Outcome.

Table 1.

Baseline Characteristics of Patients

Total patients	N = 82
Sex	Male : 44(53.6%)
Sex	Female : 38(46.4%)
Age (years)	52.0 ± 15 (21-75)
Follow up after surgery (months)	34.2 ± 18.1 (13-62)
Smoking	Smoker : 18(22%)
Smoking	Non-smoker : 64(78%)
BMI	24.5 ± 3.4 (17.7-39.7)
Pre-op ODI score	27.5 ± 8.5 (11-50)
Postop ODI score	10.9 ± 7.8 (0-32)

Table 2.

Several MRI Findings of Herniated Lumbar Disc Patients

Total patients	N = 82
Disc morphology
Protrusion	13(15.7%)
Extrusion	65(78.3%)
Sequestration	4(4.8%)
Dural sac compression
~1/3	11(13.3%)
1/3~2/3	36(43.4%)
2/3~	32(38.6%)
Nerve root compromise
Contact	30(36.6%)
Deviation	23(28%)
Compression	29(34.9%)
Modic change	23(27.7%)
Type I	6(7.2%)
Type II	15(18.1%)
Type III	2(2.4%)

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