Magnetic resonance imaging predictors of surgical outcome in patients with lumbar intervertebral disc herniation.

  • Lurie J
  • Moses R
  • Tosteson A
 et al. 
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Abstract

Study Design: A retrospective cohort design.Objective: To determine whether baseline magnetic resonance imaging 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 remains the most common source of lumbar radiculopathy treated either with discectomy or nonoperative intervention. Although magnetic resonance imaging remains the reliable "gold standard" for diagnosis, uncertainty surrounds the relationship between magnetic resonance imaging findings and treatment outcomes.Methods: Three hundred seven "complete" images from patients enrolled in a previous trial were de-identified and evaluated by 1 of 4 independent readers. Findings were compared with outcome measures including the Oswestry Disability Index. Differences in surgery and nonoperative treatment outcomes were evaluated between image characteristic subgroups and TE determined by the difference in Oswestry Disability Index scores.Results: The cohort comprised 40% females with an average age of 41.5 (±11.6) years, 61% of whom underwent discectomy for intervertebral disc herniation. Patients undergoing surgery with Modic type I endplate changes had worse outcomes (-26.4 vs. -39.7 for none and -39.2 for type 2, P = 0.002) and smaller treatment effect (-3.5 vs. -19.3 for none and -15.7 for type 2, P = 0.003). Those with compression of ≥1/3 showed the greatest improvement within the surgical group (-41.9 for ≥1/3 vs. -31.6 for none and -38.1 for

Author-supplied keywords

  • Adult
  • Analysis of Variance
  • Clinical Assessment Tools
  • Disability Evaluation
  • Diskectomy -- Methods
  • Female
  • Human
  • Intervertebral Disk Displacement -- Radiography
  • Intervertebral Disk Displacement -- Surgery
  • Intervertebral Disk Displacement -- Therapy
  • Linear Regression
  • Lumbar Vertebrae -- Pathology
  • Lumbar Vertebrae -- Surgery
  • Magnetic Resonance Imaging -- Methods
  • Male
  • Middle Age
  • Prognosis
  • Questionnaires
  • Radiculopathy -- Radiography
  • Radiculopathy -- Surgery
  • Retrospective Design
  • Treatment Outcomes

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Authors

  • Jon D Lurie

  • Rachel A Moses

  • Anna N A Tosteson

  • Tor D Tosteson

  • Eugene J Carragee

  • John A Carrino

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