Does the Size or Location of Lumbar Disc Herniation Predict the Need for Operative Treatment?

Abstract

Study Design: Retrospective cohort study. Objective: The goal of this study was to determine whether the absolute size (mm2), relative size (% canal compromise), or location of a single-level, lumbar disc herniation (LDH) on axial and sagittal cuts of magnetic resonance imaging (MRI) were predictive of eventual surgical intervention. Methods: MRIs of 89 patients were reviewed, and patients were split into groups based on type of management received (34 nonoperative vs 55 microdiscectomy). Radiographic characteristics—including size of disc herniation (mm2), size of spinal canal (mm2), location of herniation on axial (central, paracentral, foraminal) and sagittal (disc level, suprapedicle, pedicle, infrapedicle) planes, and type of herniation (bulge, protrusion, extrusion, sequestration)—were measured by 2 independent, orthopedic spine fellows and compared between groups via univariate and multivariate analyses. Results: The operative group showed a significantly higher percentage of canal compromise (39.5% vs 31.1%, P = .001) compared to the nonoperative group. Multiple logistic regression analysis showed higher odds of eventual operative intervention for a disc protrusion (odds ratio [OR] 6.30 [1.99, 19.86], P = .002) or disc extrusion (OR 11.5 [1.63, 81.2], P = .014) for Rater 1 and a higher odds of eventual surgical management for a paracentral location for both Rater 1 and Rater 2 (OR = 3.39 [1.25, 9.22], P = .017, and OR = 5.46 [1.77, 16.8], P = .003, respectively). Conclusions: Disc herniations in a paracentral location were more likely to undergo operative treatment than those more centrally located, on axial MRI views.

Biomechanical evaluation of a novel intervertebral disc repair technique for large box-shaped ruptures

“…Therefore, when simulating the disc herniation, the injury to the annulus was positioned in the left posterolateral region. This is consistent with reports that the posterolateral AF is at greatest risk of herniation ( Marchand and Ahmed, 1990 ; Divi et al, 2022 ). A typical blade used for discectomy has a width of 5 mm ( Fu et al, 2016 ), so in order to simulate the incision, a 5 mm × 5 mm box-shaped rupture was made in the left posterolateral region of the AF ( Douglas et al, 2017 ; Ren et al, 2020 ).…”

Prognosis Evaluation of MRI Combined with Magnetic Resonance Myelography on Lumbar Disc Herniation after Transforaminal Endoscopic Discectomy

“…At present, magnetic resonance imaging (MRI) technology has been widely used in the diagnosis of LDH, as the sagittal T 1 weighted image (T1WI), T2WI, and axial T2WI signals can clearly show the shape of the intervertebral disc, which has important clinical guiding significance for the measurement of intervertebral space height (ISH) and the judgement of postoperative residual intervertebral disc [9]. However, because of the discontinuous scanning and thick scanning layers, MRI cannot accurately show the anatomical structure around the nerve roots in the spinal canal, which makes it difficult to determine whether the nerve root is still compressed [10,11] or abnormal in shape, affecting doctors' judgment of the degree of postoperative recovery. Therefore, looking for an imaging examination that can accurately reflect the postoperative nerve root compression and deformation is of great importance in clinical treatment of LDH.…”

¿Es confiable la clasificación de la hernia de disco lumbar de la Universidad Estatal de Míchigan entre cirujanos de columna?

“…2,4,[6][7][8] Durante nuestro análisis encontramos una prevalencia en el sexo masculino y el nivel L5-S1 que son similares a la bibliografía publicada. 2,[7][8][9][10] Además, pudimos encontrar que la hipertensión arterial, el tabaquismo y la obesidad (factores de riesgo cardiovasculares) fueron los antecedentes prevalentes en nuestra muestra (HTA con 41%, tabaquismo con 28% y obesidad con 24%). Si bien en la actualidad su rol en el desarrollo de la degeneración discal o la recurrencia del dolor lumbar es incierto, algunos autores afirman que pueden ser determinantes.…”