No correlation identified between the proportional size of a prolapsed intravertebral disc with disability or leg pain

Abstract

Aims The aim of the study was to determine if there was a direct correlation between the pain and disability experienced by patients and size of their disc prolapse, measured by the disc’s cross-sectional area on T2 axial MRI scans. Methods Patients were asked to prospectively complete visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores on the day of their MRI scan. All patients with primary disc herniation were included. Exclusion criteria included recurrent disc herniation, cauda equina syndrome, or any other associated spinal pathology. T2 weighted MRI scans were reviewed on picture archiving and communications software. The T2 axial image showing the disc protrusion with the largest cross sectional area was used for measurements. The area of the disc and canal were measured at this level. The size of the disc was measured as a percentage of the cross-sectional area of the spinal canal on the chosen image. The VAS leg pain and ODI scores were each correlated with the size of the disc using the Pearson correlation coefficient (PCC). Intraobserver reliability for MRI measurement was assessed using the interclass correlation coefficient (ICC). We assessed if the position of the disc prolapse (central, lateral recess, or foraminal) altered the symptoms described by the patient. The VAS and ODI scores from central and lateral recess disc prolapses were compared. Results A total of 56 patients (mean age 41.1 years (22.8 to 70.3)) were included. A high degree of intraobserver reliability was observed for MRI measurement: single measure ICC was 0.99 (95% confidence interval (CI) from 0.97 to 0.99 (p < 0.001)). The PCC comparing VAS leg scores with canal occupancy for herniated disc was 0.056. The PCC comparing ODI for herniated disc was 0.070. We found 13 disc prolapses centrally and 43 lateral recess prolapses. There were no foraminal prolapses in this group. The position of the prolapse was not found to be related to the mean VAS score or ODI experienced by the patients (VAS, p = 0.251; ODI, p = 0.093). Conclusion The results of the statistical analysis show that there is no direct correlation between the size or position of the disc prolapse and a patient’s symptoms. The symptoms experienced by patients should be the primary concern in deciding to perform discectomy. Cite this article: Bone Joint J 2022;104-B(6):715–720.

Correlation between Disc Imaging Observations and Clinical Efficacy after Percutaneous Endoscopic Lumbar Discectomy: A 1‐Year Follow‐up Study

“…In addition, we have illustrated this occurrence using two instances (Figures 6 and 7). This aligns with the foundation of the earlier research conducted by Dunsmuir 22 …”

“…This aligns with the foundation of the earlier research conducted by Dunsmuir. 22 During our investigation, we noticed a decrease in the height of the operated segment following the surgical procedure and a reduction in the height of the neighboring disc postsurgery. We observed a similar decline in the average disc height and the height index.…”

“…discovered that the size of the herniated discs in conservatively treated patients with LDH did not correlate with pain severity or disability symptoms. 22 By analyzing the correlation between morphological changes in intervertebral disc cross‐sections before and after imaging studies and the change in efficacy, we discovered that parameters such as absolute area change and aspect ratio on cross‐sections did not directly connect to changes in the final efficacy index. In addition, we have illustrated this occurrence using two instances (Figures 6 and 7 ).…”

Spine

“…While a lot of us as surgeons have been guilty of treating the scan as opposed to the patient, this well-constructed study from Leeds (UK) reminds us of the importance of treating the patient. 6 This study presented prospective data collected from patients on the day of their MRI scan to see if there was an association between the size of the acute disc prolapse and their reported disability using the Oswestry Disability Index (ODI) and the visual analogue score (VAS). Exclusion criteria included diagnosis of cauda equina syndrome, infection, tumour, disc recurrence, non-disc related stenosis, and previous surgery.…”

Brain effect mechanism of lever positioning manipulation on LDH analgesia based on multimodal MRI: a study protocol

“…Lumbar disc herniation (LDH) primarily manifests as lower back and leg pain [1,2]. This condition is distinguished by its high incidence, significant disability rate, and the absence of specific pharmaceutical remedies, thereby imposing a substantial socioeconomic burden on society [3][4][5]. In a comprehensive global disease survey encompassing 291 conditions, LDH holds the highest rank in terms of disability, with a prevalence rate of 9.4% [6].…”