MRI Radiological Predictors of Requiring Microscopic Lumbar Discectomy After Lumbar Disc Herniation

Overview

Journal Global Spine J

Publisher Sage Publications

Date 2020 Feb 1

PMID 32002351

Citations 4

Authors

Christopher G Varlotta

David H Ge

Nicholas Stekas

Nicholas J Frangella

Jordan H Manning

Leah Steinmetz

Dennis Vasquez-Montes

Thomas J Errico

John A Bendo

Yong H Kim

Jonathan R Stieber

Gerard Varlotta

Charla R Fischer

Themistocles S Protopsaltis

Peter G Passias

Aaron J Buckland

Affiliations

Soon will be listed here.

Abstract

Study Design: Retrospective cohort study.

Objective: To investigate radiological differences in lumbar disc herniations (herniated nucleus pulposus [HNP]) between patients receiving microscopic lumbar discectomy (MLD) and nonoperative patients.

Methods: Patients with primary treatment for an HNP at a single academic institution between November 2012 to March 2017 were divided into MLD and nonoperative treatment groups. Using magnetic resonance imaging (MRI), axial HNP area; axial canal area; HNP canal compromise; HNP cephalad/caudal migration and HNP MRI signal (black, gray, or mixed) were measured. test and chi-square analyses compared differences in the groups, binary logistic regression analysis determined odds ratios (ORs), and decision tree analysis compared the cutoff values for risk factors.

Results: A total of 285 patients (78 MLD, 207 nonoperative) were included. Risk factors for MLD treatment included larger axial HNP area ( < .01, OR = 1.01), caudal migration, and migration magnitude ( < .05, OR = 1.90; < .01, OR = 1.14), and gray HNP MRI signal ( < .01, OR = 5.42). Cutoff values for risks included axial HNP area (70.52 mm, OR = 2.66, < .01), HNP canal compromise (20.0%, OR = 3.29, < .01), and cephalad/caudal migration (6.8 mm, OR = 2.43, < .01). MLD risk for those with gray HNP MRI signal (67.6% alone) increased when combined with axial HNP area >70.52 mm (75.5%, = .01) and HNP canal compromise >20.0% (71.1%, = .05) cutoffs. MLD risk in patients with cephalad/caudal migration >6.8 mm (40.5% alone) increased when combined with axial HNP area and HNP canal compromise (52.4%, 50%; < .01).

Conclusion: Patients who underwent MLD treatment had significantly different axial HNP area, frequency of caudal migration, magnitude of cephalad/caudal migration, and disc herniation MRI signal compared to patients with nonoperative treatment.

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