MRI Outcomes of Nonsurgical Treatment of Giant Lumbar Disc Herniation: A Prospective Clinical Study

Abstract

Background: The phenomenon of lumbar disc herniation resorption is increasingly being reported, but the occurrence of this phenomenon cannot currently be accurately predicted.Methods: We acquired magnetic resonance imaging (MRI) of patients with giant lumbar disc herniation from January 2018 to December 2019, and analyzed the prognostic value of measurements performed on the images. The patients underwent conservative treatment according to the doctor’s decision. The imaging assessments included Komori points, MSU type, Iwabuchi type, the presence of a “bull’s eye” sign on contrast-enhanced MRI, Modic type classification, initial imaging prominence rate, and maximum level projection area. Post-treatment MRI was reviewed to evaluate the outstanding prominence rate and the maximum level projection area, thereby allowing calculation of the intervertebral disc absorption rate after treatment. The rate of patients undergoing later surgery was also recorded.Results: Seventy-six patients (46 males and 30 females, aged 14–65 years [mean 37.79 ± 10.60]) were included in this study, 12 of whom underwent surgery, giving a surgical rate of 15.79%. All patients were followed up for more than 9 months. The outburst rate was 84.41% ± 14.72%. The absorptivity rate of the 64 patients under conservative treatment was 38.35% ± 40.64%, with the absorptivity of the patients with Iwabuchi type 1 and a bull’s eye sign being significantly higher than the average rate (P < 0.01).Conclusions: The resorption of giant lumbar disc herniation is a natural process. Imaging findings showed Iwabuchi type 1 and a positive bull’s eye sign on contrast-enhanced MRI to be associated with an increased probability of resorption.