Natural History of Lumbar Disc Hernia with Radicular Leg Pain: Spontaneous MRI Changes of the Herniated Mass and Correlation with Clinical Outcome

Abstract

A prospective sequential MRI study was done to investigate the morphologic changes of the lumbar disc hernia (LDH). We also studied the relationship between the MRI changes and the type of LDH and the clinical outcome. MRI was performed every 3 months from the onset for a maximum of 24 months in 42 patients with radicular leg pain and symptoms definitely diagnosed as caused by LDH. The size of the herniated mass was determined by the ratio of the anteroposterior diameter of the spinal canal to the maximum diameter of the LDH mass on T2-weighted axial images. The clinical outcome was evaluated as excellent, good, or poor depending on leg pain and physical findings. The JOA (Japanese Orthopaedic Association) score for LDH was also used to assess the outcome. Thirty-seven (88%) of the 42 patients showed >50% reduction of the hernia on MRI 3-12 months after onset, and the morphologic changes of the herniated mass were well correlated with the clinical outcome.

The added prognostic value of MRI findings for recovery in patients with low back pain in primary care: a 1-year follow-up cohort study

“…A diverse range of prognostic factors (demographics, physical factors, and psychological factors) has been studied in relation to persistent LBP [5]. The prognostic value of MRI findings in relation to recovery has mainly been studied in patients with sciatica in secondary care [6][7][8][9][10][11]; however, these results may differ from studies performed in patients with LBP in general practice.…”

Magnetic Resonance Imaging Findings as Predictors of Clinical Outcome in Patients With Sciatica Receiving Active Conservative Treatment

“…[3][4][5] The prognostic value of MRI findings in relation to relief of sciatic pain in patients treated nonsurgically has been investigated in previous prospective studies. [6][7][8][9] According to these studies, a small herniation in a large spinal canal, 6 annular rupture, 9 nerve root compression, 9 and disk extrusion 7,8 correlated with a positive outcome, whereas a foraminal location of the herniation correlated with a negative outcome. 9 Three studies have related the clinical outcome to a second MRI of the herniations seen in selected groups of patients.…”

Conservative Treatment of Lumbar Disc Herniation - A Prospective Study of Disc Herniation Encroaching More than One-third of Spinal Canal -

“…However, Takada et al 19) in their follow-up study of herniated discs using MRI, stated that the protruded type resulted in slower reduction in the size; since midsize-plus herniation only were used in this study, the protruded type disc herniation that were smaller than 1/3 spinal canal encroachment were excluded and only the extruded and sequestrated types were included. As such, in the future, additional studies are needed to investigate the differences in the results of conservative treatment among the protruded, extruded and sequestrated types.…”