Prediction of lumbar disc herniation resorption in symptomatic patients: a prospective, multi-imaging and clinical phenotype study

Hornung, Alexander; Barajas, J. Nicolás; Rudisill, Samuel S.; Aboushaala, Khaled; Butler, Alexander W.; Park, Grant; Harada, Garrett K.; Leonard, Skylar; Roberts, Ashley; An, Howard S.; Epifanov, A. V.; Albert, H; Tkachev, Alexander; Samartzis, D

doi:10.1016/j.spinee.2022.10.003

Cited by 14 publications

(7 citation statements)

References 51 publications

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“…Specifically, multiple studies have reported no association between initial herniation measurements, whereas others found larger initial herniation measurements to be associated with a shorter time to resorption. [35][36][37] While the results of the current study cannot be directly compared with those of previous works, we determined no difference in time to resorption between single-level and multilevel LDH groups, supporting the notion that initial herniation measurements are not related to time to resorption.…”

Section: Clinical Case Seriessupporting

confidence: 79%

How Does Resorption Differ Among Single-Level and Multilevel Lumbar Disc Herniations? A Prospective Multi-Imaging and Clinical Phenotype Study

Hornung,

Rudisill,

Barajas

et al. 2024

Spine

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Study Design. Prospective, Case Series. Objective. To identify and characterize any differences in specific patient factors, MRI findings, features of spontaneous disc resorption, and outcomes between patients with single- and multi-level LDH. Background. Lumbar disc herniation (LDH) is one of the most common spinal pathologies worldwide. Though many cases of LDH resolve by spontaneous resorption, the mechanism underlying this “self-healing” phenomenon remains poorly understood, particularly in the context of multi-level herniations. Methods. A one-year prospective study was conducted of patients presenting with acute symptomatic LDH between 2017 and 2019. Baseline demographics, herniation characteristics, and MRI phenotypes were recorded prior to treatment, which consisted of gabapentin, acupuncture, and avoidance of inflammatory-modulating medications. MRIs were performed approximately every 3 months after initial evaluation to determine any differences between patients with single- and multi-level LDH. Results. Ninety patients were included, 17 demonstrated multi-level LDH. Body mass index was higher amongst patients with multi-level LDH (P<0.001). Patients with multi-level LDH were more like to exhibit L3/L4 inferior endplate defects (P=0.001), L4/L5 superior endplate defects (P=0.012), and L4/L5 inferior endplate defects (P=0.020) on MRI. No other differences in MRI phenotypes (e.g., Modic changes, osteophytes, etc.) existed between groups. Resorption rate and time to resolution did not differ between those with single- and multi-level LDH. Conclusions. Resorption rates were similar between single- and multi-level LDH at various time points throughout one prospective assessment, providing insights that disc healing may have unique programmed signatures. Compared to those with single-level LDH, patients with multi-level herniations were more likely to have a higher BMI, lesser initial axial and sagittal disc measurements, and endplate defects at specific lumbar levels. In addition, our findings support the use of conservative management in patients with LDH regardless of the number of levels affected.

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Section: Clinical Case Seriessupporting

confidence: 79%

How Does Resorption Differ Among Single-Level and Multilevel Lumbar Disc Herniations? A Prospective Multi-Imaging and Clinical Phenotype Study

Hornung,

Rudisill,

Barajas

et al. 2024

Spine

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“…Additionally, neurological diseases, including lumbar disk herniation and spinal stenosis, have been proposed as causes of PE (Jin, 2015 ; Yazici et al, 2013 ). Lumbar disk herniation, spinal stenosis, and Tavlov cysts rarely show positive results in X-ray reports but can be demonstrated by the information of lesion information in MRI (Hornung et al, 2023 ; Sun et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Tarlov Cysts and Premature Ejaculation

Liu,

Sun,

Gao

et al. 2024

Arch Sex Behav

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Tarlov cysts adjacent to the spinal cord are usually asymptomatic and found incidentally via magnetic resonance imaging. On rare occasions, they increase in size to produce symptoms resembling disk herniation. We report a rare case of a sacral cyst resulting in premature ejaculation in a 32-year-old man who presented with pelvic pain and acquired premature ejaculation. Spinal nerve root decompression, excision of intraspinal Tarlov cyst, and spinal nerve root adhesion release surgery significantly improved his pain and premature ejaculation at a six-month follow-up.

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“…In addition, the fragment exhibited a high T2 signal, indicating that it consisted primarily of water or nucleus pulposus material. As an updated study suggests that early resorption of LDH may occur in 24.7% of patients, the chiropractors anticipated that there is a high probability that the herniation may diminish naturally [ 16 ]. Although physical examinations used to identify LDH [ 17 ] are poorly correlated with diagnostic evidence, the use of MRI in the diagnosis of LDH has a high diagnostic value [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…In a routine clinical setting, a recent study compared the long-term and short-term effectiveness of conservative and surgical treatments for quality of life and severity of sciatic symptoms in patients with LDH and found that there was no evidence to suggest that surgical treatment had any advantage over conservative treatment in long-term re-evaluations [ 19 ]. According to the majority of guidelines, if LDH is symptomatic after three months and conservative treatment is ineffective, surgical surgery may be recommended [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

A Severe Disc Herniation Mimics Spinal Tumor

Chu¹,

Lin²,

Huang³

et al. 2023

Cureus

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Lumbar disc herniation (LDH) is prevalent among adults aged 25-55 years who spend a considerable proportion of their time sitting or standing with heavy workloads. We report the case of a 33-year-old male waiter with severe LDH, causing compression of the nerve roots and spinal cord with neurological dysfunction, who presented to a chiropractic clinic. Magnetic resonance imaging (MRI) revealed a radiological differential diagnosis comprising LDH and an epidural mass lesion. To rule out serious pathology, a second MRI with contrast was ordered, which confirmed the diagnosis of severe LDH. Diagnosing large LDH may be challenging, and severe disc herniation often mimics spinal tumors. This study offers insights into the differential diagnosis of LDH and spinal tumors, as well as the design of a treatment strategy for severe LDH in the chiropractic clinic.

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Prediction of lumbar disc herniation resorption in symptomatic patients: a prospective, multi-imaging and clinical phenotype study

Cited by 14 publications

References 51 publications

How Does Resorption Differ Among Single-Level and Multilevel Lumbar Disc Herniations? A Prospective Multi-Imaging and Clinical Phenotype Study

How Does Resorption Differ Among Single-Level and Multilevel Lumbar Disc Herniations? A Prospective Multi-Imaging and Clinical Phenotype Study

Tarlov Cysts and Premature Ejaculation

A Severe Disc Herniation Mimics Spinal Tumor

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