Reliability (Revalidation) of MSU MRI Classification of Lumbar Disc Herniation in 100 Patients Series: Severity and Objective Surgical Criteria

Abstract

Background Data: Success rate of discectomy is greatly variable between surgeons due to lack of clear categorization of lumbar disc patients. Valid radiological objective criteria are required especially for patients with uncertain surgical indication to help in pre-operative patient assessment, surgical selection and research of post-operative outcomes of comparable level of pathology. MSU Classification reports size and location in three precise increments, described simply 1-2-3 and A-B-C providing clear objective classification of disc herniation resulting in excellent interexaminar reliability. Purpose To test reliability of MSU MRI classification of lumbar disc herniation in helping surgical selection and correlation with preoperative clinical presentation and postoperative clinical and functional outcome. Study Design Observational analytic retrospective study. Patients and Methods Retrospective investigations of one hundred patients who underwent lumbar discectomy at Ain Shams University between January 2014 and June 2015 in term of MSU classification. Results Only 2 patients (2%) in our series had grade 1-A. All other 98 patients had MSU grades with size 2 or 3 and/or B or C location or 2 or 3 combination of horizontal disc locations (A, B or C). Two cases of unintended durotomy occurred in MSU grade 3-AB (40%) and the other 3 cases occurred in grade 2-AB (60%). One case of CSF leak occurred in 3-AB herniated disc lesion (50%)

Peri-operative Radiological Factors Predicting Outcome of Discogenic Cauda Equina Syndrome

“…It appeared that disc fragment direction was related more to the canal stenosis degree with P<0.029, (Table 4) with the upward migrated fragment showed the worst canal diameter. 1,10 The clinical presentation (preoperative JOA and ODI scores) and other radiological factors like preoperative canal stenosis) seem to be more important outcome predictor than the size of the herniated disc even if it is of huge size.…”