The correlation between magnetic resonance imaging and the operative and clinical findings after lumbar microdiscectomy

Abstract

Fifty-four consecutive patients were studied prospectively with magnetic resonance imaging before microdiscectomy, and the findings correlated with clinical symptoms before and after operation. A sequestrated fragment was found in 59% of cases, a subligamentous disc sequestration in 25% and a disc protrusion in 16%. The levels operated on were L4/5-36%, L5/S1-62.5%, and one at L3/4; 71% were laterally placed, 10% lay intraforaminal and 10% medial. The diameter of the protrusion was 4 mm to 13 mm for the craniocaudal extension, and 5 mm to 18 mm for the anteroposterior extension. No correlation could be found between a neurological deficit and the size of the prolapse. A positive correlation was present between the increasing degree of canal obstruction and the degree of disc degeneration determined by imaging for extrusions, subligamentous disc sequestrations and free sequestrations. Nerve root inflammation and enlargement was seen in 36% of the images, corresponding to an operative finding of 32%. Magnetic resonance imaging is a helpful pre-operative diagnostic investigation which shows structural changes in the disc and the correct localisation and size of the disc sequestration, but there was no correlation between the imaging findings and the clinical symptoms.

Association between clinically diagnosed lumbar intervertebral disc prolapse and magnetic resonance image findings

“…However, these images are not useful in predicting neurological deficit and therefore should not be used as an indication for surgery unless there is a strong correlation with the clinical findings. 19 In our study, 34 (63.0%) patients had signs and symptoms of PLID at the level L4/5, 53.7% at L5/S1 and 11.1% cases at L3/4 level; which on MRI was found to be 68.5%, 46.3% and 11.1% respectively, showing good agreement for L4/5 and L5/S1 (k-value 0.795 and 0.705 respectively) and very good agreement for L3/4 level (p value 0.812), between the two modalities of diagnosis in detecting level of disc prolapse. MRI detected herniation at an L2/3 level in 1 case which could not diagnose clinically.…”

Value of delayed gadolinium-enhanced magnetic resonance imaging of cartilage for the pre-operative assessment of cervical intervertebral discs

“…The extend of IVD degeneration may differ between cervical IVDs in the same patient. However, the most severe degeneration and therefore the largest proteoglycan loss is to be expected in IVDs that subsequently undergo surgery . Although this is the first study investigating the value of dGEMRIC in preoperative cervical IVDs, different studies showed a reduction of IVD proteoglycan content in patients following lumbar stabilization surgery .…”

“…Therefore, the aim of our study was to determine the proteoglycan content of cervical intervertebral discs in patients who were scheduled for elective disc surgery. Elective disc surgery is commonly performed on the most severely degenerated IVDs which contain a low amount of proteoglycans . Our hypothesis was that dGEMRIC values are significantly lower in IVDs scheduled for discectomy compared to IVDs that did not require surgical intervention.…”

Die radiologische Befundung des lumbalen Bandscheibenvorfalls nach quantitativen und morphologischen Kriterien

“…Dieser ragt tiefer in den Epiduralraum bei relativ schmaler Basis. Nach Wittenberg et al [3] kann dadurch zwischen MRT-und intraoperativem Befund eine positive Korrelation bei der Beurteilung des Bandscheibenvorfalls festgestellt werden. Ein neueres Verfahren zur radiologischen Befundung des Bandscheibenvorfalls nach überwiegend quantitativen Kriterien wird von Bolm-Audorff et al [4] in den Konsensusempfehlungen zur Beurteilung von bandscheibenbedingten Berufskrankheiten der Lendenwirbelsäule beschrieben.…”

“…Nach Jackson et al[8] gilt das MRT als Goldstandard zur Diagnostik des Bandscheibenvorfalls bei höchster Sensibilität und Spezifität. Zwischen MRT-und intraoperativem Befund konnte Wittenberg et al[3] eine positive Korrelation bei der Befundung des Vorfalls feststellen. Das CT ist hierbei zweitrangig.…”