The Predictive Factors for the Resorption of a Lumbar Disc Herniation on Plain Mri

Abstract

: Previous studies have noted the morphologic changes of lumbar disc herniation (LDH) in conservative treatment and predictive value of the resorption of LDH by using contrast -enhanced MRI. However, there are few reports that note the predictive value of plain, non -enhanced MRI. Therefore, no definite predictive factors for the resorption of LDH have been detected on plain MRI. Thirty -four patients with lower limb pain receiving conservative treatment were followed for more than 6 months. MRI was performed every 3 months. The findings of the first MRI in the patients who finally had resorption of LDH (R -group, 21 patients) were compared with those of the patients who exhibited no resorption of LDH (N -group, 13 patients). The MRI evaluation included the signal intensity of LDH, migration of LDH. The transition of the visual analogue scale (VAS) of lower limb pain was also compared. The R -group had significantly more patients with iso -signal intensity in comparison to the signal intensity of the nucleus pulposus observed on T1 weighted images (WI) and high -signal intensity in comparison to the signal intensity of the annulus fibrosus observed on T2 WI, whereas the N -group had more patients with the high -signal intensity on both T1 and T2 WI. The R -group had significantly more patients with migration. The VAS significantly improved at 3 and 6 months in both groups. However, no statistically significant difference was detected between the 2 groups. It is very valuable that the results clearly indicate the predictive factors on plain MRI concerning the resorption of LDH. The study also showed that lower limb pain would gradually improve even in the patients who exhibited no resorption. Therefore, it is important in the treatment of LDH to observe the clinical symptoms carefully without overestimating MRI findings.

Long‐Term Course to Lumbar Disc Resorption Patients and Predictive Factors Associated with Disc Resorption

“…While modic change was not recognized as a predictive factor of resorption in this study, a 2014 study by Shan et al reported that whereas 35 of 85 patients in the modic change group (of whom the majority were of Type 2) did not show much difference in IDH size, the group with no modic change displayed significant decrease [32]. Iwabuchi et al purported that resorption factors could be identified on T1- and T2-weighted MRIs, with high signal intensity of IDH areas in T1- and T2-weighted MRIs in the nonregression group [33]. …”

Signal Intensity of Lumbar Disc Herniations: Correlation With Age of Herniation for Extrusion, Protrusion, and Sequestration

“…It is well known that many patients do present LDH or other degenerative changes in an MRI of their lumbar spine without any related clinical symptoms 1,6,7 and that other neurogenic, musculoskeletal, immunogenic, or neoplastic diseases can mimic clinical symptoms of LDH. [8][9][10] Thus, a clinician can never be entirely sure if an LDH in a patient's MRI with ''radicular-like'' pain is the source for the patient's pain, or if there is another pathology that generates the patient's pain.…”

“…The technique was described in former reports and showed good inter-and intraobserver reliability. 1,4 SI of nucleus pulposus was determined by forming the mean of SI of anterior, median, and posterior part of each nucleus pulposus.…”

“…There is presently insufficient data on determining age of lumbar disc herniations (LDH), that is, time since LDH occurred, by magnetic resonance imaging (MRI). The only reports that show changes of signal intensity (SI) of LDH investigated small groups of patients without focus on time since herniation occurred and without establishing a valid method of measurement 1,2 : Data on how to compare SI of a LDH of different types of MRI (different with regard to strength of magnetic field and manufacturer) is needed. A normalized ratio would enable spine specialists to compare SIs that are measured in different types of MRIs.…”

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

“…Yuan et al [12] studied the spinal canal morphology of 182 patients whose symptoms were signi cantly relieved after conservative or surgical treatment, and found that the spinal canal volume in the patients in the conservative treatment group was signi cantly greater than of the patients in the surgery group. On the basis of the different signal characteristics of protrusions on ordinary MRI, Iwabuchi et al [13] speculated that most type 1 protrusions were composed of nucleus pulposus. A nucleus pulposus with high water content and a small degree of degeneration was more likely to show vascular growth and tissue dehydration, factors realizing the resorption of protrusions.…”