The type of cervical disc herniation on MRI does not correlate to clinical outcomes

Abstract

Aims The aim of this study was to investigate whether the type of cervical disc herniation influences the severity of symptoms at the time of presentation, and the outcome after surgical treatment. Methods The type and extent of disc herniation at the time of presentation in 108 patients who underwent anterior discectomy for cervical radiculopathy were analyzed on MRI, using a four-point scale. These were dichotomized into disc bulge and disc herniation groups. Clinical outcomes were evaluated using the Neck Disability Index (NDI), 36-Item Short Form Survey (SF-36), and a visual analogue scale (VAS) for pain in the neck and arm at baseline and two years postoperatively. The perceived recovery was also assessed at this time. Results At baseline, 46 patients had a disc bulge and 62 had a herniation. There was no significant difference in the mean NDI and SF-36 between the two groups at baseline. Those in the disc bulge group had a mean NDI of 44.6 (SD 15.2) compared with 43.8 (SD 16.0) in the herniation group (p = 0.799), and a mean SF-36 of 59.2 (SD 6.9) compared with 59.4 (SD 7.7) (p = 0.895). Likewise, there was no significant difference in the incidence of disabling arm pain in the disc bulge and herniation groups (84% vs 73%; p = 0.163), and no significant difference in the incidence of disabling neck pain in the two groups (70.5% (n = 31) vs 63% (n = 39); p = 0.491). At two years after surgery, no significant difference was found in any of the clinical parameters between the two groups. Conclusion In patients with cervical radiculopathy, the type and extent of disc herniation measured on MRI prior to surgery correlated neither to the severity of the symptoms at presentation, nor to clinical outcomes at two years postoperatively. Cite this article: Bone Joint J 2022;104-B(11):1242–1248.

Lumbar Disc Herniation with Contralateral Symptoms: A Case‐Series of 11 Patients and Literature Review

“…Bilateral laminectomy and discectomy should be performed when strong evidence indicates the compression of the contralateral nerve root. With the development of minimally invasive surgery, endoscopic surgery has demonstrated similar effectiveness in treating LDH with contralateral symptoms 10,11,14,23 when compared to conventional methods. As endoscopic surgery causes less trauma, we believe that it will become a widely adopted treatment option for such cases in the future.…”

“…Due to the inconformity between symptoms and radiographic findings, the surgical approach remains controversial. Three surgical strategies have been proposed in the literature: (1) unilateral approach and discectomy on the side of the patient's symptoms 10,11 ; (2) unilateral approach and discectomy on the side of the disc herniation 7,[12][13][14][15][16][17] ; and (3) bilateral laminectomy and discectomy. 10,15,[18][19][20][21][22][23][24] Compared with the unilateral approach, a bilateral laminectomy will increase the operation time and complication risks.…”

Electrodiagnostic studies and new diagnostic modalities for evaluation of peripheral nerve disorders

“…In contrast, another study that looked at both cervical and lumbar radiculopathies using a clinical case definition found a combined sensitivity of only 57% 17 . Interestingly, the type and extent of disc herniation on MRI seem to have no correlation with clinical symptoms or postoperative outcome 18 …”

“…17 Interestingly, the type and extent of disc herniation on MRI seem to have no correlation with clinical symptoms or postoperative outcome. 18 There is little contemporary evidence on the sensitivity of CT for the diagnosis of cervical radiculopathy and it has not been compared directly with MRI of the cervical spine. From a practical perspective, CT is useful to delineate the bony anatomy of the neural foramen which may contribute to surgical treatment planning.…”

Identification and experimental validation of key extracellular proteins as potential targets in intervertebral disc degeneration

“…Subsequently, pathological changes such as bulging, protrusion, and prolapse occur, and the clinical manifestations of LBP appear in the corresponding parts. [9][10][11] In recent years, increasing evidence has suggested that some secreted proteins in the extracellular environment of IVD, namely extracellular matrix (ECM) proteins, play an important role in maintaining the structure and function of IVD. Therefore, studies of extracellular proteins in IDD processes can lead to the discovery of new therapeutic targets to delay or reverse IDD.…”