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The use of magnetic resonance imaging to predict the clinical outcome of non-surgical treatment for lumbar intervertebral disc herniation.

Choi SJ, Song JS, Kim C, Shin MJ, Ryu DS, Ahn JH, Jung SM, Park MS - Korean J Radiol (2007 Mar-Apr)

Bottom Line: A successful outcome required a patient satisfaction score greater than two and a pain reduction score greater than 50%.There was no significant difference between the responders and non-responders in terms of the type, hydration and size of the HIVD, or an association with spinal stenosis (p > 0.05).MRI could play an important role in predicting the clinical outcome of non-surgical transforaminal ESI treatment for patients with lumbar HIVD.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine, GangNeung, Korea.

ABSTRACT

Objective: We wanted to investigate the relationship between the magnetic resonance (MR) findings and the clinical outcome after treatment with non-surgical transforaminal epidural steroid injections (ESI) for lumbar herniated intervertebral disc (HIVD) patients.

Materials and methods: Transforaminal ESI were performed in 91 patients (50 males and 41 females, age range: 13-78 yrs) because of lumbosacral HIVD from March 2001 to August 2002. Sixty eight patients whose MRIs and clinical follow-ups were available were included in this study. The medical charts were retrospectively reviewed and the patients were divided into two groups; the successful (responders, n = 41) and unsatisfactory (non-responders, n = 27) outcome groups. A successful outcome required a patient satisfaction score greater than two and a pain reduction score greater than 50%. The MR findings were retrospectively analyzed and compared between the two groups with regard to the type (protrusion, extrusion or sequestration), hydration (the T2 signal intensity), location (central, right/left central, subarticular, foraminal or extraforaminal), and size (volume) of the HIVD, the grade of nerve root compression (grade 1 abutment, 2 displacement and 3 entrapment), and an association with spinal stenosis.

Results: There was no significant difference between the responders and non-responders in terms of the type, hydration and size of the HIVD, or an association with spinal stenosis (p > 0.05). However, the location of the HIVD and the grade of nerve root compression were different between the two groups (p < 0.05).

Conclusion: MRI could play an important role in predicting the clinical outcome of non-surgical transforaminal ESI treatment for patients with lumbar HIVD.

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Related in: MedlinePlus

MRI of a 56-year-old woman. Extraforaminal disc herniation with a successful result. She was suffering from severe posterior thigh and lateral leg pain with tingling sensations. Surgery was planned for this patient as conservative management with oral and intravenous medication had failed.A-C. The T1-weighted consecutive axial images. Extraforaminal disc herniation (arrow) is observed just above the level of the L5-S1 disc. Note that the disc is located at the extraforaminal course of the left L5 nerve (arrowheads). Left L5 transforaminal epidural steroid injection resulted in remarkable improvement and it removed the need for surgery. Eight months after injection the symptoms had disappeared and she was in a satisfactory condition.
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Figure 4: MRI of a 56-year-old woman. Extraforaminal disc herniation with a successful result. She was suffering from severe posterior thigh and lateral leg pain with tingling sensations. Surgery was planned for this patient as conservative management with oral and intravenous medication had failed.A-C. The T1-weighted consecutive axial images. Extraforaminal disc herniation (arrow) is observed just above the level of the L5-S1 disc. Note that the disc is located at the extraforaminal course of the left L5 nerve (arrowheads). Left L5 transforaminal epidural steroid injection resulted in remarkable improvement and it removed the need for surgery. Eight months after injection the symptoms had disappeared and she was in a satisfactory condition.

Mentions: On the MR analysis, there was no significant difference between the responders and non-responders in terms of the type, hydration and size of the herniated disc, or an association with spinal stenosis (p> 0.05) (Table 1). However, the location of the herniated disc and the grade of nerve root compression were different between the two groups (p< 0.05) (Tables 2, 3). A centrally located herniated disc was more common in the responder group (Fig. 3), and an extraforaminal disc herniation was also successfully treated (Fig. 4). Treatment of six subarticularly located herniated discs showed unsatisfactory results (Fig. 5). The grade of nerve root compression also correlated with the clinical outcome (Fig. 6). Grade 2 or 3 nerve root compression showed more unsatisfactory results than the grade 1 nerve root compression (odds ratio: 7.43 and 25.9, respectively).


The use of magnetic resonance imaging to predict the clinical outcome of non-surgical treatment for lumbar intervertebral disc herniation.

Choi SJ, Song JS, Kim C, Shin MJ, Ryu DS, Ahn JH, Jung SM, Park MS - Korean J Radiol (2007 Mar-Apr)

MRI of a 56-year-old woman. Extraforaminal disc herniation with a successful result. She was suffering from severe posterior thigh and lateral leg pain with tingling sensations. Surgery was planned for this patient as conservative management with oral and intravenous medication had failed.A-C. The T1-weighted consecutive axial images. Extraforaminal disc herniation (arrow) is observed just above the level of the L5-S1 disc. Note that the disc is located at the extraforaminal course of the left L5 nerve (arrowheads). Left L5 transforaminal epidural steroid injection resulted in remarkable improvement and it removed the need for surgery. Eight months after injection the symptoms had disappeared and she was in a satisfactory condition.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2626775&req=5

Figure 4: MRI of a 56-year-old woman. Extraforaminal disc herniation with a successful result. She was suffering from severe posterior thigh and lateral leg pain with tingling sensations. Surgery was planned for this patient as conservative management with oral and intravenous medication had failed.A-C. The T1-weighted consecutive axial images. Extraforaminal disc herniation (arrow) is observed just above the level of the L5-S1 disc. Note that the disc is located at the extraforaminal course of the left L5 nerve (arrowheads). Left L5 transforaminal epidural steroid injection resulted in remarkable improvement and it removed the need for surgery. Eight months after injection the symptoms had disappeared and she was in a satisfactory condition.
Mentions: On the MR analysis, there was no significant difference between the responders and non-responders in terms of the type, hydration and size of the herniated disc, or an association with spinal stenosis (p> 0.05) (Table 1). However, the location of the herniated disc and the grade of nerve root compression were different between the two groups (p< 0.05) (Tables 2, 3). A centrally located herniated disc was more common in the responder group (Fig. 3), and an extraforaminal disc herniation was also successfully treated (Fig. 4). Treatment of six subarticularly located herniated discs showed unsatisfactory results (Fig. 5). The grade of nerve root compression also correlated with the clinical outcome (Fig. 6). Grade 2 or 3 nerve root compression showed more unsatisfactory results than the grade 1 nerve root compression (odds ratio: 7.43 and 25.9, respectively).

Bottom Line: A successful outcome required a patient satisfaction score greater than two and a pain reduction score greater than 50%.There was no significant difference between the responders and non-responders in terms of the type, hydration and size of the HIVD, or an association with spinal stenosis (p > 0.05).MRI could play an important role in predicting the clinical outcome of non-surgical transforaminal ESI treatment for patients with lumbar HIVD.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine, GangNeung, Korea.

ABSTRACT

Objective: We wanted to investigate the relationship between the magnetic resonance (MR) findings and the clinical outcome after treatment with non-surgical transforaminal epidural steroid injections (ESI) for lumbar herniated intervertebral disc (HIVD) patients.

Materials and methods: Transforaminal ESI were performed in 91 patients (50 males and 41 females, age range: 13-78 yrs) because of lumbosacral HIVD from March 2001 to August 2002. Sixty eight patients whose MRIs and clinical follow-ups were available were included in this study. The medical charts were retrospectively reviewed and the patients were divided into two groups; the successful (responders, n = 41) and unsatisfactory (non-responders, n = 27) outcome groups. A successful outcome required a patient satisfaction score greater than two and a pain reduction score greater than 50%. The MR findings were retrospectively analyzed and compared between the two groups with regard to the type (protrusion, extrusion or sequestration), hydration (the T2 signal intensity), location (central, right/left central, subarticular, foraminal or extraforaminal), and size (volume) of the HIVD, the grade of nerve root compression (grade 1 abutment, 2 displacement and 3 entrapment), and an association with spinal stenosis.

Results: There was no significant difference between the responders and non-responders in terms of the type, hydration and size of the HIVD, or an association with spinal stenosis (p > 0.05). However, the location of the HIVD and the grade of nerve root compression were different between the two groups (p < 0.05).

Conclusion: MRI could play an important role in predicting the clinical outcome of non-surgical transforaminal ESI treatment for patients with lumbar HIVD.

Show MeSH
Related in: MedlinePlus