Prediction of lumbar disc herniation resorption in symptomatic patients: a prospective,multi-imaging and clinical phenotype study |
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| Affiliation: | 2. The International Spine Research and Innovation Initiative, Rush University Medical Center, Orthopaedic Building, 2nd floor, 1611 W. Harrison St, Chicago, IL 60612, USA;3. Tkachev and Epifanov Clinic, Novouzenskaya str, 6-B, Volograd, 400120, Russia;4. The Modic ClinicJernbanegade 43. sal th 5000 Odense, Denmark;1. School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, Australia;2. Sydney Musculoskeletal Health, The University of Sydney, Camperdown, Sydney, Australia;3. Sydney Spine Institute, Burwood, Sydney, Australia;4. Neuro Spine Surgery Research Group (NSURG), Sydney, Australia;5. University of Oklahoma Medical Center, Oklahoma City, OK, USA;6. Discipline of Chiropractic, School of Health, Medical and Applied Sciences, CQUniversity, Brisbane, Queensland, Australia;7. University of Technology Sydney, Ultimo, Sydney, Australia;8. Liverpool Hospital, Liverpool, Sydney, Australia;9. Concord General Repatriation Hospital, Concord, Sydney, Australia;10. Faculty of Medicine, University of New South Wales, Sydney, Australia;11. Wearables and Gait Assessment Research Group [WAGAR], Sydney Australia;1. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA;2. Spine Nevada, Reno, NV 89521, USA;1. Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei City, Taiwan;2. Department of Medical Education, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu City, Taiwan;3. Department of Orthopedics, College of Medicine, National Taiwan University, No1, Jen-Ai Rd, Taipei, Taiwan;4. Department of Orthopedics Surgery, Massachusetts General Hospital;5. Department of Orthopedic, University Medical Center Utrecht, Utrecht, The Netherlands;6. Department of Computer Science and Engineering, National Taiwan Ocean University, Keelung, Taiwan;1. Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden MC & Haga Teaching Hospital, Albinusdreef 2, Leiden, 2300, NH, The Netherlands;2. Northwest Clinics, Wilhelminalaan 12, Alkmaar, 1815, NH, The Netherlands;3. Spaarne Gasthuis, Spaarnepoort 1, Hoofddorp, 2134, NH, The Netherlands;1. Department of Orthopedic Surgery, Kurume University, Fukuoka, Japan;2. Department of Orthopedic Surgery, Kurume Medical Center, Fukuoka, Japan |
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| Abstract: | ![]()
BACKGROUND CONTEXTSymptomatic lumbar disc herniations (LDH) are very common. LDH resorption may occur by a “self-healing” process, however this phenomenon remains poorly understood. By most guidelines, if LDH remains symptomatic after 3 months and conservative management fails, surgical intervention may be an option.PURPOSEThe following prospective study aimed to identify determinants that may predict early versus late LDH resorption.STUDY DESIGN/SETTINGProspective study with patients recruited at a single center.PATIENT SAMPLENinety-three consecutive patients diagnosed with acute symptomatic LDH were included in this study (n=23 early resorption and n=67 late resorption groups) with a mean age of 48.7±11.9 years.OUTCOMES MEASUREBaseline assessment of patient demographics (eg, smoking status, height, weight, etc.), herniation characteristics (eg, the initial level of herniation, the direction of herniation, prevalence of multiple herniations, etc.) and MRI phenotypes (eg, Modic changes, end plate abnormalities, disc degeneration, vertebral body dimensions, etc.) were collected for further analysis. Lumbar MRIs were performed approximately every 3 months for 1 year from time of enrollment to assess disc integrity.METHODSAll patients were managed similarly. LDH resorption was classified as early (<3 months) or late (>3 months). A prediction model of pretreatment factors was constructed.RESULTSNo significant differences were noted between groups at any time-point (p>.05). Patients in the early resorption group experienced greater percent reduction of disc herniation between MRI-0-MRI-1 (p=.043), reduction of herniation size for total study duration (p=.007), and percent resorption per day compared to the late resorption group (p<.001). Based on multivariate modeling, greater L4 posterior vertebral height (coeff:14.58), greater sacral slope (coeff:0.12), and greater herniated volume (coeff:0.013) at baseline were found to be most predictive of early resorption (p<.05).CONCLUSIONSThis is the first comprehensive imaging and clinical phenotypic prospective study, to our knowledge, that has identified distinct determinants for early LDH resorption. Early resorption can occur in 24.7% of LDH patients. We developed a prediction model for early resorption which demonstrated great overall performance according to pretreatment measures of herniation size, L4 posterior body height, and sacral slope. A risk profile is proposed which may aid clinical decision-making and managing patient expectations |
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