TY - JOUR
T1 - Does the Size or Location of Lumbar Disc Herniation Predict the Need for Operative Treatment?
AU - Divi, Srikanth N.
AU - Makanji, Heeren S.
AU - Kepler, Christopher K.
AU - Anderson, D. Greg
AU - Goyal, Dhruv K.C.
AU - Warner, Eric D.
AU - Galetta, Matthew S.
AU - Hilibrand, Alan S.
AU - Kaye, I. David
AU - Kurd, Mark F.
AU - Radcliff, Kristen E.
AU - Rihn, Jeffrey A.
AU - Woods, Barrett I.
AU - Vaccaro, Alexander R.
AU - Schroeder, Gregory D.
N1 - Publisher Copyright:
© The Author(s) 2020.
PY - 2022/3
Y1 - 2022/3
N2 - Study Design: Retrospective cohort study. Objective: The goal of this study was to determine whether the absolute size (mm2), relative size (% canal compromise), or location of a single-level, lumbar disc herniation (LDH) on axial and sagittal cuts of magnetic resonance imaging (MRI) were predictive of eventual surgical intervention. Methods: MRIs of 89 patients were reviewed, and patients were split into groups based on type of management received (34 nonoperative vs 55 microdiscectomy). Radiographic characteristics—including size of disc herniation (mm2), size of spinal canal (mm2), location of herniation on axial (central, paracentral, foraminal) and sagittal (disc level, suprapedicle, pedicle, infrapedicle) planes, and type of herniation (bulge, protrusion, extrusion, sequestration)—were measured by 2 independent, orthopedic spine fellows and compared between groups via univariate and multivariate analyses. Results: The operative group showed a significantly higher percentage of canal compromise (39.5% vs 31.1%, P =.001) compared to the nonoperative group. Multiple logistic regression analysis showed higher odds of eventual operative intervention for a disc protrusion (odds ratio [OR] 6.30 [1.99, 19.86], P =.002) or disc extrusion (OR 11.5 [1.63, 81.2], P =.014) for Rater 1 and a higher odds of eventual surgical management for a paracentral location for both Rater 1 and Rater 2 (OR = 3.39 [1.25, 9.22], P =.017, and OR = 5.46 [1.77, 16.8], P =.003, respectively). Conclusions: Disc herniations in a paracentral location were more likely to undergo operative treatment than those more centrally located, on axial MRI views.
AB - Study Design: Retrospective cohort study. Objective: The goal of this study was to determine whether the absolute size (mm2), relative size (% canal compromise), or location of a single-level, lumbar disc herniation (LDH) on axial and sagittal cuts of magnetic resonance imaging (MRI) were predictive of eventual surgical intervention. Methods: MRIs of 89 patients were reviewed, and patients were split into groups based on type of management received (34 nonoperative vs 55 microdiscectomy). Radiographic characteristics—including size of disc herniation (mm2), size of spinal canal (mm2), location of herniation on axial (central, paracentral, foraminal) and sagittal (disc level, suprapedicle, pedicle, infrapedicle) planes, and type of herniation (bulge, protrusion, extrusion, sequestration)—were measured by 2 independent, orthopedic spine fellows and compared between groups via univariate and multivariate analyses. Results: The operative group showed a significantly higher percentage of canal compromise (39.5% vs 31.1%, P =.001) compared to the nonoperative group. Multiple logistic regression analysis showed higher odds of eventual operative intervention for a disc protrusion (odds ratio [OR] 6.30 [1.99, 19.86], P =.002) or disc extrusion (OR 11.5 [1.63, 81.2], P =.014) for Rater 1 and a higher odds of eventual surgical management for a paracentral location for both Rater 1 and Rater 2 (OR = 3.39 [1.25, 9.22], P =.017, and OR = 5.46 [1.77, 16.8], P =.003, respectively). Conclusions: Disc herniations in a paracentral location were more likely to undergo operative treatment than those more centrally located, on axial MRI views.
KW - LDH
KW - MRI
KW - bulge
KW - extrusion
KW - location
KW - lumbar disc herniation
KW - protrusion
KW - sequestration
KW - size
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U2 - 10.1177/2192568220948519
DO - 10.1177/2192568220948519
M3 - Article
C2 - 32935569
AN - SCOPUS:85091062396
SN - 2192-5682
VL - 12
SP - 237
EP - 243
JO - Global Spine Journal
JF - Global Spine Journal
IS - 2
ER -