Does the Size or Location of Lumbar Disc Herniation Predict the Need for Operative Treatment?

Srikanth N. Divi, Heeren S. Makanji, Christopher K. Kepler, D. Greg Anderson, Dhruv K.C. Goyal*, Eric D. Warner, Matthew S. Galetta, Alan S. Hilibrand, I. David Kaye, Mark F. Kurd, Kristen E. Radcliff, Jeffrey A. Rihn, Barrett I. Woods, Alexander R. Vaccaro, Gregory D. Schroeder

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)237-243
Number of pages7
JournalGlobal Spine Journal
Issue number2
StatePublished - Mar 2022


  • LDH
  • MRI
  • bulge
  • extrusion
  • location
  • lumbar disc herniation
  • protrusion
  • sequestration
  • size

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology


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