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

• Published in: Korean journal of radiology Vol. 8; no. 2; pp. 156 - 163
• Main Authors: Choi, Soo-Jung, Song, Jae Seok, Kim, Chunghwan, Shin, Myung Jin, Ryu, Dae Sik, Ahn, Jae Hong, Jung, Seung Moon, Park, Man Soo
• Format: Journal Article
• Language: English
• Published: Korea (South) 01.03.2007
• Subjects: Adolescent; Adult; Aged; Chi-Square Distribution; Female; Humans; Intervertebral Disc Displacement - drug therapy; Intervertebral Disc Displacement - pathology; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Predictive Value of Tests; Steroids - therapeutic use; Treatment Outcome
• ISSN: 1229-6929

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