Postoperative MRI findings 5 years after lumbar microdiscectomy

MRI Characteristics at a Mean of Thirteen Years After Lumbar Disc Herniation Surgery in Adolescents: A Case-Control Study

The purpose of this study was to describe the prevalence of lumbar spine degeneration in adult individuals who had undergone lumbar disc herniation surgery during adolescence.

Morphological parameters of fourth lumbar spinous process palpation: a three-dimensional reconstruction of computed tomography

Background

The localization of lumbar fourth spinous process (L4-SP) is an important anatomical landmark, and identifying its accurate position is essential for the diagnosis and treatment of waist diseases.

Methods

Five hundred participants were scanned with positive and lateral computed tomography (CT), which aimed to clarify anatomic characteristics of L4-SP. Anatomical parameters of the surface localization of L4-SP were measured and recorded through a three-dimensional (3D) reconstruction.

Results

Five hundred participants were classified into three types according to the position of BC with the iliac spine. There are just 266 that the line between the highest point of the iliac spine on both sides located on L4-SP (type I, 53.20%), 16 above L4-SP (type II, 3.20%), and 218 below L4-SP (type III, 43.60%). BC in type I (15.92 ± 1.30 mm) is longer than type III (15.56 ± 1.32 mm). While the angle combined with AB and BC is different in the three groups, the angle in type I (173.00 ± 4.83°) is larger than that in type II (164.69 ± 5.50°) and type III (159.45 ± 8.39°). Other measurements were not found any significant differences between above.

Conclusion

The traditional palpation for L4-SP is not absolutely exact. The accuracy rate is only 53.20%, and the errors may cause serious consequences.

Association between MRI findings and clinical outcomes in a period of 5 years after lumbar spine microdiscectomy

BACKGROUND

To evaluate the associations between magnetic resonance imaging (MRI) findings and pain, disability and quality of life before surgery and up to 5 years after lumbar microdiscectomy.

MATERIALS AND METHODS

Sixty-one patients who underwent one-level lumbar microdiscectomy by the same surgeon participated in this analytic, observational, prospective study. Lumbar spine MRI was performed preoperatively and 5 years postoperatively. Pain, disability and quality of life were measured with VAS, ODI, Roland Morris and SF-36 pre- and up to 5 years postoperatively. Subsequently associations between radiological findings and clinical outcomes were recorded.

RESULTS

Before surgery patients with disc extrusion or sequestration, with increased thecal sac compression (d > 2/3), with Modic changes (MC) 2 and 3 on the operated level and Pfirrmann grades IV and V on the operated and both adjacent discs presented the worst preoperative clinical outcomes. MC preoperatively were not related with postoperative results, in contrast with the type of disc herniation and thecal sac compression. Preoperative Pfirrmann grade IV and V on the operated and both adjacent discs and postoperative MC 2 and 3 on the operated level were related to poor clinical outcomes 36-60 months post-discectomy.

CONCLUSIONS

Extrusion or sequestration of the operated disc, increased compression of thecal sac, MC 2 and 3 on the operated level and Pfirrmann grades IV and V on the operated and adjacent discs were associated with the worst clinical outcomes. Nerve root impingement, facet joint arthritis, perineural fibrosis and disc granulation tissue had no effect on clinical scores.