Prediction of lumbar disc herniation resorption in symptomatic patients: a prospective, multi-imaging and clinical phenotype study

Symptomatic 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....

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Published in:	The spine journal Vol. 23; no. 2; pp. 247 - 260
Main Authors:	Hornung, Alexander L., Barajas, J. Nicolas, Rudisill, Samuel S., Aboushaala, Khaled, Butler, Alexander, Park, Grant, Harada, Garrett, Leonard, Skylar, Roberts, Ashley, An, Howard S., Epifanov, Anton, Albert, Hanne B., Tkachev, Alexander, Samartzis, Dino
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-02-2023
Subjects:	Disc Herniation Humans Intervertebral Disc Degeneration Intervertebral Disc Displacement - complications Intervertebral Disc Displacement - diagnostic imaging Lumbar Vertebrae - diagnostic imaging Lumbar Vertebrae - surgery Magnetic Resonance Imaging - methods Outcomes Phenotype Prediction Prognosis Prospective Studies Resorption Treatment Outcome Herniation Resorption Prognosis Disc Outcomes Prediction
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Summary:	Symptomatic 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. The following prospective study aimed to identify determinants that may predict early versus late LDH resorption. Prospective study with patients recruited at a single center. Ninety-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. Baseline 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. All patients were managed similarly. LDH resorption was classified as early (<3 months) or late (>3 months). A prediction model of pretreatment factors was constructed. No 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). This 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
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1529-9430 1878-1632
DOI:	10.1016/j.spinee.2022.10.003