quarta-feira, 8 de maio de 2013


2013 Feb 20. [Epub ahead of print]

Magnetic Resonance Imaging Predictors of Surgical Outcome in Patients with Lumbar Intervertebral Disc Herniation.


From the Departments of 1Medicine, and 2Community and Family Medicine, Dartmouth Medical School, Lebanon, New Hampshire 3Department of Orthopaedics, Dartmouth Medical School, Lebanon, New Hampshire 4Department of Orthopaedic Surgery, Stanford School of Medicine, Palo Alto, California 5Department of Radiology, John's Hopkins Medical School, Baltimore, Maryland 6National Orthopaedic Imaging Associates, Greenbrae, California; and 7Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York.


Study Design: A retrospective cohort designObjective: To determine if baseline MRI findings including central/foraminal stenosis, Modic change, disc morphology, facet arthropathy, disc degeneration, nerve root impingement, and thecal sac compression are associated with differential surgical treatment effect.Summary of Background Data: Intervertebral Disc Herniation (IDH) remains the most common source of lumbar radiculopathy treated either with discectomy or non-operative intervention. Although MRI remains the reliable gold standard for diagnosis, uncertainty surrounds the relationship between MRI findings and treatment outcomes.Methods: Three-hundred-and-seven "complete" images from patients enrolled in a previous trial were de-identified and evaluated by one of 4 independent readers. Findings were compared to outcome measures including the Oswestry Disability Index. Differences in surgery and non-operative treatment outcomes were evaluated between image characteristic subgroups and TE determined by the difference in ODI scores.Results: The cohort was comprised of 40% females with an average age of 41.5 (±11.6), 61% of which underwent discectomy for IDH. Patients undergoing surgery with Modic type I endplate changes had worse outcomes (-26.4 versus -39.7 for none and -39.2 for type 2, p = 0.002) and smaller treatment effect (-3.5 versus -19.3 for none and -15.7 for type 2, p = 0.003). Those with compression > = 1/3 showed the greatest improvement within the surgical group (-41.9 for > = 1/3 versus -31.6 for none and -38.1 for <1 -11.7="" -15.2="" and="" class="highlight" compared="" for="" furthermore="" highest="" none="" p="0.015)." span="" te="" the="" to="">patients
with minimal nerve root impingement demonstrated worse surgical outcomes (-26.5 versus -41.1 for "displaced" and -38.9 for "compressed", p = 0.016).Conclusion: Among patients with IDH, those with thecal sac compression > = 1/3 had greater surgical treatment effect than those with small disc herniations and Modic type I changes. Additionally, patients with nerve root "compression" and "displacement" benefit more from surgery than those with minimal nerve-root impingement.

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