Prediction of Lumbar Disc Herniation Resorption and Self-Healing in Symptomatic Patients: <em>a Prospective, Multi-Imaging and Clinical Phenotype Study</em> — The International Society for the Study of the Lumbar Spine
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  2. SESSION #9 - CLINICAL IMAGING AND OUTCOME
  3. Prediction of Lumbar Disc Herniation Resorption and Self-Healing in Symptomatic Patients: a Prospective, Multi-Imaging and Clinical Phenotype Study

Prediction of Lumbar Disc Herniation Resorption and Self-Healing in Symptomatic Patients: a Prospective, Multi-Imaging and Clinical Phenotype Study (#45)

Alexander J. Hornung 1 , J. Nicolas Barajas 1 , Samuel S Rudisill 1 , Alexander Butler 1 , Grant J Park 1 , Garrett Harada 1 , Skylar F Leonard 2 , Ashley C Roberts 1 , Howard S An 1 , Anton Epinof 3 , Hanne B Albert 4 , Alexander Tkachev 3 , Dino Samartzis 1
  1. Department of Orthopaedic Surgery, Rush University Medical Center , Chicago, IL, USA
  2. International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
  3. Tkachev and Epifanov Clinic, Volgograd, Russia
  4. The Modic Clinic, Odense, Denmark

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Introduction: Symptomatic lumbar disc herniations (LDH) are very common. However, LDH resorption is a “self-healing” phenomenon that may develop yet remains not well 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.    

 

Methods: A one-year prospective study was conducted of consecutive patients diagnosed with acute symptomatic LDH. All patients were managed similarly. Baseline entailed assessment of patient demographics (e.g., smoking status, height, weight, etc.), herniation characteristics (e.g., the initial level of herniation, the direction of herniation, prevalence of multiple herniations, etc.) and MRI phenotypes (e.g Modic changes, endplate abnormalities, disc degeneration, vertebral body dimensions, etc.) were collected for further analysis. MRIs were performed approximately every 3 months from time of enrolment to assess disc integrity. LDH resorption was classified as early (<3 months) or late (>3 months) (Figure 1). A prediction model of pretreatment factors was constructed.  

 

Results: 90 patients were included (n=23-early-resorption, n=67-late-resorption groups) with a mean age of 48.7±11.9 years. A greater percent reduction of disc herniation between MRI-0 (baseline) to MRI-1 (p=0.043), greater reduction of herniation size for total study duration (p=0.007) and increased percent resorption per day was noted in the early LDH resorption group (p<0.001). Multivariate modeling yielded greater L4 posterior vertebral height (coeff:14.58), sacral slope (coeff:0.12), and herniated disc volume (coeff:0.013) at baseline as most predictive of early resorption (p<0.05).

 

Discussion: 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. The “vertebral body profile,” is the strongest predictor for disc resorption and represents a paradigm shift as to how such pathologies can occur that can eventually lead to disc “self-healing.” A risk profile is proposed that will aid clinical decision-making and manage patient expectations.    

 

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