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

  • Alexander L. Hornung
    Affiliations
    Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, 2nd Floor, 1611 W. Harrison St, Chicago, IL 60612, USA

    The International Spine Research and Innovation Initiative, Rush University Medical Center, Orthopaedic Building, 2nd floor, 1611 W. Harrison St, Chicago, IL 60612, USA
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  • J. Nicolas Barajas
    Affiliations
    Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, 2nd Floor, 1611 W. Harrison St, Chicago, IL 60612, USA

    The International Spine Research and Innovation Initiative, Rush University Medical Center, Orthopaedic Building, 2nd floor, 1611 W. Harrison St, Chicago, IL 60612, USA
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  • Samuel S. Rudisill
    Affiliations
    Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, 2nd Floor, 1611 W. Harrison St, Chicago, IL 60612, USA

    The International Spine Research and Innovation Initiative, Rush University Medical Center, Orthopaedic Building, 2nd floor, 1611 W. Harrison St, Chicago, IL 60612, USA
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  • Khaled Aboushaala
    Affiliations
    Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, 2nd Floor, 1611 W. Harrison St, Chicago, IL 60612, USA

    The International Spine Research and Innovation Initiative, Rush University Medical Center, Orthopaedic Building, 2nd floor, 1611 W. Harrison St, Chicago, IL 60612, USA
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  • Alexander Butler
    Affiliations
    Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, 2nd Floor, 1611 W. Harrison St, Chicago, IL 60612, USA

    The International Spine Research and Innovation Initiative, Rush University Medical Center, Orthopaedic Building, 2nd floor, 1611 W. Harrison St, Chicago, IL 60612, USA
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  • Grant Park
    Affiliations
    Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, 2nd Floor, 1611 W. Harrison St, Chicago, IL 60612, USA

    The International Spine Research and Innovation Initiative, Rush University Medical Center, Orthopaedic Building, 2nd floor, 1611 W. Harrison St, Chicago, IL 60612, USA
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  • Garrett Harada
    Affiliations
    Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, 2nd Floor, 1611 W. Harrison St, Chicago, IL 60612, USA

    The International Spine Research and Innovation Initiative, Rush University Medical Center, Orthopaedic Building, 2nd floor, 1611 W. Harrison St, Chicago, IL 60612, USA
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  • Skylar Leonard
    Affiliations
    Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, 2nd Floor, 1611 W. Harrison St, Chicago, IL 60612, USA

    The International Spine Research and Innovation Initiative, Rush University Medical Center, Orthopaedic Building, 2nd floor, 1611 W. Harrison St, Chicago, IL 60612, USA
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  • Ashley Roberts
    Affiliations
    Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, 2nd Floor, 1611 W. Harrison St, Chicago, IL 60612, USA

    The International Spine Research and Innovation Initiative, Rush University Medical Center, Orthopaedic Building, 2nd floor, 1611 W. Harrison St, Chicago, IL 60612, USA
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  • Howard S. An
    Affiliations
    Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, 2nd Floor, 1611 W. Harrison St, Chicago, IL 60612, USA

    The International Spine Research and Innovation Initiative, Rush University Medical Center, Orthopaedic Building, 2nd floor, 1611 W. Harrison St, Chicago, IL 60612, USA
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  • Anton Epifanov
    Affiliations
    Tkachev and Epifanov Clinic, Novouzenskaya str, 6-B, Volograd, 400120, Russia
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  • Hanne B. Albert
    Affiliations
    The Modic ClinicJernbanegade 43. sal th 5000 Odense, Denmark
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  • Alexander Tkachev
    Correspondence
    Tkachev Clinic, Novouzenskaya str, 6-B, Volograd, 400120, Russia; Tel:+78442990333
    Affiliations
    Tkachev and Epifanov Clinic, Novouzenskaya str, 6-B, Volograd, 400120, Russia
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  • Dino Samartzis
    Correspondence
    Corresponding author: Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, 2nd Floor, 1611 W. Harrison St, Chicago, IL 60612, USA; Tel: +1-312-942-9805; fax: +1-312-942-2101
    Affiliations
    Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, 2nd Floor, 1611 W. Harrison St, Chicago, IL 60612, USA

    The International Spine Research and Innovation Initiative, Rush University Medical Center, Orthopaedic Building, 2nd floor, 1611 W. Harrison St, Chicago, IL 60612, USA
    Search for articles by this author
Published:October 12, 2022DOI:https://doi.org/10.1016/j.spinee.2022.10.003

      ABSTRACT

      BACKGROUND CONTEXT

      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.

      PURPOSE

      The following prospective study aimed to identify determinants that may predict early versus late LDH resorption.

      STUDY DESIGN/SETTING

      Prospective study with patients recruited at a single center.

      PATIENT SAMPLE

      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.

      OUTCOMES MEASURE

      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.

      METHODS

      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.

      RESULTS

      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).

      CONCLUSIONS

      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

      Keywords

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