Spinal stenosis and disc herniation are the two
most frequent causes of lumbosacral nerve root compression. This
can result in muscle weakness and present with or without pain. The
difficulty when managing patients with these conditions is knowing
when surgery is better than non-operative treatment: the evidence
is controversial. Younger patients with a lesser degree of weakness
for a shorter period of time have been shown to respond better to surgical
treatment than older patients with greater weakness for longer.
However, they also constitute a group that fares better without
surgery. The main indication for surgical treatment in the management
of patients with lumbosacral nerve root compression should be pain
rather than weakness.
The aim of the study was to determine if there was a direct correlation between the pain and disability experienced by patients and size of their disc prolapse, measured by the disc’s cross-sectional area on T2 axial MRI scans. Patients were asked to prospectively complete visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores on the day of their MRI scan. All patients with primary disc herniation were included. Exclusion criteria included recurrent disc herniation, cauda equina syndrome, or any other associated spinal pathology. T2 weighted MRI scans were reviewed on picture archiving and communications software. The T2 axial image showing the disc protrusion with the largest cross sectional area was used for measurements. The area of the disc and canal were measured at this level. The size of the disc was measured as a percentage of the cross-sectional area of the spinal canal on the chosen image. The VAS leg pain and ODI scores were each correlated with the size of the disc using the Pearson correlation coefficient (PCC). Intraobserver reliability for MRI measurement was assessed using the interclass correlation coefficient (ICC). We assessed if the position of the disc prolapse (central, lateral recess, or foraminal) altered the symptoms described by the patient. The VAS and ODI scores from central and lateral recess disc prolapses were compared.Aims
Methods
