Three-dimensional Radiological Classification Of Lumbar Disc Herniation In Relation To The Clinical Symptom And Prognosis: A Large Sample Retrospective Investigation And An Averaged Thirty Months Follow-up

BackgroundWith the development of imaging technology, biomechanics, endoscopic techniques and so on, we are able to determine the pathological cause of low back pain and leg pain at a much earlier stage, and to provide proper treatment. However, despite knowing the definite cause of the leg pain at an early stage, we cannot accurately answer the patients'questions as to whether and when their pain will disappear. Lumbar disc herniation(LDH) is the most common cause that lead to symptoms of low back pain and leg pain. Various factors of predictive value for the LDH's clinical outcome have been identified. Morphological characteristics have been playing an important role. Imaging technology, such as computed tomography (CT) and magnetic resonance imaging (MRI) are used for primary investigation. To further evaluate the importance of the imaging distribution of the disc herniation for the clinical symptoms and prognosis, we used the detailed three-dimensional radiological classification to describe the distribution and size of lumbar disc herniations and their relation to clinical symptoms and prognosis.ObjectivesThis study was designed to describe the distribution and size of lumbar disc herniations with three-dimensional radiological classification and to study the potential relationship with clinical symptoms. The status quo of treatment on different radiological classification was also described. By follow-up, we aimed to seek out whether the three-dimensional radiological classification is one of the prognosis factors of lumbar disc herniations in conservative or surgical treatmentMethodsThe study population consisted of 261 patients(284 segments) who suffered from LDH, and were examined by CT or MRI to establish a definite diagnosis. The three-dimensional radiological classification were used to describe the distribution and size of lumbar disc herniations. We also record the patient profile(sex, age, occupation, history of LDH) and their treatment. ODI score, JOA score and VAS score were applied to evaluate function of patients at the first visit and follow up. According to the outcome, relationship between three-dimensional radiological classification and clinical symptoms were probed. Not only those patients who were treated in conservative method but those receiving surgical treatment were followed up. Based on the results of follow-up, possible correlations between the three-dimensional radiological classification and the prognosis of lumbar disc herniations in both conservative and surgical groups were probed.ResultThe research consisted of 261 patients (284 segment) who suffered from LDH, from 2006 to 2010. The three-dimensional radiological classification, were used to describe the lumbar disc herniation distribution. According to the three-dimensional radiological classification, patients with different distribution and size of lumbar disc herniations have no significant difference (P>0.05)in ODI score, JOA score and VAS score on the first visit. The conservative group consisting of 46 patients(54 segments), was followed up for 28.22 months (12-72) on average.3 patients of them were lost. ODI score, JOA score and VAS score were used to evaluate the clinical outcome at the first vist and the last follow -up. Compared with the first vist, the improvement over time were statistically significant(P<0.05). Patients of the conservative treatment got a good result at the last follow up. But we also discovered that there was no significant difference with the improvement rates of ODI score, JOA score and VAS score in different three-dimensional classification (P>0.05).The surgical group contained 215 patients(229 segments), who were followed up for averaged 30.02 months(12-126),with 5 patients lost. ODI score, JOA score and VAS score were used to evaluate the clinical outcome at the first vist and last follow up. Compared with the first vist, the improvement over time were statistically significant(P<0.05). Patients of surgical treatment also got a good result at the last follow up. We found that there were significant differences with the improvement rates of ODI score, JOA score and VAS scor in the coronal plane (P>0.05).For the prominence in Area 3, in the coronal plane, recovery after surgery seemed mildly worse than those in other area, but still has satisfactory outcome when followed up. For patients with herniation located on "Level I, Area 2, Area a", both surgical and conservative treatment brought them good prognosis, without significant difference(p>0.05). And for those with herniation on "Level I, Area2, Area b", although patients with surgery have advantage on JOA score compared with patients in conservative group, they turned out to be equal on prognosis.Conclusion According to the three-dimensional radiological classification, most of the lumbar disc herniations distributed in the Level I, in the sagittal plane; the prominences were mainly located in Area 1 or 2, and in Area a, in the coronal plane. Clinical symptoms did not depend on the distribution and size of the lumbar disc herniations with the three-dimensional classification. Patients with conservative treatment got a good result at the last follow up. But the three-dimensional classification was not evidently identified as a factor predicting the prognosis. And those receiving surgical treatment also got their complaints relieved at the last follow up. We found that the prominence in the coronal plane could be an influencing factor of the prognosis. We have reasons to expect good result on conservative treatment for lumbar disc herniation on "Level I Area 1~2, Area a~b"...