PMID- 31580903 OWN - NLM STAT- MEDLINE DCOM- 20210623 LR - 20210623 IS - 1878-1632 (Electronic) IS - 1529-9430 (Linking) VI - 20 IP - 3 DP - 2020 Mar TI - Preoperative MRI predictors of health-related quality of life improvement after microscopic lumbar discectomy. PG - 391-398 LID - S1529-9430(19)31005-8 [pii] LID - 10.1016/j.spinee.2019.09.020 [doi] AB - BACKGROUND: Lumbar herniated nucleus pulposus (HNP) is a common spinal pathology often treated by microscopic lumbar discectomy (MLD), though prior reports have not demonstrated which preoperative MRI factors may contribute to significant clinical improvement after MLD. PURPOSE: To analyze the MRI characteristics in patients with HNP that predict meaningful clinical improvement in health-related quality of life scores (HRQoL) after MLD. STUDY DESIGN/SETTING: Retrospective clinical and radiological study of patients undergoing MLD for HNP at a single institution over a 2-year period. PATIENT SAMPLE: Eighty-eight patients receiving MLD treatment for HNP. OUTCOME MEASURES: Cephalocaudal Canal Migration; Canal & HNP Anterior-Posterior (AP) Lengths and Ratio; Canal & HNP Axial Areas and Ratio; Hemi-Canal & Hemi-HNP Axial Areas and Ratio; Disc appearance (black, gray, or mixed); Baseline (BL); and 3-month (3M) postoperative HRQoL scores. METHODS: Patients >18 years old who received MLD for HNP with BL and 3M HRQoL scores of PROMIS (Physical Function, Pain Interference, and Pain Intensity), ODI, VAS Back, and VAS Leg scores were included. HNP and spinal canal measurements of cephalocaudal migration, AP length, area, hemi-area, and disc appearance were performed using T2 axial and sagittal MRI. HNP measurements were divided by corresponding canal measurements to calculate AP, Area, and Hemi-Area ratios. Using known minimal clinically important differences (MCID) for each DeltaHRQoL score, patients were separated into two groups based on whether they reached MCID (MCID+) or did not reach MCID (MCID-). The MCID for PROMIS pain intensity was calculated using a decision tree. A linear regression illustrated correlations between PROMIS vs ODI and VAS Back/Leg scores. Independent t-tests and chi-squared tests were utilized to investigate significant differences in HNP measurements between the MCID+ and MCID- groups. RESULTS: There were 88 MLD patients included in the study (Age=44.6+/-14.9, 38.6% female). PROMIS pain interference and pain intensity were strongly correlated with ODI and VAS Back/Leg (R>/=0.505), and physical function correlated with ODI and VAS Back/Leg (R=-0.349) (all p<.01). The strongest MRI predictors of meeting HRQoL MCID were gray disc appearance, HNP area (>116.6 mm(2)), and Hemi-Area Ratio (>51.8%). MCID+ patients were 2.7 times more likely to have a gray HNP MRI signal than a mixed or black HNP MRI signal in five out of six HRQoL score comparisons (p<.025). MCID+ patients had larger HNP areas than MCID- patients had in five out of six HRQoL score comparisons (116.6 mm(2)+/-46.4 vs 90.0 mm(2)+/-43.2, p<.04). MCID+ patients had a greater Hemi-Area Ratio than MCID- patients had in four out of six HRQoL score comparisons (51.8%+/-14.7 vs 43.9%+/-14.9, p<.05). CONCLUSIONS: Patients who met MCID after MLD had larger HNP areas and larger Hemi-HNP Areas than those who did not meet MCID. These patients were also 2.7x more likely to have a gray MRI signal than a mixed or black MRI signal. When accounting for HNP area relative to canal area, patients who met MCID had greater Hemi-HNP canal occupation than patients who did not meet MCID. The results of this study suggest that preoperative MRI parameters can be useful in predicting patient-reported improvement after MLD. CI - Copyright (c) 2019 Elsevier Inc. All rights reserved. FAU - Varlotta, Christopher G AU - Varlotta CG AD - Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Health, New York, NY, USA. FAU - Manning, Jordan H AU - Manning JH AD - Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Health, New York, NY, USA. FAU - Ayres, Ethan W AU - Ayres EW AD - Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Health, New York, NY, USA. FAU - Wang, Erik AU - Wang E AD - Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Health, New York, NY, USA. FAU - Woo, Dainn AU - Woo D AD - Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Health, New York, NY, USA. FAU - Vasquez-Montes, Dennis AU - Vasquez-Montes D AD - Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Health, New York, NY, USA. FAU - Alas, Haddy AU - Alas H AD - Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Health, New York, NY, USA. FAU - Brown, Avery AU - Brown A AD - Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Health, New York, NY, USA. FAU - Egers, Max AU - Egers M AD - Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Health, New York, NY, USA. FAU - Kim, Yong AU - Kim Y AD - Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Health, New York, NY, USA. FAU - Bendo, John A AU - Bendo JA AD - Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Health, New York, NY, USA. FAU - Fischer, Charla R AU - Fischer CR AD - Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Health, New York, NY, USA. FAU - Protopsaltis, Themistocles S AU - Protopsaltis TS AD - Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Health, New York, NY, USA. FAU - Stieber, Jonathan R AU - Stieber JR AD - Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Health, New York, NY, USA. FAU - Buckland, Aaron J AU - Buckland AJ AD - Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Health, New York, NY, USA. Electronic address: aaronbuckland@me.com. LA - eng PT - Journal Article DEP - 20190930 PL - United States TA - Spine J JT - The spine journal : official journal of the North American Spine Society JID - 101130732 SB - IM MH - Adult MH - Diskectomy MH - Female MH - Humans MH - *Lumbar Vertebrae/diagnostic imaging/surgery MH - Magnetic Resonance Imaging MH - Male MH - Middle Aged MH - *Quality of Life MH - Retrospective Studies MH - Treatment Outcome OTO - NOTNLM OT - Health-related quality of life scores OT - Herniated nucleus pulposus OT - Magnetic resonance imaging OT - Microlumbar discectomy OT - Oswestry disability index OT - Patient-Reported Outcome Measurement Information System metrics OT - Visual analog scale EDAT- 2019/10/04 06:00 MHDA- 2021/06/24 06:00 CRDT- 2019/10/04 06:00 PHST- 2019/06/20 00:00 [received] PHST- 2019/09/20 00:00 [revised] PHST- 2019/09/23 00:00 [accepted] PHST- 2019/10/04 06:00 [pubmed] PHST- 2021/06/24 06:00 [medline] PHST- 2019/10/04 06:00 [entrez] AID - S1529-9430(19)31005-8 [pii] AID - 10.1016/j.spinee.2019.09.020 [doi] PST - ppublish SO - Spine J. 2020 Mar;20(3):391-398. doi: 10.1016/j.spinee.2019.09.020. Epub 2019 Sep 30.