Magnetic resonance imaging analysis of percutaneous discectomy. A preliminary report.
Twenty-one consecutive patients (27 lumbar discs) were treated by percutaneous discectomy for lumbar herniated disc disease from July 1988 through March 1989. Twenty-six discs in 20 patients were evaluated with preoperative and postoperative magnetic resonance images graded by a neuroradiologist blinded to the clinical and prior imaging results. Fifteen patients were treated by one-level percutaneous discectomy and six patients by two-level percutaneous discectomy. The disc herniations were graded with respect to size, type, location, and hydration status on the magnetic resonance image scans. The postoperative magnetic resonance images were obtained 2-6 months after percutaneous discectomy. Early clinical outcomes after percutaneous discectomy were compared with the various magnetic resonance imaging parameters. Overall, treatment for thirteen patients (62%) was considered clinically successful (decrease or elimination of pain) after percutaneous discectomy, whereas treatment for eight (38%) patients was considered to clinically fail (persistence of pain) with follow-up ranging from 1 to 6 months postoperatively. Three of the patients in whom treatment failed have been subsequently treated successfully by laminotomy and discectomy. On the average, there is a small absolute decrease (5% of the anteroposterior diameter of the spinal canal) in the size of disc herniations when treated by percutaneous discectomy. Although this study is limited by a small sample size and lacks statistical significance, it appears that an early clinical success after percutaneous discectomy may be related to a few magnetic resonance imaging parameters.(ABSTRACT TRUNCATED AT 250 WORDS)
Bernhardt
M
M
Charles A. Dana Research Institute, Department of Orthopaedic Surgery, Beth Israel Hospital/Harvard Medical School, Boston, Massachusetts.
Gurganious
L R
LR
Bloom
D L
DL
White
A A
AA
D000328:Adult; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D011859:Radiography; D016896:Treatment Outcome