Determinants of spontaneous resorption of intervertebral disc herniations.
METHODS
A follow-up of disc herniation (herniated nucleus pulposus [HNP]) resorption on magnetic resonance imaging (MRI).


OBJECTIVE
To assess the determinants of resorption of HNP.


BACKGROUND
Neovascularization in the outermost areas of HNP, presenting as an enhancing rim in gadolinium diethylenetriamine pentaacetic acid MR images, is thought to be a major determinant of spontaneous resorption of HNP.


METHODS
Patients with HNP-induced sciatica at baseline were rescanned at 2 months (N = 74) and after 12 months (N = 53). The volume of HNP (mm), thickness (mm) and extent (%) of enhancement, and the degree of HNP migration (Komori classification) were analyzed. Repeated measures analysis of covariance was used in statistical analysis.


RESULTS
Significant resorption of HNP occurred from baseline to 2 months, although the resorption rate was more pronounced over the whole 1-year follow-up. Higher baseline scores of rim enhancement thickness, higher degree of HNP displacement in the Komori classification, and age category 41-50 years were associated with a higher resorption rate. Thickness of rim enhancement was a stronger determinant of spontaneous resorption than extent of rim enhancement. Clinical symptom alleviation occurs concordantly with a faster resorption rate.


CONCLUSIONS
MRI is a useful prognostic tool for identifying patients with HNP-induced sciatica with a benign natural course.
Autio
Reijo A
RA
Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland. reijo.autio@mhso.fi
Karppinen
Jaro
J
Niinimäki
Jaakko
J
Ojala
Risto
R
Kurunlahti
Mauno
M
Haapea
Marianne
M
Vanharanta
Heikki
H
Tervonen
Osmo
O