[(Modic) signal alterations of vertebral endplates and their correlation to a minimally invasive treatment of lumbar disc herniation using epidural injections].
OBJECTIVE
To study the influence of (Modic) signal alterations (SA) of the cartilage endplate (CEP) of vertebrae L3-S1 on the outcome of an in-patient minimally invasive treatment (MIT) using epidural injections on patients with lumbar disc herniation (LDH).


METHODS
The MR images of 59 consecutive patients with LDH within segments L3/L4 - L5/S1 undergoing in-patient minimally invasive treatment with epidural injections were evaluated in a clinical study. The (Modic) signal alterations of the CEP were recorded using T1- and T2-weighted sagittal images. On the basis of the T2-weighted sagittal images, the extension and distribution of the SA were measured by dividing each CEP into 9 areas. The outcome of the MIT was recorded using the Oswestry Disability Index (ODI) before and after therapy and in a 3-month follow-up. Within a subgroup of patients (n = 35), the distribution and extension of the signal alterations were correlated with the development of the ODI.


RESULTS
Segments with LDH showed significantly more (p < 0.001) SA of the CEP than segments without LDH. Although the extension of the SA was not dependent on sex, it did increase significantly with age (p = 0.017). The outcome after MIT did not depend on the sex and age of the patients nor on the type of LDH. The SA extension tended to have a negative correlation with the outcome after MIT after 3 months (p = 0.071). A significant negative correlation could be established between the SA extension in the central section of the upper endplate and the outcome after 3 months (p = 0.019).


CONCLUSIONS
1. Lumbar disc herniation is clearly associated with the prevalence of (Modic) signal alterations. 2. Extensive signal alterations tend to correlate with a negative outcome of an MIT using epidural injections. 3. Such SA in the central portion of the upper CEP correlate significantly with a negative treatment result. 4. The central portion of the upper CEP being extensively affected by (Modic) SA is a negative predictor for the success of a minimally invasive pain therapy.
Liphofer
J P
JP
Institut für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, St. Josef-Hospital Bochum. mr.lipho@web.de
Theodoridis
T
T
Becker
G T
GT
Koester
O
O
Schmid
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001853:Bone Marrow / Q000187:drug effects / Q000473:pathology; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007268:Injections, Epidural; D007403:Intervertebral Disc / Q000187:drug effects* / Q000473:pathology; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000188:drug therapy*; D008159:Lumbar Vertebrae / Q000187:drug effects* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008619:Mepivacaine / Q000008:administration & dosage*; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000175:diagnosis / Q000188:drug therapy; D010007:Osteochondritis / Q000175:diagnosis / Q000188:drug therapy; D017063:Outcome Assessment, Health Care; D012447:Sacrum / Q000187:drug effects* / Q000473:pathology; D013126:Spinal Nerve Roots / Q000187:drug effects / Q000473:pathology; D013223:Statistics as Topic; D014221:Triamcinolone / Q000008:administration & dosage*
D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D014221:Triamcinolone; D008619:Mepivacaine