J Korean Neurosurg Soc.  2016 Sep;59(5):478-484. 10.3340/jkns.2016.59.5.478.

Surgery versus Nerve Blocks for Lumbar Disc Herniation : Quantitative Analysis of Radiological Factors as a Predictor for Successful Outcomes

• Kim J
• Hur JW
• Lee JB
• Park JY

• KMID: 2351716
• DOI: http://doi.org/10.3340/jkns.2016.59.5.478

Abstract

OBJECTIVE
To assess the clinical and radiological factors as predictors for successful outcomes in lumbar disc herniation (LDH) treatment.
METHODS
Two groups of patients with single level LDH (L4-5) requiring treatment were retrospectively studied. The surgery group (SG) included 34 patients, and 30 patients who initially refused the surgery were included in the nerve blocks group (NG). A visual analogue scale (VAS) for leg and back pain and motor deficit were initially evaluated before procedures, and repeated at 1, 6, and 12 months. Radiological factors including the disc herniation length, disc herniation area, canal length-occupying ratio, and canal area-occupying ratio were measured and compared. Predicting factors of successful outcomes were determined with multivariate logistic regression analysis after the optimal cut off values were established with a receiver operating characteristic curve.
RESULTS
There was no significant demographic difference between two groups. A multivariate logistic regression analysis with radiological and clinical (12 months follow-up) data revealed that the high disc herniation length with cutoff value 6.31 mm [odds ratio (OR) 2.35; confidence interval (CI) 1.21-3.98] was a predictor of successful outcomes of leg pain relief in the SG. The low disc herniation length with cutoff value 6.23 mm (OR 0.05; CI 0.003-0.89) and high baseline VAS leg (OR 12.63; CI 1.64-97.45) were identified as predictors of successful outcomes of leg pain relief in the NG.
CONCLUSION
The patients with the disc herniation length larger than 6.31 mm showed successful outcomes with surgery whereas the patients with the disc herniation length less than 6.23 mm showed successful outcomes with nerve block. These results could be considered as a radiological criteria in choosing optimal treatment options for LDH.

Keyword

Lumbar disc herniation; Surgery; Nerve block; Outcomes; Criteria

MeSH Terms

Back Pain
Humans
Leg
Logistic Models
Nerve Block*
Retrospective Studies
ROC Curve

Figure

• 

  Fig. 1 The method of measurement of disc herniation and spinal canal length and area taken from an axial image at the L4–5 foraminal level. A : disc herniation length, B : canal cross-section length, C : disc herniation area, D : canal cross-section area. The canal length-occupying ratio of the herniated disc to the spinal canal, A/B, and the canal area-occupying ratio, C/D, were calculated.

• 

  Fig. 2 Changes in the VAS scores and MRC grade before the procedure and repeated at 1 month, 6 months, and 12 months in both groups. A : Changes of VAS leg scores. B : Changes of VAS back scores. C : Changes of MRC grade. Values are presented as the mean±SD. VAS : visual analogue scale, MRC : Medical Research Council.

• 

  Fig. 3 A ROC curve was obtained to determine the optimal cutoff values (dot). The optimal cutoff values (sensitivity, specificity) were 6.31 mm (0.82, 0.54) for the SG (A) and 6.23 mm (0.68, 0.58) for the NG (B). The AUC was 0.66 for the SG and 0.64 for the NG. SG : surgery group, NG : nerve blocks group.

• 

  Fig. 4 Outcome evaluation according to MacNab classification. A : Leg pain relief for the SG. B : Leg pain relief for the NG. C : Back pain relief for the SG. D : Back pain relief for the NG. SG : surgery group, NG : nerve blocks group.

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