Seo Jun-Yeong, Roh Young-Ho, Kim Young-Hoon, Ha Kee-Yong
Department of Orthopaedic Surgery, Jeju National University Hospital, School of Medicine, Jeju National University, Jeju, Republic of Korea.
Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-Gu, Seoul, 137-040, Republic of Korea.
Eur Spine J. 2016 May;25(5):1393-1402. doi: 10.1007/s00586-014-3587-1. Epub 2014 Sep 25.
To investigate volumetric changes in lumbar disc herniation (LDH) using three-dimensional measurements obtained by magnetic resonance imaging (MRI) and to identify possible factors affecting such changes.
Between January 2004 and December 2011, 43 patients who underwent conservative treatment for LDH were enrolled. In all, 56 disc levels were investigated. MRI was performed on two or more occasions (minimally, at the initial visit and 6 months later). The volume of each herniated disc was determined. For each patient, disc migration, morphology, initial LDH size, and clinical outcome were evaluated.
The mean volumes of herniated discs at the initial and follow-up visits were 1,304.57 ± 837.99 and 993.84 ± 610.04 mm(3), respectively. The mean change in volume from the initial to the follow-up visit was 310.73 ± 743.60 mm(3). Volumes decreased at 35 disc levels and increased at 21 levels. The disc containment, the extent of LDH, the initial size of the herniated disc, and the degree of intactness of the posterior longitudinal ligament were significantly correlated with disc resorption and an increase in disc volume (p = 0.01, p = 0.018, p = 0.001, and p < 0.001, respectively). No significant association was evident between disc volumetric change and clinical outcome.
We observed that LDH is a dynamic disease and that a herniated disc is not always spontaneously resorbed, in contrast to what has been reported previously. Alleviation of clinical symptoms can be achieved via conservative treatment even if the volume of the herniated disc changes. Spinal surgeons should not only present an option of initial non-surgical treatment to LDH patients but should also inform them that the LDH may change in size during daily activity or exercise.
利用磁共振成像（MRI）获得的三维测量结果研究腰椎间盘突出症（LDH）的体积变化，并确定影响此类变化的可能因素。
2004年1月至2011年12月期间，纳入43例接受LDH保守治疗的患者。共研究了56个椎间盘节段。MRI在两个或更多时间点进行（最少在初次就诊时和6个月后）。确定每个突出椎间盘的体积。对每位患者评估椎间盘移位、形态、初始LDH大小和临床结果。
初次就诊和随访时突出椎间盘的平均体积分别为1304.57±837.99和993.84±610.04mm³。从初次就诊到随访时的平均体积变化为310.73±743.60mm³。35个椎间盘节段的体积减小，21个节段的体积增加。椎间盘包容性、LDH范围、突出椎间盘的初始大小以及后纵韧带的完整程度与椎间盘吸收和椎间盘体积增加显著相关（分别为p = 0.01、p = 0.018、p = 0.001和p < 0.001）。椎间盘体积变化与临床结果之间无明显关联。
我们观察到LDH是一种动态疾病，与先前报道的情况相反，突出的椎间盘并不总是会自发吸收。即使突出椎间盘的体积发生变化，通过保守治疗也可实现临床症状的缓解。脊柱外科医生不仅应向LDH患者提供初始非手术治疗的选择，还应告知他们LDH在日常活动或锻炼期间大小可能会发生变化。
