Lumbar Disk Herniation: A Clinical Epidemiological and Radiological Evaluation

Edona Sopaj Azemi; Sandër Kola; Irena Kola; Marjeta Tanka; Fatmir Bilaj; Erjona Abazaj

doi:10.3889/oamjms.2022.8828

Authors

Edona Sopaj Azemi Department of Imagery
Sandër Kola Department of Imagery, University Hospital Centre “Mother Theresa”, Tirana, Albania
Irena Kola Department of Imagery, University of Medicine, Faculty of Technical Medical Science, Tirana, Albania
Marjeta Tanka Department of Imagery, University Hospital Centre “Mother Theresa”, Tirana, Albania
Fatmir Bilaj Department of Imagery, University Hospital Centre “Mother Theresa”, Tirana, Albania
Erjona Abazaj Department of Imagery https://orcid.org/0000-0003-2386-4605

DOI:

https://doi.org/10.3889/oamjms.2022.8828

Keywords:

Lumbar disk herniation, Low back pain, Epidemiology, Radiology evaluation, Clinical findings

Abstract

BACKGROUND: A herniated disc in the spine is a condition during which a nucleus pulposus is displaced from intervertebral space.

AIM: The study aimed to investigate and observe variation of clinical, epidemiological, and radiological aspects for patients suspected of lumbar herniation based on observed evaluation of CT and MRI imagery.

METHODS: This is a cross-sectional study conducted during the periods March 2015 and November 2019. Patients were subjected to MRI and CT based on the emergency or scheduled of diagnose. All MRI scans were obtained with 1.5 tesla MRI machine and for CT had undergone examinations with one of the following equipment: Siemens with 128 slice and Phillips 64 slice. The patients were placed in supine position.

RESULTS: Overall 194 symptomatic patients were recruited as a participant in this study, 118 men and 76 women with an average age of 44.9 ±10.4 years. Patients belong to the active age (35–44-years-old and 45–54-years-old) appeared to have the highest percentage of lumbar disk herniation (LDH) 30.9% and 25.8%, respectively. There were a significant association between such as epidemiological data (such as gender, BMI, age groups, and employment status) and presence of LDH, p ˂ 0.05. Acute pain was presented in 69.07% of patients and according to complaint associated with low back pain (LBP), most of them 47.4% appeared with Right Sciatica. MRI is the most diagnostic methods used in evaluation of LDH in 52% of patients, and CT was used in 48% of them. The most common changes were between L2-L3, L3-L4, and L4-L5. Furthermore, the grading findings which corresponding to lumbosacral segment were Grade I and Grade II. Grade V was less common.

CONCLUSION: This study involving patients with lumbar disk herniation and associated LBP showed that a combination of clinical features and epidemiological predicted the presence or absence of a significant association. Further research is required to validate these findings in different types of LDH and LBP for other findings and conditions.

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References

Dydyk AM, Massa RN, Mesfin FB. Disc Herniation. Treasure Island, FL: StatPearls Publishing; 2022.

Park CH, Park ES, Lee SH, Lee KK, Kwon YK, Kang MS, et al. Risk factors for early recurrence after transforaminal endoscopic lumbar disc decompression. Pain Physician. 2019;22(2):E133-8. PMid:30921991 DOI: https://doi.org/10.36076/ppj/2019.22.E133

Huang JS, Fan BK, Liu JM. Overview of risk factors for failed percutaneous transforaminal endoscopic discectomy in lumbar disc herniation. Zhongguo Gu Shang. 2019;32(2):186-9. https://doi.org/10.3969/j.issn.1003-0034.2019.02.019 PMid:30884940

Okan T, Veysel A, Yaldiz, Can. Spontaneous regression of herniated nucleus pulposus. The clinical findings of 76 patients. Medicine. 2019;98(8):e14667. https://doi.org/10.1097/MD.0000000000014667 PMid:30813213 DOI: https://doi.org/10.1097/MD.0000000000014667

Amin RM, Andrade NS, Neuman BJ. Lumbar disc herniation. Curr Rev Musculoskelet Med. 2017;10(4):507-16. https://doi.org/10.1007/s12178-017-9441-4 DOI: https://doi.org/10.1007/s12178-017-9441-4

Gálvez MM, Cordovez J, Okuma PC, Montoya MC, Asahi KT. Differential diagnoses for disc herniation. Rev Chil Radiol. 2017;23(2):66-76. DOI: https://doi.org/10.4067/S0717-93082017000200006

van Rijn RM, Wassenaar M, Verhagen AP, Ostelo RW, Ginai AZ, de Boer MR, et al. Computed tomography for the diagnosis of lumbar spinal pathology in adult patients with low back pain or sciatica: A diagnostic systematic review. Eur Spine J. 2012;21(2):228-39. https://doi.org/10.1007/s00586-011-2012-2 PMid:21915747 DOI: https://doi.org/10.1007/s00586-011-2012-2

Yi JS, Cha JG, Han JK, Kim HJ. Imaging of herniated discs of the cervical Spine: Inter-modality differences between 64-slice multidetector CT and 1.5-T MRI. Korean J Radiol. 2015;16(4):881-8. https://doi.org/10.3348/kjr.2015.16.4.881 PMid:26175589 DOI: https://doi.org/10.3348/kjr.2015.16.4.881

Lurie JD, Tosteson AN, Tosteson TD, Carragee E, Carrino JA, Kaiser J, et al. Reliability of magnetic resonance imaging readings for lumbar disc herniation in the Spine patient outcomes research trial (SPORT). Spine. 1976;33(9):991-8. https://doi.org/10.1097/BRS.0b013e31816c8379 PMid:18427321 DOI: https://doi.org/10.1097/BRS.0b013e31816c8379

American Academy of Neurology. Practice parameters: Magnetic resonance imaging in the evaluation of low back syndrome. Report of the Quality Standards Subcommittee of the American academy of neurology. Neurology. 1994;44(4):767-70. https://doi.org/10.1212/wnl.44.4.767 PMid:8164844 DOI: https://doi.org/10.1212/WNL.44.4.767

Lurie JD, Doman DM, Spratt KF, Tosteson AN, Weinstein JN. Magnetic resonance imaging interpretation in patients with symptomatic lumbar spine disc herniations: Comparison of clinician and radiologist readings. Spine. 1976;34:701-5. https://doi.org/10.1097/BRS.0b013e31819b390e PMid:19333103 DOI: https://doi.org/10.1097/BRS.0b013e31819b390e

Tang C, Moser FG, Reveille J, Bruckel J, Weisman MH. Cauda equina syndrome in ankylosing spondylitis: Challenges in diagnosis, management, and pathogenesis. J Rheumatol. 2019;46(12):1582-8. https://doi.org/10.3899/jrheum.181259 PMid:30936280 DOI: https://doi.org/10.3899/jrheum.181259

Saleem S, Aslam HM, Rehmani MA, Raees A, Alvi AA, Ashraf J. Lumbar disc degenerative disease: Disc degeneration symptoms and magnetic resonance image findings. Asian Spine J. 2013;7(4):322-34. https://doi.org/10.4184/asj.2013.7.4.322 PMid:24353850 DOI: https://doi.org/10.4184/asj.2013.7.4.322

Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr., Shekelle P, et al. Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American college of physicians and the American pain society. Ann Intern Med. 2007;147(7):478-91. https://doi.org/10.7326/0003-4819-147-7-200710020-00006 PMid:17909209 DOI: https://doi.org/10.7326/0003-4819-147-7-200710020-00006

Bečulić H, Skomorac R, Jusić A, Alić F, Imamović M, Mekić-Abazović A, et al. Impact of timing on surgical outcome in patients with cauda equina syndrome caused by lumbar disc herniation. Med Glas (Zenica). 2016;13(2):136-41. https://doi.org/10.17392/861-16 PMid:27452326

Small SA, Perron AD, Brady WJ. Orthopedic pitfalls: Cauda equina syndrome. Am J Emerg Med. 2005;23(2):159-63. https://doi.org/10.1016/j.ajem.2004.03.006 PMid:15765336 DOI: https://doi.org/10.1016/j.ajem.2004.03.006

Huang SL, Liu YX, Yuan GL, Zhang J, Yan HW. Characteristics of lumbar disc herniation with exacerbation of presentation due to spinal manipulative therapy. Medicine (Baltimore). 2015;94(12):e661. https://doi.org/10.1097/MD.0,000000000000661 PMid:25816037 DOI: https://doi.org/10.1097/MD.0000000000000661

Douglas-Akinwande AC, Rydberg J, Shah MV, Phillips MD, Caldemeyer KS, Lurito JT, et al. Accuracy of contrast-enhanced MDCT and MRI for identifying the severity and cause of neural foraminal stenosis in cervical radiculopathy: A prospective study. AJR Am J Roentgenol. 2010;194:55-61. https://doi.org/10.2214/AJR.09.2988 PMid:20028905 DOI: https://doi.org/10.2214/AJR.09.2988

Hudgins WR. Computer-aided diagnosis of lumbar disc herniation. Spine (Phila Pa 1976). 1983;8:604-15. https://doi.org/10.1097/00007632-198309000-00006 PMid:6228018 DOI: https://doi.org/10.1097/00007632-198309000-00006

Modic MT, Masaryk T, Boumphrey F, Goormastic M, Bell G. Lumbar herniated disk disease and canal stenosis: Prospective evaluation by surface coil MR, CT, and myelography. AJR Am J Roentgenol. 1986;147:757-65. https://doi.org/10.2214/ajr.147.4.757 PMid:3489378 DOI: https://doi.org/10.2214/ajr.147.4.757

Hoy D, Brooks P, Blyth F, Buchbinder R. The epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010;24(6):769-81. https://doi.org/10.1016/j.berh.2010.10.002 PMid:21665125. DOI: https://doi.org/10.1016/j.berh.2010.10.002

Pearson AM. Sex differences in lumbar disc herniation: Point of view. Spine. 2016;41(15):1253. https://doi.org/10.1097/BRS.0000000000001624 PMid:27479019 DOI: https://doi.org/10.1097/BRS.0000000000001624

Strömqvist F, Ahmad M, Hildingsson C, Jönsson B, Strömqvist B. Gender differences in lumbar disc herniation surgery. Acta Orthop. 2008;79(5):643-9. https://doi.org/10.1080/17453670810016669 PMid:18839371 DOI: https://doi.org/10.1080/17453670810016669

Omidi-Kashani F, Hasankhani EG, Rafeemanesh E, Seyf P, et al. Impact of obesity and underweight on surgical outcome of lumbar disc herniation. Asian J Neurosci. 2014;2014;753286. https://doi.org/10.1155/2014/753286 DOI: https://doi.org/10.1155/2014/753286

Centers for Disease Control and Prevention; 2013. Available from: https://www.cdc.gov/mmwr/pdf/other/su6203.pdf [Last accessed on 2021 Sep 25].

World Health Organization. Obesity and Overweight: Fact Sheet; 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight [Last accessed on 2021 Sep 25].

Yusuf E, Bijsterbosch J, Slagboom PE, Rosendaal FR, Huizinga TW, Kloppenburg M. Body mass index and alignment and their interaction as risk factors for progression of knees with radiographic signs of osteoarthritis. Osteoarthritis Cartilage. 2011;19(9):1117-22. https://doi.org/10.1016/j.joca.2011.06.001 PMid:21722745 DOI: https://doi.org/10.1016/j.joca.2011.06.001

Runhaar J, Koes BW, Clockaerts S, Bierma-Zeinstra SM. A systematic review on changed biomechanics of lower extremities in obese individuals: A possible role in development of osteoarthritis. Obes Rev. 2011;12(12):1071-82. https://doi.org/10.1111/j.1467-789X.2011.00916.x PMid:21812903 DOI: https://doi.org/10.1111/j.1467-789X.2011.00916.x

Walid MS, Zaytseva N. History of spine surgery in older obese patients. Ger Med Sci. 2011;9:DOC05. https://doi.org/10.3205/000128 PMid:21468327

Samartzis D, Karppinen J, Luk KD, Cheung KM. Body mass index and its association with lumbar disc herniation and sciatica: A large-scale, population-based study. Global Spine J. 2014;4(1):1376593. https://doi.org/10.1055/s-0034-1376593 DOI: https://doi.org/10.1055/s-0034-1376593

Schroeder GD, Guyre C, Vaccaro A. The epidemiology and pathophysiology of lumbar disc herniations. Sem Spine Surg. 2016;28(1):2-7. https://doi.org/10.1053/j.semss.2015.08.003 DOI: https://doi.org/10.1053/j.semss.2015.08.003

Seidler A, Bergmann A, Jäger M, Ellegast R, Ditchen D, Elsner G, et al. Cumulative occupational lumbar load and lumbar disc disease--results of a German multi-center case-control study (EPILIFT). BMC Musculoskelet Disord. 2009;10:48. https://doi.org/10.1186/1471-2474-10-48 PMid:19422710 DOI: https://doi.org/10.1186/1471-2474-10-48

Hong C, Lee CG, Song H. Characteristics of lumbar disc degeneration and risk factors for collapsed lumbar disc in Korean farmers and fishers. Ann Occup Environ Med. 2021;33(1):e16. https://doi.org/10.35371/aoem.2021.33.e16 PMid:34754477 DOI: https://doi.org/10.35371/aoem.2021.33.e16

Gregory DS, Seto CK, Wortley GC, Shugart CM. Acute lumbar disk pain: Navigating evaluation and treatment choices. Am Fam Physician. 2008;78(7):835-42. PMid:18841731

Huang W, Han Z, Liu J, Yu L, Yu X. Risk factors for recurrent lumbar disc herniation: A systematic review and metaanalysis. Medicine (Baltimore). 2016;95(2):e2378. https://doi.org/10.1097/MD.0000000000002378 PMid:26765413 DOI: https://doi.org/10.1097/MD.0000000000002378

Leven DM, Passias PG, Errico TJ, Lafage V, Bianco K, Lee A, et al. Risk factors for reoperation in patients treated surgically for intervertebral disc herniations: A subanalysis of the eightyear data from the sport trial. Spine J. 2014;14:S95-6. DOI: https://doi.org/10.1016/j.spinee.2014.08.242