Association of preoperative co-occurring intervertebral disc-related degenerative features with one-year lumbar discectomy outcomes: A proposal for and preliminary testing of a novel MRI-based criterion

TL;DR

This study proposes a new MRI-based criterion to assess preoperative disc degeneration and finds it predicts worse outcomes after lumbar discectomy.

Contribution

A novel MRI-based criterion called 'Advanced Preoperative Degeneration' (APD) is introduced and tested for predicting discectomy outcomes.

Findings

Patients with APD had significantly higher leg pain and disability at one-year follow-up compared to those without APD.

The APD criterion integrates multiple degenerative features to predict poorer surgical outcomes.

Overall, patients improved after discectomy, but APD-positive patients had worse long-term results.

Abstract

This study developed a criterion for preoperative co-occurring intervertebral disc (IVD)-related degenerative features and evaluated its association with one-year outcomes following single-level lumbar discectomy.

The novel literature-based criterion, termed “Advanced Preoperative Degeneration” (APD), required the operated segment to exhibit preoperatively at least two advanced-level phenotypes from endplate damage (EPD), Modic changes (MC), and IVD degeneration. Subsequently, a retrospective single-center register-based study of patients treated with single-level micro- or endoscopic lumbar discectomy at a tertiary-level hospital between 2017 and 2022 was performed. The patients were categorized into three groups, APD-positive, APD1/3, and APD0, based on the presence of two or more, one, or none of the required phenotypes, respectively. A mixed-effects model was employed to assess between-group differences in improvement of LBP and leg pain (0–100 VAS), disability (ODI), and quality of life (EQ-5D-3L) from baseline to the one-year postoperative time point.

The cohort consisted of 140 patients (mean age: 45.3 years; 81 [57.9 %] male). Overall, the patients exhibited significant improvements in all PROMs after discectomy. However, at the one-year follow-up, the APD-positive group exhibited significantly higher leg pain and disability levels than the APD0 group, with mean scores of 31.4 versus 19.6 for leg pain and 20.6 versus 12.0 for ODI, respectively.

This study introduces a novel approach by integrating preoperative co-occurring IVD-related degenerative features into a composite APD criterion. Meeting the APD criterion was associated with significantly poorer one-year outcomes for leg pain and disability following lumbar discectomy.

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