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The Association Between Preoperative MRI Findings and Surgical Revision Within Three Years After Surgery for Lumbar Disc Herniation

Ziegler, Dorthe Schoeler MSc∗,†; Carreon, Leah MD, MSc∗,†; Andersen, Mikkel Oesterheden MD∗,†; Jensen, Rikke Krüger MSc, PhD

doi: 10.1097/BRS.0000000000002947

Study Design. This cohort study was an analysis of prospectively collected data in the DaneSpine Database.

Objective. The objective was to determine whether preoperative magnetic resonance imaging (MRI) findings were associated with the frequency of surgical revision due to recurrent lumbar disc herniation (LDH) within 3 years after first-time, single-level, simple lumbar discectomy.

Summary of Background Data. Because of a risk of poorer outcome in patients receiving revision surgery compared with first-time discectomy, there is a need to identify patients with LDH in risk of surgical revision prior to the primary discectomy. The association between preoperative MRI findings and revision surgery in patients with LDH has not been thoroughly studied.

Methods. Following an interobserver reliability study preoperative MRIs were evaluated. Potential predictive variables for surgical revision were evaluated using univariate and multivariate logistic regression analysis. Also, a sum-score of the number of MRI findings at the involved level was assessed.

Results. In a study population of 451 operated patients, those who had surgical revision were significantly younger and were significantly less likely to have vertebral endplate signal changes Type 2 (OR 0.36 (95% CI 0.15–0.88)) or more than five MRI findings (OR 0.45 (95% CI 0.21–0.95)) at the involved level than the patients not undergoing surgical revision. Surgical revision was not significantly associated with any other MRI findings.

Conclusions. In general, preoperative MRI findings have a limited explanatory value in predicting surgical revision within 3 years after first-time, single-level, simple lumbar discectomy. Both the single variable VESC Type 2 and a sum-score > 5 MRI findings at the operated level were found to be negatively associated with patients undergoing surgical revision.

Level of evidence: 3

A study of the association between pre-operative single or summed MRI findings and surgical revision within three years in patients with lumbar disc herniation. We found that pre-operative MRI findings had a limited explanatory value.

Spine Surgery and Research, Spine Center of Southern Denmark – part of Lillebaelt Hospital, Middelfart, Denmark

Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark

Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark.

Address correspondence and reprint requests to Dorthe Schoeler Ziegler, MSc, Spine Surgery and Research, Spine Center of Southern Denmark, Oestre Hougvej 55, 5500 Middelfart, Denmark; E-mail:

Received 8 August, 2018

Revised 26 October, 2018

Accepted 5 November, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

The IMK foundation, the Foundation for Chiropractic Research and Postgraduate Education, and the Region of Southern Denmark funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, grants, employment, travel/accommodations/meeting expenses.

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