Abstract
Background: In studies using MRI to describe disc changes over time, herniations have been reported to reduce in 35–100% of cases.
The aim of this study was to describe the development of disc related MRI-findings in patients with sciatica treated conservatively using a validated evaluation protocol.
Methods: Included in this prospective intervention study were; 181 patients with radicular pain below the knee, leg pain ≥ 3, duration of leg pain between 2 and 52 weeks. The patients were randomized into one of two active conservative treatment regimes lasting eight weeks. All included patients were scanned at baseline and again at 14 months follow-up. MRI evaluation was performed, using a validated evaluation protocol.
Results: In 139 (90%) of 154 patients included (median age 46 years) was it possible to identify a symptomatic disc level: 33 bulging discs, 52 focal protrusions, 10 broad-based protrusions, 36 extrusions, and 8 sequestrations.
Three percent of bulges and 38% of focal protrusions improved, whereas 75 – 100% of the more substantial herniations, i.e. broad-based, extrusions, and sequestrations improved (p< 0.0001). Improvement over time for nerve root compromise was seen in 60% of the cases. Disc signal, disc height, and HIZ remained unchanged in 63–73%. Treatment and age groups did not show any differences. However, gender differences were found in relation to baseline findings and development over time.
Conclusion: In general, symptomatic discs showed good MRI-prognosis, especially for those extruded. This study implies that active conservative treatment does not interfere with disc morphology as seen on MRI.
Correspondence should be addressed to Mr J. O’Dowd, Honorary Secretary at SBPR c/o BOA, Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE.
