Akaworn Mahatthanatrakul1, Vit Kotheeranurak2, Guang-Xun Lin3, Jung-Woo Hur3, Ho Jung Chung3, Jin-Sung Kim4. 1. Department of Orthopaedics, Naresuan University Hospital, Phitsanulok, Thailand. 2. Department of Orthopaedics, Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand. 3. Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea. 4. Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea. mdlukekim@gmail.com.
Abstract
PURPOSE: Postoperative magnetic resonance imaging (MRI) after microdiscectomy for lumbar disc herniation frequently shows spinal canal compression by the remaining annulus, which gradually decreases over time. Transforaminal endoscopic lumbar discectomy (TELD) can remove the herniation with minimal trauma to surrounding soft tissue. We aim to identify this remodeling of annulus fibrosus and the change of disc signal after TELD. METHODS: We reviewed patients who underwent TELD. Clinical data obtained were Oswestry disability index (ODI) and visual analog scale (VAS) for back and leg pain. Residual mass signal and disc protrusion size were measured in postoperative MRI. RESULTS: Thirty-one patients were reviewed. The mean age was 38.3 ± 14.4 years (range 18 to 76 years). ODI was 18.2% at the first follow-up and 12.7% at the last follow-up (p = 0.009). VAS for back and leg pain were 2.0 and 1.0 without significant change during follow-up. Disc protrusion size was reduced by 67.7% at the 1-year follow-up (p < 0.001). The residual mass signals at postoperative day 1 were high in 12 cases, intermediate in 18 cases, and low in1 case. The signal intensity was correlated with the percentage of disc protrusion reduction (p = 0.048). The percentage of disc protrusion reduction correlated with the last follow-up ODI (p = 0.018). CONCLUSION: One year after TELD, annulus remodeling was observed with an average of 67.7% of size reduction. The high signal intensity of residual mass at day 1 correlated with disc protrusion reduction at follow-up MRI. The percentage of disc protrusion reduction associated with the ODI at the final follow-up.
PURPOSE: Postoperative magnetic resonance imaging (MRI) after microdiscectomy for lumbar disc herniation frequently shows spinal canal compression by the remaining annulus, which gradually decreases over time. Transforaminal endoscopic lumbar discectomy (TELD) can remove the herniation with minimal trauma to surrounding soft tissue. We aim to identify this remodeling of annulus fibrosus and the change of disc signal after TELD. METHODS: We reviewed patients who underwent TELD. Clinical data obtained were Oswestry disability index (ODI) and visual analog scale (VAS) for back and leg pain. Residual mass signal and disc protrusion size were measured in postoperative MRI. RESULTS: Thirty-one patients were reviewed. The mean age was 38.3 ± 14.4 years (range 18 to 76 years). ODI was 18.2% at the first follow-up and 12.7% at the last follow-up (p = 0.009). VAS for back and leg pain were 2.0 and 1.0 without significant change during follow-up. Disc protrusion size was reduced by 67.7% at the 1-year follow-up (p < 0.001). The residual mass signals at postoperative day 1 were high in 12 cases, intermediate in 18 cases, and low in1 case. The signal intensity was correlated with the percentage of disc protrusion reduction (p = 0.048). The percentage of disc protrusion reduction correlated with the last follow-up ODI (p = 0.018). CONCLUSION: One year after TELD, annulus remodeling was observed with an average of 67.7% of size reduction. The high signal intensity of residual mass at day 1 correlated with disc protrusion reduction at follow-up MRI. The percentage of disc protrusion reduction associated with the ODI at the final follow-up.
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