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Does disk space degeneration according to Los Angeles and Modic scales have relation with recurrent disk herniation?
Saied Abrishamkar1, Mehdi Mahmoudkhani1, Bahram Aminmansour1
1Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran.
Background:
After single disk herniation operation, about 5-20% recurrences may occur. Different etiology may affect the prevalence of recurrence. Disk degeneration according to Modic and Los Angles scales could affect recurrence rate. This study wants to show the relationship between disk space degeneration according to these scales on severity, time, and prevalence of disk herniation recurrence.
Materials And Methods:
Thirty-four patients presented with radicular pain (with or without back pain) and history of lumbar disk surgery was included in this prospective study. Pre- and postoperative T2-weighted sagittal magnetic resonance imaging (MRI) compared for Modic and Los Angeles disk degeneration grading, then, data analysis on SPSS (version 20) software, paired t-test, and others.
Results:
The result of study shows for first operation that grade (II) Los Angeles is the most common, but, for second procedure grade (IV) was less common and the mostly decreased (from 14.7 to 9.2%). In addition, Wilcoxon test shows no change of Los Angeles grading for both first and second surgery (P = 0.06). Whereas; based on Modic criteria grading was different from first operation, in other words, grade (I) (41.2%) in first operation was changed to 20.6% in second operation (P = 0.007).
Conclusion:
Our study showed that the Los Angeles criterion is more practical and useful for prediction of recurrence and in the patients with Los Angles grade III and IV and grade II and III on Modic scale, the chance of recurrence is less than patients with lower grades.
Insights
Recurrence after lumbar disk surgery is linked to disc degeneration. The Los Angeles scale is more practical for predicting recurrence, with higher grades indicating a lower chance of repeat herniation.
Area of Science:
- Spine surgery
- Radiology
- Orthopedics
Background:
- Lumbar disk herniation recurrence rates range from 5-20% after initial surgery.
- Disk degeneration, assessed by Modic and Los Angeles scales, may influence recurrence.
- Understanding these degeneration scales can clarify recurrence patterns.
Purpose of the Study:
- To investigate the relationship between lumbar disk degeneration (Modic and Los Angeles scales) and the severity, timing, and prevalence of disk herniation recurrence.
- To evaluate the predictive utility of different disk degeneration grading systems for surgical outcomes.
Main Methods:
- Prospective study of 34 patients with a history of lumbar disk surgery and radicular pain.
- Pre- and postoperative T2-weighted sagittal MRI analyzed for Modic and Los Angeles disk degeneration grading.
- Statistical analysis using SPSS, including paired t-tests and Wilcoxon tests.
Main Results:
- Los Angeles scale: Grade II was most common pre-surgery; Grade IV decreased significantly post-surgery (14.7% to 9.2%). No significant change in Los Angeles grading between first and second surgeries (P=0.06).
- Modic scale: Grade I significantly decreased from 41.2% in the first operation to 20.6% in the second (P=0.007).
- Higher grades on both scales were associated with lower recurrence rates.
Conclusions:
- The Los Angeles criterion is a practical tool for predicting lumbar disk herniation recurrence.
- Patients with Los Angeles grades III and IV, and Modic grades II and III, have a lower likelihood of recurrence compared to those with lower grades.
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