Association between MRI findings and clinical outcomes in a period of 5 years after lumbar spine microdiscectomy

  • Evangelos I. PapanastasiouEmail author
  • Daphne J. Theodorou
  • Stavroula J. Theodorou
  • Emilios E. Pakos
  • Avraam Ploumis
  • Anastasios V. Korompilias
  • Ioannis D. Gelalis
Original Article • SPINE - LUMBAR



To evaluate the associations between magnetic resonance imaging (MRI) findings and pain, disability and quality of life before surgery and up to 5 years after lumbar microdiscectomy.

Materials and methods

Sixty-one patients who underwent one-level lumbar microdiscectomy by the same surgeon participated in this analytic, observational, prospective study. Lumbar spine MRI was performed preoperatively and 5 years postoperatively. Pain, disability and quality of life were measured with VAS, ODI, Roland Morris and SF-36 pre- and up to 5 years postoperatively. Subsequently associations between radiological findings and clinical outcomes were recorded.


Before surgery patients with disc extrusion or sequestration, with increased thecal sac compression (d > 2/3), with Modic changes (MC) 2 and 3 on the operated level and Pfirrmann grades IV and V on the operated and both adjacent discs presented the worst preoperative clinical outcomes. MC preoperatively were not related with postoperative results, in contrast with the type of disc herniation and thecal sac compression. Preoperative Pfirrmann grade IV and V on the operated and both adjacent discs and postoperative MC 2 and 3 on the operated level were related to poor clinical outcomes 36–60 months post-discectomy.


Extrusion or sequestration of the operated disc, increased compression of thecal sac, MC 2 and 3 on the operated level and Pfirrmann grades IV and V on the operated and adjacent discs were associated with the worst clinical outcomes. Nerve root impingement, facet joint arthritis, perineural fibrosis and disc granulation tissue had no effect on clinical scores.


Lumbar microdiscectomy MRI findings Pain Disability Quality of life 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Lurie J, Tosteson T, Tosteson A et al (2014) Surgical versus non-operative treatment for lumbar disc herniation: eight-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila pa 1976) 39(1):3–16. CrossRefGoogle Scholar
  2. 2.
    Gelalis ID, Papanastasiou EI, Pakos EE et al (2019) Clinical outcomes after lumbar spine microdiscectomy: a 5-year follow-up prospective study in 100 patients. Eur J Orthop Surg Traumatol 29(2):321–327. CrossRefPubMedGoogle Scholar
  3. 3.
    Mariconda M, Galasso O, Attingenti P et al (2010) Frequency and clinical meaning of long-term degenerative changes after lumbar discectomy visualized on imaging tests. Eur Spine J 19(1):136–143. CrossRefPubMedGoogle Scholar
  4. 4.
    Brinjikji W, Luetmer PH, Comstock B et al (2015) Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol 36(4):811–816. CrossRefPubMedGoogle Scholar
  5. 5.
    Gelalis ID, Papanastasiou EI, Theodorou DJ et al (2019) Postoperative MRI findings 5 years after lumbar microdiscectomy. Eur J Orthop Surg Traumatol 29(2):313–320. CrossRefPubMedGoogle Scholar
  6. 6.
    Fardon DF, Williams AL, Dohring EJ et al (2014) Lumbar Disc nomenclature: version 2.0. Spine (Phila Pa 1976) 39(24):E1448–E1465. CrossRefGoogle Scholar
  7. 7.
    Weishaupt D, Zanetti M, Boos N et al (1999) MR imaging and CT in osteoarthritis of the lumbar facet joints. Skelet Radiol 28:215–219 (PMID: 10384992) CrossRefGoogle Scholar
  8. 8.
    Pfirrmann CWA, Metzdorf A, Zanetti M et al (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 26(17):1873–1878CrossRefGoogle Scholar
  9. 9.
    Modic MT, Steinberg PM, Ross JS et al (1988) Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166(1):193–199. CrossRefGoogle Scholar
  10. 10.
    Boscainos PJ, Sapkas G, Stilianessi E et al (2003) Greek versions of the Oswestry and Roland-Morris Disability Questionnaires. Clin Orthop Relat Res 411:40–53. CrossRefGoogle Scholar
  11. 11.
    Cheung KM, Karppinen J, Chan D et al (2009) Prevalence and pattern of lumbar magnetic resonance imaging changes in a population study of one thousand forty-three individuals. Spine (Phila Pa 1976) 34(9):934–940. CrossRefGoogle Scholar
  12. 12.
    Li T, Han D, Liu B et al (2014) Clinical assessment of reformed lumbar microdiscectomy. Eur J Orthop Surg Traumatol 24:23. CrossRefPubMedGoogle Scholar
  13. 13.
    Ahmadi SA, Burkert IP, Steiger HJ et al (2018) Multidimensional long-term outcome analysis after single-level lumbar microdiscectomy: a retrospective single-centre study. Eur J Orthop Surg Traumatol 28:189. CrossRefPubMedGoogle Scholar
  14. 14.
    Lurie JD, Moses R, Tosteson AN et al (2014) Magnetic resonance imaging predictors of surgical outcome in patients with lumbar intervertebral disc herniation. Spine (Phila Pa 1976) 38(14):1216–1225. CrossRefGoogle Scholar
  15. 15.
    Chin KR, Tomlinson DT, Auerbach JD et al (2008) Success of lumbar microdiscectomy in patients with Modic changes and low-back pain: a prospective pilot study. J Spinal Disord Tech 21(2):139–144. CrossRefPubMedGoogle Scholar
  16. 16.
    Laustsen AF, Bech-Azeddine R (2016) Do Modic changes have an impact on clinical outcome in lumbar spine surgery? A systematic literature review. Eur Spine J 25(11):3735–3745. CrossRefPubMedGoogle Scholar
  17. 17.
    Weiner BK, Vilendecic M, Ledic D et al (2015) Endplate changes following discectomy: natural history and associations between imaging and clinical data. Eur Spine J 24(11):2449–2457. CrossRefPubMedGoogle Scholar
  18. 18.
    Sørile A, Moholdt V, Kvistad KA et al (2012) Modic type I changes and recovery of back pain after lumbar microdiscectomy. Eur Spine J 21(11):2252–2258. CrossRefGoogle Scholar
  19. 19.
    Briseño MR, Phukan RD, Leonard DA et al (2016) The influence of adjacent level disc disease on discectomy outcomes. Eur Spine J 25(1):230–234. CrossRefPubMedGoogle Scholar
  20. 20.
    Lee YS, Choi ES, Song CJ (2009) Symptomatic nerve root changes on contrast-enhanced MR imaging after surgery for lumbar disk herniation. AJNR Am J Neuroradiol 30(5):1062–1067. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • Evangelos I. Papanastasiou
    • 1
    Email author
  • Daphne J. Theodorou
    • 2
  • Stavroula J. Theodorou
    • 3
  • Emilios E. Pakos
    • 1
  • Avraam Ploumis
    • 4
  • Anastasios V. Korompilias
    • 1
  • Ioannis D. Gelalis
    • 1
  1. 1.Department of Orthopaedic SurgeryUniversity of Ioannina School of MedicineIoanninaGreece
  2. 2.Department of RadiologyGeneral Hospital of IoanninaIoanninaGreece
  3. 3.Department of RadiologyUniversity Hospital of IoanninaIoanninaGreece
  4. 4.Physical Medicine and Rehabilitation ClinicUniversity of Ioannina Medical SchoolIoanninaGreece

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