1: Spine. 2006 Jun 15;31(14):1605-12; discussion 1613.

Natural course of disc morphology in patients with sciatica: an MRI study using a
standardized qualitative classification system.

Jensen TS, Albert HB, Soerensen JS, Manniche C, Leboeuf-Yde C.

The Back Research Center, Clinical Locomotion Science, University of Southern
Denmark, Ringe, Denmark.

STUDY DESIGN: A prospective observational study of patients with sciatica.
OBJECTIVES: To describe the 14-month development of disc-related MRI findings in 
patients with sciatica receiving active conservative treatment. SUMMARY OF
BACKGROUND DATA: Previous studies of disc changes over time have reported
reduction of herniations in 35% to 100% of cases. This wide range may be
explained by differences in patient populations and classifications used to
describe disc herniations. METHODS: Data were obtained from patients with
radicular pain (n = 181) who were randomly allocated into one of two active
conservative treatment regimens lasting 8 weeks. All patients were scanned at
baseline and at 14 months of follow-up. Variables of interest in the present
study were disc contour and nerve root compromise at the presumed symptomatic
disc level. Disc contour was assessed using the recommendations from the Combined
Task Forces of NASS, ASSR, and ASNR. RESULTS: In all, 154 patients were included 
in this study (70 women and 84 men; range, 18-65 years; mean and median age, 45
years). It was possible to identify the symptomatic disc level in 90% of
patients. Extrusions or sequestrations were more common in individuals younger
than 45 years and in men. Men were also more likely to have nerve root
compromise. Only 3% of bulges and 38% of focal protrusions improved, whereas 75% 
to 100% of broad-based protrusions, extrusions, and sequestrations improved (P < 
0.0001). Nerve root compromise improved in 21% to 80% depending on the disc
contour. Neither type of treatment nor age had any effect on the development of
MRI findings over time. However, nerve root compromise was more likely to improve
in men. CONCLUSIONS: This classification system could be used to identify the
majority of symptomatic disc levels. At 14 months, the MRI outcome was generally 
good for disc herniations and nerve root compromise. Nerve root compromise had
the best MRI prognosis if the disc was extruded at baseline. There were
significant differences between men and women in relation to baseline findings as
well as in relation to development of MRI findings over time.

PMID: 16778696 [PubMed - indexed for MEDLINE]

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