In patients with cervical radiculopathy, the type and extent of disc herniation measured on magnetic resonance imaging (MRI) prior to surgery correlated neither to the severity of the symptoms at presentation, nor to clinical outcomes at two years postoperatively. This is according to new research, published in The Bone and Joint Journal by Xiaoyu Yang (Leiden University Medical Centre, Leiden, the Netherlands) et al.
The aim of the study was to investigate whether the type of cervical disc herniation influences the severity of symptoms at the time of presentation, and the outcome after surgical treatment.
The type and extent of disc herniation at the time of presentation in 108 patients who underwent anterior discectomy for cervical radiculopathy were analysed on MRI, using a four-point scale. These were dichotomised into disc bulge and disc herniation groups.
Clinical outcomes were evaluated using the Neck Disability Index (NDI), 36-Item Short Form Survey (SF-36), and Visual Analogue Scale (VAS) for neck pain and arm pain at baseline and two years postoperatively. The perceived recovery was also assessed at this timepoint.
At baseline, 46 patients had a disc bulge and 62 had a herniation. There was no significant difference in the mean NDI and SF-36 between the two groups at baseline. Those in the disc bulge group had a mean NDI of 44.6 (standard deviation [SD] 15.2) compared with 43.8 (SD 16) in the herniation group (p=0.799), and a mean SF-36 of 59.2 (SD 6.9) compared with 59.4 (SD 7.7; p=0.895).
Likewise, there was no significant difference in the incidence of disabling arm pain in the disc bulge and herniation groups (84% vs. 73%; p=0.163), and no significant difference in the incidence of disabling neck pain in the two groups (70.5% (n= 31) vs. 63% (n = 39); p=0.491). In addition, at two years after surgery, no significant difference was found in any of the clinical parameters between the two groups.
Speaking to Spinal News International, Yang said: “The presence of a disc herniation, compared with the presence of a simple disc bulge without explicit protrusion or extrusion of disc materials, did not significantly change the presenting characteristics of the patients as they all had similar severe symptoms as assessed by NDI, SF-36, and VAS disabling arm/neck pain. Therefore, disc bulges can produce severe symptoms, especially for those patients with herniation of the nucleus pulposus.
“In the present study, we were unable to show that the type of disc herniation predicted the outcome. However, we were able to show that patients with a disc bulge can have an excellent outcome following anterior cervical discectomy, as also seen in patients with severe herniation. This finding is clinically significant since patients, surgeons, and insurers may overlook a diagnosis of degenerative cervical radiculopathy and/or the role of surgery in the treatment of a minor disc bulge as opposed to a large one.”