Article
Is there a clinical significance of contrast-enhancement in previously non-operated patients with lumbar disc herniations?
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Authors
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Mario Löhr
- Neurochirurgische Klinik und Poliklinik, Universitätsklinikum Würzburg
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Bert Bosche
- Klinik für Neurologie, Universitätsklinikum Essen
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Frank Berg
- Abteilung für Neuroradiologie, Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg
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Werner Stenzel
- Institut für Neuropathologie, Charité – Universitätsmedizin Berlin
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Marek Molcanyi
- Institut für Neurophysiologie, Universität zu Köln
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Ralf-Ingo Ernestus
- Neurochirurgische Klinik und Poliklinik, Universitätsklinikum Würzburg
| Published: | May 13, 2014 |
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Outline
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Objective: The histopathological correlate of peridiscal gadolinium enhancement of previously non-operated lumbar disc herniations in magnetic resonance imaging (MRI) is supposed to represent an inflammatory reaction. However, the clinical significance of this neuroradiological finding is still a matter of debate. The aim of this study was to identify the reasons for contrast enhancement and to estimate its relevance for treatment decisions.
Method: We prospectively included 31 consecutive patients with a single-level, unilateral lumbar disc herniation confirmed by MRI after gadolinium DTPA administration. The typical patterns of peridiscal contrast enhancement were classified, correlated to histopathological and immunohistochemical findings at the corresponding sites of the herniated fragments, and, furthermore, to clinical symptoms like duration of radicular pain and incidence of sensorimotor deficits.
Results: Peridiscal contrast enhancement was found in 17 patients in a linear pattern but in 4 cases also encasing the adjacent rootlet. However, there was no significant correlation between gadolinium uptake and the presence of sensorimotor deficits or the duration of radicular symptoms. Apart from the finding of marked degenerative changes in all disc specimen, 18 cases exhibited an increased cellularity in the marginal areas with CD68+ macrophages and fibroblasts as the prevailing cells, scattered CD3+ T-lymphocytes and neovascularisation of different degrees, thus representing a chronic and unspecific immune response. Peridiscal contrast enhancement on MRI was significantly correlated to the histopathologic evidence of tissue inflammation. However, no correlation was found between the histological evidence or degree of inflammation and pain duration or the occurrence of motor and sensory disturbances.
Conclusions: Contrast-enhanced MRI proved to be a sensitive method for the detection of an unspecific inflammatory reaction in previously non-operated disc herniations. However, such a peridiscal inflammation did not contribute to the severity of sciatica or sensorimotor root symptoms in this series. But since the presence of macrophages and neovascularisation indicates tissue degradation and remodelling, gadolinium enhancement of herniated disc fragment might be predictive for their eventual resorption and, thus, may favour a conservative treatment approach in patients without neurological abnormalities.
