Correlation between MSU Classifications in Preoperative MRI with Pain Relief in Patients with Radiculopathy, Treated by Intradiscal Discogel Injection

Background: Various tools and techniques of evaluation have been used to determine the severity of disc herniation in various regions of the spine, especially in the cervical and lumbar areas. But many of these techniques had been unable to correlate the severity of clinical manifestations with the severity of herniated disc. Introducing the new MSU Classification system, considering the two parameters of location and size of the herniated part, claims to be able to make a high correlation between the severity of clinical symptoms and the severity of the hernia. But this degree of correlation is still a question, particularly, about several methods of herniated disc treatments (especially drug treatments) are still unknown. In this study, the goal is evaluation of the correlation between the severity and extension of hernia in the cervical and lumbar regions based on MSU classification with pain relief following the intradiscal injection of Discogel in patients with disc herniation.

Materials and Methods: This study is a cross-sectional analytical study. The study population includes all patients who referred to Firoozgar Hospital, Tehran-Iran, from 2014 to 2018 with diagnosis of radiculopathy and after the necessary workups treated with intradiscal injection of Discogel. Patients’ medical file was evaluated for response to this treatment based on changes in pain severity on the VAS scale before the intervention and 2 weeks, 6, 12, and 18 months after the intervention. Cervical/lumbar MRIs were also reviewed prior to the procedure, and the location of the disc herniation was determined based on the size and location of the hernia according to the MSU classification. Finally, the relation between the type of hernia and the amount of pain reduction in the mentioned times was studied.

Results: In the present study, a total of 120 patients with discopathic pain (87 patients with lumbar and 33 patients with cervical involvement) were included in the study. Assessing the mean severity of lumbar pain relief and evaluation of its correlation with the MSU classification system in all three levels L3–4, L4–5, and L5–S1 and all five cervical levels indicate a mismatch between the amount of pain relief and the classification system at 2 weeks and 6 months after discogel injection. Most patients in their lumbar and cervical regions were significantly painless during this period in all MSU classification classes (p > 0.05). However, the number of painless patients in the lumbar and cervical region after 12 months of follow-up were significantly higher in classes A1, A2, AB2, and B2 and after 18 months of follow-up were significantly higher in classes A1 and A2 (p < 0.05).

Conclusion: Although the MSU classification system is not very effective in correlation of the amount of pain relief and the severity of these herniated discs in short-term of follow-up study (<6 months), but by determining the cases of cervical and lumbar disc herniation with a favorable response to discogel injection during long-term follow-up (12 and 18 months) have an important role in patient selection and rationalization of treatment expectations. Also, by comparing the treatment results of other methods, discogel injection can be recommended as a preliminary and minimally invasive method in selected cases.

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Artikel online veröffentlicht:
14. Dezember 2021