Value of contrast-enhanced MRI for predicting resorption of ruptured lumbar disc herniation: a prospective study of 82 cases.

Abstract

Although contrast-enhanced magnetic resonance imaging (MRI) appears to have value for predicting resorption of ruptured lumbar disc herniation (LDH), prospective studies are lacking and confirmation is warranted. A single-center prospective study was conducted to evaluate the value of contrast-enhanced MRI for predicting ruptured LDH resorption from January 2024 to May 2025. 90 patients with ruptured LDH were enrolled, and 82 patients were included for analysis. All patients underwent contrast-enhanced MRI to classify the type of enhancement: type I, the enhancement completely surrounds the herniated intervertebral disc (IVD) (complete bull's sign); type II, the enhancement only partially surrounds the herniated IVD (partial bull's sign); and type III, no enhancement around the herniated IVD. After 9 months of follow-up, changes in the Oswestry Disability Index (ODI) score and resorption rate were calculated. 25 patients (30.49%) underwent surgical treatment, while 57 (69.51%) completed non-surgical treatment without requiring surgery. In the non-surgical group, the enhancement type was as follows: type I, 27 patients; type II, 14 patients; and type III, 16 patients. Resorption occurred in 81.48% of patients with type I enhancement, 50% of patients with type II, and 0 patient with type III. The resorption rate significantly differed between the patients with types I, II, and III enhancement (52.46% ± 26.94%, 44.26% ± 38.04%, and 8.86% ± 13.81%, respectively; F = 13.171; p < 0.001). Patients with ruptured LDH can achieve clinical symptom relief with non-surgical treatment, and some patients may experience resorption. Contrast-enhanced MRI shows value for predicting resorption in ruptured LDH. Chinese Clinical Trial Registry; Registration number: ChiCTR2400094586; Date of Registration: December 25, 2024 (retrospective registration).