Identification of intervertebral disc regeneration with magnetic resonance imaging after a long-term follow-up in patients treated with percutaneous diode laser nucleoplasty: a retrospective clinical and radiological analysis of 14 patients

Abstract

The aim of this study was to demonstrate regeneration of intervertebral discs undergoing laser therapy with sagittal relaxation time (T2) mapping after a long-term follow-up. Fourteen patients (9 men, 5 women; age range 20-57years; mean age 36.5years) treated with percutaneous 908-nm wave-length diode laser nucleoplasty for lumbar disc prolapsus at our clinic between January 2006 and June 2009 were studied. For the application of laser nucleoplasty in the past, patients who did not have central canal stenosis and/or lateral stenosis, sequestered disc fragment, operation scars and bleeding disorders were selected. The intervertebral disc levels undergoing laser therapy were L3-L4 (n=2) or L4-L5 (n=12). Patients were called for follow-up visits after a maximum 6-years (n=2) or a minimum 3years (n=3) with a mean of 4.4years. The patients' clinical status for leg pain was evaluated according to the visual analog scale (VAS) and subsequently, a lumbar magnetic resonance imaging was performed. Sagittal T2 mapping was performed for the intervertebral discs undergoing laser nucleoplasty. We analyzed the relationship between T2 in the regions of interest (ROIs), which is known to correlate with changes in the composition of intervertebral discs, and the degree of degeneration determined using the Pfirrmann grading system and VAS of patients. On the basis of the evaluation of the results of intervertebral discs in all patients, there was a significant increase in T2 in the anterior NP (ROI 2, +10.3ms; p<0.05). A significant increase was noted in T2 in the middle NP (ROI 3, +24.6ms; p<0.001). The most significant increase was recorded for the posterior NP (ROI 4, +28.6ms; p<0.001). No significant decrease was found in T2 in the anterior and posterior AF (ROI 1, -1.5ms; p=0.925; ROI 5, -0.1ms; p=0.683). According to the Pfirrmann grading system, disc degeneration grades before laser therapy were recorded as grade III (n=6) and grade IV (n=8) whereas disc degeneration grades after laser therapy were found to be grade I (n=6) and II (n=8). A significant decrease was noted in Pfirrmann grades of disc degeneration after laser therapy (p<0.0005). In this study, there was a prolongation of T2 indicating regeneration in the nucleus pulposus after laser therapy and these results were found to be consistent with VAS measurements after a long-term follow-up. This study, which demonstrates the quantitative efficacy of laser therapy, indicates that MRG can be more effectively used in the future.