Diagnosis Of Lumbar Disc Herniation Research Articles

Natural language processing-driven artificial intelligence models for the diagnosis of lumbar disc herniation with L5 and S1 radiculopathy: a preliminary evaluation

To develop and validate natural language processing (NLP)-driven artificial intelligence (AI) models for the diagnosis of lumbar disc herniation (LDH) with L5 and S1 radiculopathy using electronic health records (EHRs). EHRs of patients undergoing single-level Percutaneous Endoscopic Lumbar Discectomy (PELD) for the treatment of LDH at the L4/5 or L5/S1 level between June 1, 2013, and December 31, 2021, were collected. The primary outcome was LDH with L5 and S1 radiculopathy, which was defined as nerve root compression recorded in the operative notes. Datasets were created using the history of present illness (HPI) text and positive symptom (PS) text with radiculopathy (L5 or S1), respectively. The datasets were randomly split into a training set and a testing set in a 7:3 ratio. Two machine learning (ML) models, the Long Short-Term Memory (LSTM) network and Extreme Gradient Boosting (XGBoost), were developed using the training set. Performance evaluation of the models on the testing set was done using measures such as the receiver operating characteristic (ROC) curve, area under the curve (AUC), accuracy, recall, F1-score, and precision. The study included a total of 1681 patients, with 590 patients having L5 radiculopathy and 1091 patients having S1 radiculopathy. Among the four models developed, the LSTM model based on PS text showed the best discrimination in the testing set, with precision (0.9054), recall (0.9405), accuracy (0.8950), F1-score (0.9226), and AUC (0.9485). This study provides preliminary validation of the concept that NLP-driven AI models can be used for the diagnosis of lumbar disease using EHRs. This study could pave the way for future research that may develop more comprehensive and clinically impactful AI-driven diagnostic systems.

An approach to the diagnosis of lumbar disc herniation using deep learning models.

Background: In magnetic resonance imaging (MRI), lumbar disc herniation (LDH) detection is challenging due to the various shapes, sizes, angles, and regions associated with bulges, protrusions, extrusions, and sequestrations. Lumbar abnormalities in MRI can be detected automatically by using deep learning methods. As deep learning models gain recognition, they may assist in diagnosing LDH with MRI images and provide initial interpretation in clinical settings. YOU ONLY LOOK ONCE (YOLO) model series are often used to train deep learning algorithms for real-time biomedical image detection and prediction. This study aims to confirm which YOLO models (YOLOv5, YOLOv6, and YOLOv7) perform well in detecting LDH in different regions of the lumbar intervertebral disc. Materials and methods: The methodology involves several steps, including converting DICOM images to JPEG, reviewing and selecting MRI slices for labeling and augmentation using ROBOFLOW, and constructing YOLOv5x, YOLOv6, and YOLOv7 models based on the dataset. The training dataset was combined with the radiologist's labeling and annotation, and then the deep learning models were trained using the training/validation dataset. Results: Our result showed that the 550-dataset with augmentation (AUG) or without augmentation (non-AUG) in YOLOv5x generates satisfactory training performance in LDH detection. The AUG dataset overall performance provides slightly higher accuracy than the non-AUG. YOLOv5x showed the highest performance with 89.30% mAP compared to YOLOv6, and YOLOv7. Also, YOLOv5x in non-AUG dataset showed the balance LDH region detections in L2-L3, L3-L4, L4-L5, and L5-S1 with above 90%. And this illustrates the competitiveness of using non-AUG dataset to detect LDH. Conclusion: Using YOLOv5x and the 550 augmented dataset, LDH can be detected with promising both in non-AUG and AUG dataset. By utilizing the most appropriate YOLO model, clinicians have a greater chance of diagnosing LDH early and preventing adverse effects for their patients.

Association of Hematologic Parameters with Post-operative Outcomes in Patients Undergoing Lumbar Disc Herniation Surgery

Objective: In this study, we aimed to determine whether hematologic parameters have an effect on the post-operative outcomes in patients operated for lumbar disc herniation. Material and Methods: The study was conducted in the retrospective cohort design in the Department of Neurosurgery of Ankara Güven Hospital and included patients who were hospitalized and treated with the diagnosis of Lumbar Disc Herniation (LDH) between 01.01.2019 and 31.12.2020. Patients' pre-operative hematologic parameters, which were routinely studied preoperatively, and Visual Analogue Scale (VAS) scoring records, which were routinely used to monitor pain levels, were retrospectively reviewed, and the outpatient clinic notes of the patients within 6 months post-operatively were evaluated. Results: Among 117 patients hospitalized with LDH over a 1-year period, 87 patients were included in the study. 30 LDH patients, owning factors that may affect wound healing and platelet function (active infection/diabetes mellitus, antiaggregants/anticoagulants) were excluded. When Hb was examined from the pre-operative hematological parameters, anemia was detected in 6 (7%) of 87 patients; however, it had no significant effects on VAS scores and surgical outcomes (p>0.05). Pre-operative Neutrophil-to-Lymphocyte Ratio (NLR) was elevated in 17 (20%) of the 87 patients, and the VAS score of these patients was found to be 1.5-fold higher than normal patients (p=0.031). Post-operative complications (infection, hemorrhage and cerebrospinal fluid fistula) were detected in 5 (6%) of the 87 patients who underwent surgery, and it was found that the pre-operative NLR values were high in these 5 patients. It was also found that high NLR increased the risk of post-operative complications 1.4-fold in patients (p=0.002). No results could be obtained regarding the platelet values because this parameter was within the normal range preoperatively in all patients. Conclusion: In the present study, the effects of hematological parameters on lumbar disc surgery were investigated, and it was concluded that elevated NLR values increased wound site infection among post-operative complications and VAS scores.

Clinical feasibility of MRI-based synthetic CT imaging in the diagnosis of lumbar disc herniation: a comparative study.

Computed tomography (CT) and magnetic resonance imaging (MRI) are indicated for use in preoperative planning and may complicate diagnosis and place a burden on patients with lumbar disc herniation. To investigate the diagnostic potential of MRI-based synthetic CT with conventional CT in the diagnosis of lumbar disc herniation. After obtaining prior institutional review board approval, 19 patients who underwent conventional and synthetic CT imaging were enrolled in this prospective study. Synthetic CT images were generated from the MRI data using U-net. The two sets of images were compared and analyzed qualitatively by two musculoskeletal radiologists. The images were rated on a 4-point scale to determine their subjective quality. The agreement between the conventional and synthetic images for a diagnosis of lumbar disc herniation was determined independently using the kappa statistic. The diagnostic performances of conventional and synthetic CT images were evaluated for sensitivity, specificity, and accuracy, and the consensual results based on T2-weighted imaging were employed as the reference standard. The inter-reader and intra-reader agreement were almost moderate for all evaluated modalities (κ = 0.57-0.79 and 0.47-0.75, respectively). The sensitivity, specificity, and accuracy for detecting lumbar disc herniation were similar for synthetic and conventional CT images (synthetic vs. conventional, reader 1: sensitivity = 91% vs. 81%, specificity = 83% vs. 100%, accuracy = 87% vs. 91%; P < 0.001; reader 2: sensitivity = 84% vs. 81%, specificity = 85% vs. 98%, accuracy = 84% vs. 90%; P < 0.001). Synthetic CT images can be used in the diagnostics of lumbar disc herniation.

Value of imaging examinations in diagnosing lumbar disc herniation: A systematic review and meta-analysis.

To systematically review the clinical value of three imaging examinations (Magnetic Resonance Imaging, Computed Tomography, and myelography) in the diagnosis of Lumbar Disc Herniation. Databases including PubMed, Embase, The Cochrane Library, Web of Science, CBM, CNKI, WanFang Data, and VIP were electronically searched to collect relevant studies on three imaging examinations in the diagnosis of Lumbar Disc Herniation from inception to July 1, 2021. Two reviewers using the Quality Assessment of Diagnostic Accuracy Studies-2 tool independently screened the literature, extracted the data, and assessed the risk of bias of included studies. Then, meta-analysis was performed by using Meta-DiSc 1.4 software and Stata 15.0 software. A total of 38 studies from 19 articles were included, involving 1,875 patients. The results showed that the pooled Sensitivity, pooled Specificity, pooled Positive Likelihood Ratio, pooled Negative Likelihood Ratio, pooled Diagnostic Odds Ratio, Area Under the Curve of Summary Receiver Operating Characteristic, and Q* were 0.89 (95%CI: 0.87-0.91), 0.83 (95%CI: 0.78-0.87), 4.57 (95%CI: 2.95-7.08), 0.14 (95%CI: 0.09-0.22), 39.80 (95%CI: 18.35-86.32), 0.934, and 0.870, respectively, for Magnetic Resonance Imaging. The pooled Sensitivity, pooled Specificity, pooled Positive Likelihood Ratio, pooled Negative Likelihood Ratio, pooled Diagnostic Odds Ratio, Area Under the Curve of Summary Receiver Operating Characteristic, and Q* were 0.82 (95%CI: 0.79-0.85), 0.78 (95%CI: 0.73-0.82), 3.54 (95%CI: 2.86-4.39), 0.19 (95%CI: 0.12-0.30), 20.47 (95%CI: 10.31-40.65), 0.835, and 0.792, respectively, for Computed Tomography. The pooled Sensitivity, pooled Specificity, pooled Positive Likelihood Ratio, pooled Negative Likelihood Ratio, pooled Diagnostic Odds Ratio, Area Under the Curve of Summary Receiver Operating Characteristic, and Q* were 0.79 (95%CI: 0.75-0.82), 0.75 (95%CI: 0.70-0.80), 2.94 (95%CI: 2.43-3.56), 0.29 (95%CI: 0.21-0.42), 9.59 (95%CI: 7.05-13.04), 0.834, and 0.767 respectively, for myelography. Three imaging examinations had high diagnostic value. In addition, compared with myelography, Magnetic Resonance Imaging had a higher diagnostic value.

The relationship of pain, sleeping pattern, quality of life, and kinesiopobia with depressive symptoms in patients with lumbar disc hernia

Pain, muscle spasms, loss of muscle strength, and deteriorated posture adversely affect the patient's daily life activities and quality of life. Within the scope of this research, we aimed to elucidate pain, sleep quality, quality of life, and kinesiophobia levels in patients with lumbar disc herniation and to determine their relationship with depressive symptoms. The data of 74 patients who applied to our institution between 01/01/2020 – 01/04/2023 with a diagnosis of lumbar disc herniation have been analyzed retrospectively Sociodemographic information form (SIF), Nottingham Health Profile (NHP), Tampa Kinesiophobia Scale (TKS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Scale (BDS), and Visual Analogue Scale (VAS) were applied to the participants in the study. A statistically significant difference has been achieved between the groups in the VAS pain severity, TAMPA, Pittsburgh sleep quality scale, 1, 2 in the NSP scale, and the sub-dimensions of emotion, sleep, social, physical and energy (p&lt;0.05). All scale scores of patients with depressive symptoms were higher than those without depressive symptoms. A statistically significant relationship existed between BDS scores and all scale scores (p&lt;0.05). The patients' BDS scale score and VAS pain severity, TAMPA, NSP (pain), and NSP (physical) scale scores were low, Pittsburgh, NSP (emotion), NSP (sleep), NSP (social), NSP (energy), NSP 1. It was observed that there was a moderate relationship between the 2 scale scores. Regarding the outcomes of this research, one could say that depressive symptoms negatively affect sleeping patterns and the quality of life of patients with lumbar disc hernia.

Physical Therapy Diagnosis of Lumbar Disc Herniation: Role and Function - an Overview

Background: Discus hernia represents an intervertebral disk prolapse. The intervertebral disk provides stability in rest state and distributes the load of the spinal column on the move. Changes that lead to the occurrence of disc prolapse are desiccation, reduction of proteoglycan content, mucoid degeneration, and fibrosing tissue uptake. Predisposing factors of lumbar pain are heavy physical tasks with lifting loads over twenty pounds, especially professional use of heavy tools. Objective: The aims of this article is the review of diagnostics and physical therapy of lumbar disc herniation at levels L4/L5 and L5/S1. Methods: Authors used descriptive method for review lumbar disc herniation including diagnostic procedures and physical therapx based on scientific literature stored in medical databses PubMed, Scopus, Hinari, etc.. Results: The most common area of the spine to experience a herniated disk is the low back, just below the waist level. Herniated disks also commonly occur in the neck.. Conclusion: Rehabilitation is a delicate problem and requires long-term treatment and multidisciplinary cooperation, and is carried out in accordance with the principles of diagnostic and physical therapy of lumbar dics herniation depending of level of demaged and level of causes of lumbar disc herniation. The majority of herniated disks do not require surgery, and respond best to physical therapy. Physical therapists design personalized treatment programs to help people with herniated disks regain normal movement, reduce pain, and get back to their regular activities.

Diagnostic values of 2 different techniques for controversial lumbar disc herniation by conventional imaging examination: 3D-DESS vs. CT plain scan.

Background: The aim of this study was to explore the significance of three-dimensional double-echo steady-state (3D-DESS) sequence and multidetector computed tomography (CT) plain scan in the diagnosis of lumbar disc herniation (LDH) remaining controversial in conventional magnetic resonance imaging (MRI), and to compare the efficiency between 3D-DESS and CT in diagnosing controversial patients by conventional MRI. Methods: A total of 61 patients with controversial LDH diagnosed by conventional MRI were collected. Before operation, the disease of these patients was further confirmed by 3D-DESS sequences and continuous CT plain scan from L3 to S1. Finally, for patients whose postoperative curative effect was marked and symptoms were obviously alleviated, the sensitivity, specificity and accuracy. Results: Among, 59 patients with remarkably relieved symptoms after operation were included, and 2 patients with varying degrees of non-remission of pain and partial dysfunction after operation were excluded. The sensitivity, specificity and accuracy of 3D-DESS were 94.6, 100 and 94.9%, respectively, and those of CT were 75.0, 33.3 and 72.9%, respectively. Conclusion: 3D-DESS is a very useful diagnostic method for patients with some special types of LDH that remain controversial in conventional imaging diagnostic methods. Through 3D-DESS, the morphology of lumbosacral nerve roots can be directly observed, which is conducive to the improvement of the sensitivity, specificity and accuracy, thus further reducing the misdiagnosis rate. Moreover, 3D-DESS plays a guiding role in the formulation of operative methods.

The effect of intradiscal injection of percutaneous radiopaque gel ethanol on pain in patients with lumbar disc herniation: Our clinical experience

Introduction: Lumbar disc herniation (LDH); It is an important disease that is common in society and can cause socioeconomic problems. There are many treatment algorithms for LDH, including medical and surgical. Our aim in this study; To evaluate the clinical results of patients with LDH who did not benefit from conservative treatment after percutaneous intradiscal radiopaque gel ethanol (RGE) procedure in the light of the literature. Methods: A total of 44 levels of percutaneous intradiscal RGE were applied to 41 patients, 14 men and 27 women, hospitalized with the diagnosis of LDH. patients; Demographic characteristics, treatments they received, lumbar magnetic resonance imaging (MRI) taken 6 months later, visual analog scores (VAS) before and 6 months after percutaneous intradiscal RGE procedure, complications, side effects and patient satisfaction after the procedure were evaluated. Results: The VAS values of the patients were 8 before the procedure and 4.2 6 months after the procedure. A 47.5% reduction in pain was observed and these data were evaluated as statistically significant. When patients were asked about their satisfaction with the procedure after the percutaneous RGE procedure; 4 patients answered "poor", 13 patients "moderate", 13 patients "good" and 11 patients "excellent". The rate of those who were satisfied with the procedure was 90.2%, and these data were not considered statistically significant. Conclusion: As a result; Percutaneous intradiscal RGE procedure, in patients with a diagnosis of LDH and who did not benefit from conservative treatment; It can be a minimally invasive technique that reduces pain.

Experience of MRI in the Diagnosis of Lumbar Disc Herniation

Experience of MRI in the Diagnosis of Lumbar Disc Herniation

Ultrasonography in the diagnosis of lumbar disc herniation in young adult

The aim: to assess the value of ultrasonography in the diagnosis of a lumbar herniation disc in young adults.&#x0D; Material and methods: 27 patients aged 17-21 years (8 girls, 19 boys) were included in our study. During the examination by a neurologist, all patients reported pain in the lower back. The results of the ultrasound investigation were compared with MRI. Ultrasonography (USG) was conducted on a Philips HD 11XE device using a convection transducer in the frequency range 2-5 MHz; MRI - General Electric, Signa HDI, 1.5T.&#x0D; Results: at the L3-L4 segment, hernia was diagnosed in 2 (7.4±5.0 %) cases, at the L4-L5 segment - in 14 (51.9±9.6 %) cases, and at the L5-S1 segment - in 11 (40.7±9.5 %) cases, respectively. The hernia at the segments of L5-S1 and L4-L5 was diagnosed significantly (P&lt;0.001) more often than at the segment of L3-L4. Median hernia was diagnosed in 12 (44.4±9.6 %) cases, paramedian - in 11 (40.7±9.5 %) cases and posterolateral - in 4 ( 14.8±6.8 %) cases, respectively. The median and paramedian hernia was diagnosed significantly (P&lt;0.05) more than the posterolateral. In ultrasound, only in one case, a posterolateral hernia was interpreted as paramedian&#x0D; Conclusions: 1) The lumbar hernia are localized at the segments of L5-S1 and L4-L5 significantly (P&lt;0.001) more often than at the other segments; 2) Sciatica is significantly more common in posterolateral localization of lumbar disc herniation; 3) The ultrasonography couldbe used to find out the causes of back pain in young adult

Building a simulated educational environment for the diagnosis of lumbar disk herniation using axial view MRI scans

Building a simulated educational environment for the diagnosis of lumbar disk herniation using axial view MRI scans

Should the Surgical Instrument Parts That Are Broken and Remain in the Distance of the Disc Be Removed? Should It Be Quit? A Case Report

Background and Aim: Lumbar posterior open microdiscectomy is a procedure that is widely used to treat lumbar disc diseases. These operations have a low risk of complications. It is unusual for the tool to break and remain in the intervertebral space during surgery. In this situation, we wanted to provide a set of suggestions based on our research of the literature on pituitary forceps blade fractures and the procedure for removing the fractured portion from the disc space during lumbar posterior open microdiscectomy surgery. Case Presentation: 10 days ago, a 37-year-old female patient presented to our clinic complaining of low back pain, left leg pain, and left foot weakness. A diagnosis of lumbar disc herniation necessitating surgery was obtained following neurological and radiographic examinations. The patient was advised to have surgery. The patient had standard lumbar microdiscectomy surgery. However, the tip of the pituitary forceps was broken during disc removal and remained in the L5-S1 disc space. The scope confirmed that the alien object was in space. After the evaluation, it was decided to remove the piece of instrument that was broken and remained in the disc space. The broken surgical handpiece was removed and documented under fluoroscopy. Additionally, it was forwarded to the technical unit for examination. Conclusion: A few case reports in the literature describe a surgical tool piece fracture that remained in the disc distance of the lumbar microdiscectomy. Complication management may be time-consuming and risky. Such a complication should be addressed and resolved appropriately because this situation might have detrimental terms on surgical risks and the legal procedure.

Building a simulated educational environment for the diagnosis of lumbar disk herniation using axial view MRI scans

Building a simulated educational environment for the diagnosis of lumbar disk herniation using axial view MRI scans

Clinical Value of MRI in the Diagnosis of Lumbar Disc Herniation

Clinical Value of MRI in the Diagnosis of Lumbar Disc Herniation

173. The timing and incidence of surgical intervention following diagnosis of lumbar disc herniation at military treatment facilities

BACKGROUND CONTEXT The clinical syndrome of radiculopathy from lumbar disc herniation (LDH) is a major cause of morbidity and cost among United States civilians and active duty service members. LDH is one of the most common diagnoses in spine practice with the incidence of incidence of symptomatic LDH in the United States estimated at 1% to 2%. PURPOSE The purposes of this study were to determine survival of conservative management of lumbar disc herniation in the military health system (MHS), and to determine risk factors to fail conservative management amongst MHS beneficiaries. STUDY DESIGN/SETTING After IRB approval we performed a retrospective observational review of Military Health System (MHS) beneficiaries. PATIENT SAMPLE The Military Heath System Data Repository (MDR) contains patient specific detail on all health care beneficiaries including active duty service members, dependents and retirees. In this set of patients, we then identified patients that failed conservative management, finding the time to the first post-diagnosis encounter for lumbar microdiscectomy or lumbar decompression. OUTCOME MEASURES Multivariable Cox proportional hazards models were used to evaluate the associations of patient and diagnosing facility characteristics with time to surgical intervention over the study period. METHODS The MDR was queried for all patients diagnosed with lumbar disc herniation from FY2011-2018; the earliest such diagnosis was kept for each patient as the initial diagnosis. Censoring was determined to be the first day of the last month each patient was eligible to receive MHS benefits. Patients were also queried for history of smoking status (yes/no) at any time during MHS care, age at the time of diagnosis, sex, MHS beneficiary category, and the skill/training of the diagnosing provider. RESULTS A total of 84,985 MHS beneficiaries including 62,771 active duty service members were diagnosed with LDH in a military treatment facility during the study period. 10,532 (12.4%) MHS beneficiaries, including 7,650 (10.9%) active duty service, failed conservative management onto surgical intervention with lumbar microdiscectomy or lumbar decompression. Multivariable Cox regression among all health care beneficiaries revealed that younger age, male sex, and history of smoking were each associated with higher risk of surgical intervention independent of diagnosing facility characteristics. CONCLUSIONS LDH compromises the readiness of our troops and negatively impacts healthcare costs for the Department of Defense (DoD). MHS beneficiaries with LDH have a good prognosis with approximately 88% of patients successfully completing conservative management. However, younger patients with a history of smoking should be educated that they are more likely to fail conservative management than patients without those demographic features. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Analysis of the Application Value of MRI and CT Diagnosis of Lumbar Disc Herniation

Objective: To analyze the application value of MRI and CT diagnosis for those with lumbar disc herniation. Methods: The data of 62 patients with LDH treated in our hospital from January 2019 to December 2019 were analyzed retrospectively. All patients were diagnosed as LDH after operation, and 62 patients were treated with MRI and CT. The accuracy of CT and MRI in the diagnosis was analyzed according to the gold standard of operation results. Results: 62 patients were diagnosed as LDH after operation, including 25 cases with intervertebral disc herniation, 12 cases with intervertebral disc prolapse, 8 cases with intervertebral disc nodule, 7 cases with intervertebral disc dissociation as well as 10 cases with intervertebral disc bulge. The accuracy of MRI diagnosis (95.16%) was higher than that of CT (75.81%), and the difference was statistically significant (P&lt;0.05). Conclusion: For the diagnosis of LDH, MRI is more accurate, but CT is faster and cheaper. Both of them have their own advantages and can be chosen clinically according to the actual situation of patients on the basis of ensuring the diagnostic accuracy.

Analysis of the Application Value of MRI and CT in the Diagnosis of Lumbar Disc Herniation

Analysis of the Application Value of MRI and CT in the Diagnosis of Lumbar Disc Herniation

A Noninvasive Assistant System in Diagnosis of Lumbar Disc Herniation.

The purpose of this study is the application of pressure sensors in diagnostics and evaluation of the accuracy diagnostics of lumbar disc herniation at levels L4/L5 and L5/S1 using the aforementioned platform. The motivation behind the idea to apply the pressure measurement platform is the fact that the motor weakness of plantar and dorsal flexia of the feet is one of the absolute indications for the operative treatment of patients with lumbar disc herniation at the indicated levels. In patients, MRI diagnosis of the lumbosacral spine served as the ground truth in the diagnosis of herniation at L4/L5 and L5/S1 levels. The inclusive criteria for the study were the proven muscle weakness based on manual muscle tests performed prior to surgery, after seven days of surgery and after physical therapy. The results obtained with the manual muscular test were compared with the results obtained using our platform. The study included 33 patients who met the inclusion criteria. The results of the measurements indicate that the application of our platform with pressure sensors has the same sensitivity diagnostics as a manual muscle test, when done preoperatively and postoperatively. After physical therapy, pressure sensors show statistically significantly better sensitivity compared to the clinical manual muscle test. The obtained results are encouraging in the sense that the pressure platform can be an additional diagnostic method for lumbar disc herniation detection and can indicate the effectiveness of operative treatment and physical therapy after operation. The main advantage of the system is the cost; the whole system with platform and sensors is not expensive.

106. Subclinical propionibacterium acnes infection estimation in the intervertebral disc (SPInE-ID)

BACKGROUND CONTEXT Low back pain and vertebral end plate abnormalities are common conditions within the population. Subclinical infection caused by indolent pathogens can potentially lead to these findings, with differentiation between them notably challenging from a clinical perspective. Progressive infection of the intervertebral disc has been extensively associated with increasing low back pain, with Propionibacterium acnes specifically implicated with in relation to sciatica. PURPOSE To identify if the presence of an infective pathogen within the intervertebral disc is primary or is a result of intraoperative contamination, and whether this correlates to low back pain. STUDY DESIGN/SETTING Single-center prospective cohort. PATIENT SAMPLE Subjects included within the study will be between the ages of 18 and 65 years and have a diagnosis of lumbar disc herniation requiring open decompression surgery. OUTCOME MEASURES Tissue culture and pathogen identificationNRSODIEQ-5DModic changesESR, CRP, Leucogram. METHODS Excised herniated disc fragments, muscle and ligamentum flavum samples will be collected during surgery and sent to microbiology for tissue culture and pathogen identification. A disc infection is considered if only disc tissue has a positive culture growth. Score questionnaires for pain, functionality and quality of life will be given preoperatively and at 1, 3, 6 and 12 months postoperatively. An MRI will be performed 12 months after surgery for analysis of Modic changes and baseline comparison. The primary endpoint is the rate of disc infection in patients with symptomatic degenerative disease. The secondary endpoints will be performance scores, Modic incidence and size. RESULTS Ninety-five patients were enrolled and completed one-year follow-up with full data collected. Eighteen patients (18.9%) presented at least one of the 3 collected tissues with a positive culture and 4 patients (4.21%) presented only intervertebral disc positive tissue culture, which was considered disc infection, while other patients were considered contaminated. P. acnes was cultured in 2 of the 4 infected discs. NRS for low back pain and sciatica, and ODI improved from mean baseline 7, 6 and 45 to final follow-up 1.2, 2.2, and 16, respectively. Performance score improvements were not statistically related to presence of disc infection. Modic changes and increasing of size over time were not related to disc positive culture. No patients developed clinical discitis over time. CONCLUSIONS Based on a strict methodology of tissue culturing and contamination controls, subclinical infection rate of the intervertebral lumbar disc is at 4.2% and is overestimated in the current literature. Subclinical disc infection is not related to worse outcomes after lumbar microdiscectomy in patients with lumbar disc herniation, and worsening of Modic changes over time is not related to the presence of pathogens in the disc. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.