Posterior Cartilage Endplate Disruption on T1-weighted Magnetic Resonance Imaging as a Predictor for Postoperative Recurrence of Lumbar Disk Herniation

Study design: A retrospective cohort study. Objective: This study aimed to investigate the relationship between disruption of cartilage endplates and postoperative recurrence of lumber disk herniation (LDH) using preoperative T1-weighted magnetic resonance imaging (MRI-T1WI). Summary of Background Data: Recurrence of LDH is a relatively common complication after discectomy. Although several risk factors have been identified, their predictive capability remains limited. Previous histologic studies reported that cartilage endplates were present in 85% of patients with recurrent LDH. Methods: Patients with a single level of LDH who underwent open or microendoscopic discectomy were retrospectively reviewed. On the basis of preoperative sagittal MRI-T1WI, cartilage endplates were divided into anterior and posterior portions at the center of the disk and evaluated for discontinuity. Patient background characteristics, spinopelvic sagittal parameters, degrees of disk degeneration, and recurrence level were also evaluated. Results: A total of 100 patients were included in this study (mean age, 50.5 years old; 41% female). Symptomatic recurrence of LDH occurred in 15 patients (15%). There were no significant differences in patient background characteristics (age, 46.9 vs. 51.2 years old; %female, 60% vs. 38%; smoking, 33% vs. 41%; diabetes mellitus, 27% vs. 29%) or spinopelvic parameters (PI, 44.1 vs. 47.0 degrees; PT, 16.8 vs. 19.4 degrees; SS, 27.3 vs. 27.6 degrees; LL, 37.7 vs. 33.7 degrees). In the recurrence group, MRI-T1WI showed a higher rate of cartilage endplate disruption in the posterior portion than in the no-recurrence group (73% vs. 34%, P =0.01). A multivariate analysis demonstrated that the disruption of the posterior cartilage endplate remained an independent predictor of recurrence. Conclusions: Disruption in the posterior cartilage endplate on preoperative MRI-T1WI was closely associated with recurrence after LDH surgery. These results suggest that this MRI finding is a practical and useful predictor of LDH recurrence. Level of Evidence: Level III.