Clinical Significance of Protrusion Edge Enhancement Using Contrast-Enhanced Magnetic Resonance Imaging in The Conservative Treatment of Giant Lumbar Disc Herniation: A Prospective Observational Study

Abstract Background: Contrast-enhanced lumbar spine magnetic resonance imaging (MRI) was used to predict the efficacy of conservative treatment of giant lumbar disc herniation.Methods: From June 2017 to June 2019, 30 patients with giant lumbar disc herniation with positive and negative bull’s eye signs on contrast-enhanced lumbar spine MRI were assessed to measure differences in the rate of intervertebral disc herniation, rate of protrusion absorption, treatment effect, protrusion rate, and curative effect according to the lumbar Japanese Orthopedic Association (JOA) score before and after treatment.Results: Thirty patients with positive and negative bull’s eye signs (36 men and 24 women) aged 19 to 58 years (mean, 36.37 ± 9.56 years) were included. All patients were followed up for more than 1 year, and at least one MRI review was conducted within 1 year of treatment. The results of the first and final MRI examinations were compared. The protrusion rate was 82.16% ± 14.58% before treatment and 32.20% ± 30.80% after treatment, and the absorptivity of the protrusion was 59.48% ± 38.62%. There was no statistically significant difference in the general data before treatment between the positive and negative groups (P > 0.05). After treatment, the protrusion rate in the positive and negative bull’s eye sign groups was 14.41% ± 14.37% and 49.99% ± 32.70%, respectively (P < 0.05). The absorptivity in the positive and negative bull’s eye sign groups was 83.09% ± 15.54% and 35.87% ± 40.49%, respectively (P 0.05); however, there was a statistically significant difference in the JOA score between the two groups at 3 months (P < 0.05) and 1 year (P < 0.05) after treatment.Conclusions: Conservative treatment of giant lumbar disc herniation has a satisfactory clinical effect. Contrast-enhanced MRI can be used to predict the resorption of giant lumbar disc herniation. Protrusion resorption is more likely to occur in patients with than without a bull’s eye sign.Trial registration: Chinese Clinical Trial Registry (No. ChiCTR1900022377). Retrospectively registered 08 April 2019.