Michigan State University Classification for Lumbar Disc Herniation [Neurosurgery Wiki]

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====== Michigan State University Classification for Lumbar Disc Herniation ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/14UrQ4NgJAsKm8T-Mi23Vh-F--tOgj3Ah9iX-7BoPPiVi8GYdJ/?limit=15&utm_campaign=pubmed-2&fc=20230527152332}}

Research shows good [[reliability]] in the Michigan State University Classification for [[Lumbar Disc Herniation]] among spine surgeons, as well as very good when reclassifying the [[intraobserver]]; having a sagittal MRI slice to classify them would be very useful, but more research is needed to give a prognostic value to the location and size of the hernia and its relation with the surgical indication
((Cristiani-Winer M, Ortiz P, Orosco-Falcone D, Guimbard-Pérez J, Carabajal J, Eluani M. ¿Es confiable la clasificación de la hernia de disco lumbar de la Universidad Estatal de Míchigan entre cirujanos de columna? [Is the Michigan State University lumbar disc herniation classification reliable among spine surgeons?]. Acta Ortop Mex. 2022 Mar-Apr;36(2):104-109. Spanish. PMID: 36481551.)).
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Beyond standardization of radiologic description, MSU classification proved to be useful in the definition of prognosis and possibly in the selection of surgical candidates. However, these data should be confirmed by prospective studies on a larger sample of patients, also including those underway for conservative treatment
((d'Ercole M, Innocenzi G, Ricciardi F, Bistazzoni S. Prognostic Value of Michigan State University (MSU) Classification for Lumbar Disc Herniation: Is It Suitable for Surgical Selection? Int J Spine Surg. 2021 Jun;15(3):466-470. doi: 10.14444/8068. Epub 2021 May 7. PMID: 33963037; PMCID: PMC8176838.)).


{{::michigan_state_university_classification_for_lumbar_disc_herniation.jpg?500|}}

It simply classifies herniation size as 1-2-3 and location as A-B-C, with inter-examiner reliability of 98%. A second prospective series of 100 discectomies was performed between 2000 and 2002, based on the new criteria, to validate this classification scheme. All patients with size-1 lesions were electively excluded from surgical consideration in our study. The Oswestry Disability Index from both series was better than most published outcome norms for lumbar microdiscectomy. The two series reported 96 and 90% good to excellent outcomes, respectively, at 1 year, and 84 and 80% at 5 years. The most frequent types of herniation selected for surgery in each series were types 2-B and 2-AB, suggesting the combined importance of both size and location. The MSU Classification is a simple and reliable method to objectively measure herniated lumbar disc. When used in correlation with appropriate clinical findings, the MSU Classification can provide objective criteria for surgery that may lead to a higher percentage of good to excellent outcomes
((Mysliwiec LW, Cholewicki J, Winkelpleck MD, Eis GP. MSU classification for herniated lumbar discs on MRI: toward developing objective criteria for surgical selection. Eur Spine J. 2010 Jul;19(7):1087-93. doi: 10.1007/s00586-009-1274-4. Epub 2010 Jan 19. PMID: 20084410; PMCID: PMC2900017.)).
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Findings demonstrate moderate homogeneity of ratings given by residents; however, test-retest results proved the ratings to be consistent
((Kaliya-Perumal AK, Luo CA, Yeh YC, Tsai YF, Chen MJ, Tsai TT. RELIABILITY OF THE MICHIGAN STATE UNIVERSITY (MSU) CLASSIFICATION OF LUMBAR DISC HERNIATION. Acta Ortop Bras. 2018;26(6):411-414. doi: 10.1590/1413-785220182606201444. PMID: 30774517; PMCID: PMC6362681.))
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Based on findings it seems that MSU classification can be used in patients' selection to achieve the best treatment outcome after intradiscal ozone injection among patients with lumbar disc herniation
((Hosseini B, Taheri M, Sheibani K. Comparing the results of intradiscal ozone injection to treat different types of intervertebral disc herniation based on MSU classification. Interv Neuroradiol. 2019 Feb;25(1):111-116. doi: 10.1177/1591019918800458. Epub 2018 Sep 18. PMID: 30227808; PMCID: PMC6378534.)).

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Beyond [[standardization]] of radiologic description, MSU [[classification]] proved to be useful in definition of prognosis and possibly in selection of surgical candidates. However, these data should be confirmed by prospective studies on a larger sample of patients, also including those under way for conservative treatment
((d'Ercole M, Innocenzi G, Ricciardi F, Bistazzoni S. Prognostic Value of Michigan State University (MSU) Classification for Lumbar Disc Herniation: Is It Suitable for Surgical Selection? Int J Spine Surg. 2021 Jun;15(3):466-470. doi: 10.14444/8068. Epub 2021 May 7. PMID: 33963037; PMCID: PMC8176838.))
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Between March 2012 and September 2018, a total of 441 segments from 394 patients with LDH were included in the study. LDH was classified according to the Michigan State University (MSU) classification, in which the degree of LDH is divided into 3 levels (expressed as 1, 2, and 3) and the location of LDH is divided into 4 zones (described as A, AB, B, and C). Bilateral FJOA was graded from 0 to 3 using the criteria introduced by Weishaupt et al., and bilateral facet orientations were measured on axial MRI slices. A mixed-effects ordinal logistic regression model was utilized to determine the potential factors that may be associated with FJOA, including sex, age, body mass index (BMI), segment, facet orientation and tropism, and the degree and location of LDH.

Results: In general, the prevalence of FJOA (grade ≥ 2) was 66.2% in LDH segments. For both the left and right sides, the degree of LDH was associated with the severity of FJOA (p < 0.01). Age and BMI were also associated with the severity of left and right FJOA (p = 0.002 and p < 0.001 for age, p < 0.001 and p = 0.003 for BMI, respectively), while segment, facet orientation, and facet tropism were not (p > 0.05 for all). Notably, MSU-B LDH was associated with greater odds of having more severe FJOA on the herniation side (left: p < 0.001, odds ratio (OR) = 2.714, 95% confidence interval (CI) = 1.583~4.650; right: p = 0.003, OR = 2.615, 95% CI = 1.405~4.870). However, other locations of LDH were not associated with the severity of FJOA (p > 0.05 for all).

Conclusions: Both the degree of LDH and MSU-B LDH are associated with the severity of FJOA. The association between LDH and FJOA highlights the complexity of the etiology of FJOA
((Zhu K, Su Q, Chen T, Zhang J, Yang M, Pan J, Wan W, Zhang A, Tan J. Association between lumbar disc herniation and facet joint osteoarthritis. BMC Musculoskelet Disord. 2020 Jan 29;21(1):56. doi: 10.1186/s12891-020-3070-6. PMID: 31996194; PMCID: PMC6990568.))
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the new combined technique of ELND and PLDD using a Ho:YAG laser is a reliable method in patients with MSU classification 3AB herniated discs, with an acceptable success rate and a low complication rate within 12 months after treatment. We think that randomized controlled studies are required for this method to be included in treatment algorithms
((Beyaz SG, Ülgen AM, Kaya B, İnanmaz ME, Ergönenç T, Eman A, Doğan B. A Novel Combination Technique: Three Points of Epiduroscopic Laser Neural Decompression and Percutaneous Laser Disc Decompression With the Ho:YAG Laser in an MSU Classification 3AB Herniated Disc. Pain Pract. 2020 Jun;20(5):501-509. doi: 10.1111/papr.12878. Epub 2020 Mar 9. PMID: 32065508.)).

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OCN is an effective treatment for radicular pain due to disk herniation. Pain duration (< 1 year), MSU disk herniation type (1A, 1B, 1C, 2A, and 2B), disk degeneration grade 2, and absence of foraminal stenosis are all associated with the successful outcome and should be carefully evaluated before OCN
((Leoni MLG, Caruso A, Micheli F. Factors Predicting Successful Outcome for Ozone Chemonucleolysis in Lumbar Disk Herniation. Pain Pract. 2021 Jul;21(6):653-661. doi: 10.1111/papr.13006. Epub 2021 Mar 26. PMID: 33721371.)).