Histopathologic degenerative score as a predictor of minimal clinically important difference in pain and functionality following surgical treatment for disc herniation

Hakija Bečulić; Emir Begagić; Sabina Šegalo; Fatima Juković-Bihorac; Emsel Papić; Ragib Pugonja; Amina Džidić-Krivić; Adem Nuhović; Goran Lakičević; Semir Vranić; Mirza Pojskić

doi:10.17305/bb.2024.10877

Authors

Hakija Bečulić Department of Neurosurgery, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina; Department of Anatomy, School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina
Emir Begagić Department of General Medicine, School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina https://orcid.org/0000-0002-3988-8911
Sabina Šegalo Department of Laboratory Technologies, Faculty of Health Studies, University of Sarajevo, Sarajevo, Bosnia and Herzegovina https://orcid.org/0000-0002-9280-3278
Fatima Juković-Bihorac Department of Pathology, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
Emsel Papić Department of Laboratory Technologies, Faculty of Health Studies, University of Sarajevo, Sarajevo, Bosnia and Herzegovina https://orcid.org/0009-0003-7251-2750
Ragib Pugonja Department of Anatomy, School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina
Amina Džidić-Krivić Department of Neurology, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
Adem Nuhović Department of General Medicine, School of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
Goran Lakičević Department of Neurosurgery, University Hospital Mostar, Mostar, Bosnia and Herzegovina
Semir Vranić College of Medicine, QU Health, Qatar University, Doha, Qatar https://orcid.org/0000-0001-9743-7265
Mirza Pojskić Department of Neurosurgery, University Hospital Marburg, Marburg, Germany https://orcid.org/0000-0002-6123-5589

DOI:

https://doi.org/10.17305/bb.2024.10877

Keywords:

Degenerative disc disease, histopathology, intervertebral disc displacement, pain measurement, treatment outcome

Abstract

Lumbar disc herniation (LDH) often results in significant pain and disability, and histopathologic evaluation of intervertebral discs offers critical insights into treatment outcomes. This prospective observational study explores histopathologic (HP) changes in intervertebral discs (IVD) and their association with clinical outcomes following surgical treatment for lumbar disc herniation (LDH). A cohort of 141 patients undergoing magnetic resonance imaging (MRI)-confirmed LDH surgery underwent HP evaluation using a semi-quantitative Histopathologic Degeneration Score (HDS). Preoperatively and at a six-month follow-up, comprehensive clinical assessment included the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS), with a minimal clinically important difference (MCID) calculated from ODI and VAS. Results indicated significant associations between higher HDS and adverse clinical outcomes, including persistent pain and greater disability post-surgery. Specifically, HDS ≥ 7 was predictive (OR = 6.25, 95%CI: 2.56-15.23) of disability outcomes measured with MCID-ODI (AUC: 0.692, 95%CI: 0.609-0.767, P < 0.001), and HDS ≥ 8 was predictive (OR = 1.72, 95%CI: 1.04-2.77) of persistent pain measured with MCID-VAS (AUC: 0.628, 95%CI: 0.598-0.737, P = 0.008), highlighting the diagnostic potential of HDS in assessing postoperative recovery. This study underscores the potential of HP evaluation using HDS to provide valuable insights into disease progression and outcomes in LDH patients, complementing conventional radiologic methods. The findings support the application of personalized treatment strategies based on HP findings while acknowledging challenges in interpretation and clinical implementation.