Prognostic Value of Michigan State University (MSU) Classification for Lumbar Disc Herniation: Is It Suitable for Surgical Selection?

Lumbar disc herniation (LDH) is the most common cause of radiculopathy; patients with severe pain refractory to conservative management or neurological deficits are candidates to surgical procedures. Michigan State University (MSU) classification is a radiological codification considering both the size of the LDH and its medial to lateral location on the axial plane. The purpose of this retrospective study is to identify which kind of LDH, according to the MSU scheme, is more likely to cause a motor deficit. We performed a retrospective analysis on data obtained from 114 patients treated with 117 lumbar microdiscectomies after failure of non-operative care. All patients underwent neurological and functional evaluation before and after surgery according to the following: Oswestry Disability Index, visual analog scale, and Japanese Orthopaedic Association back pain evaluation questionnaire. Magnetic resonance imaging proved that disc herniation was classified according to the MSU scheme and was correlated with motor disturbances expressed according to Medical Research Council grade. Statistical analysis showed a significant correlation between the lateral location of disc herniation (preforaminal and extraforaminal LDH, respectively MSU B and MSU C) and the grade of muscle weakness, given that the LDH in these locations poorly responded to medical therapy and was at higher risk for motor deficit onset; no significant correlation with the size was observed. 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.