ArticleFrontiers in medicine2026
Rim enhancement on MRI predicts long-term outcomes in extruded/migrated lumbar disc herniation managed with an inflammation-preserving protocol: a 6-year prospective cohort study.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: Based on the theory of resorption of herniated nucleus pulposus (HNP), this study aimed to investigate the long-term clinical and radiological outcomes of patients with extruded/migrated LDH treated with an inflammation-preserving protocol, and to evaluate the prognostic value of the rim enhancement sign in predicting HNP resorption and clinical efficacy over 6 years. Methods: A prospective single-arm cohort study was designed, enrolling 66 patients with extruded or migrated LDH treated at our hospital between January 2016 and September 2019, with follow-up extending to 6 years. All patients received standardized conservative treatment combined with an inflammation-preserving protocol centered on avoidance of non-steroidal anti-inflammatory drugs. Based on the presence of a high-signal rim enhancement of the herniated nucleus pulposus on pre-treatment lumbar contrast-enhanced MRI, patients were divided into a Rim Enhancement Positive group and a Rim Enhancement Negative control group. The herniation volume was dynamically measured via MRI, and the resorption rate was calculated. Clinical outcomes were comprehensively evaluated using baseline data, Japanese Orthopedic Association (JOA) scores, Oswestry Disability Index (ODI), and the positive angle of the Straight Leg Raising Test (SLRT). Results: All 66 patients completed the 6-year follow-up. The mean age was 35.91 ± 10.07 years, with 48 males and 18 females. No statistically significant differences were found in baseline characteristics such as age, gender, and disease duration between the two groups ( Conclusion: In patients with extruded and migrated LDH managed with an inflammation-preserving protocol, favorable long-term outcomes were observed, with rim enhancement serving as a useful prognostic indicator for nucleus pulposus resorption and symptomatic improvement. However, due to the single-arm design, the specific contribution of inflammation preservation requires validation in future controlled trials.
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