Comparative analysis of the intervertebral disc signal and annulus changes between immediate and 1-year postoperative MRI after transforaminal endoscopic lumbar discectomy and annuloplasty

  • Akaworn Mahatthanatrakul
  • Vit Kotheeranurak
  • Guang-Xun Lin
  • Jung-Woo Hur
  • Ho Jung Chung
  • Jin-Sung KimEmail author
Spinal Neuroradiology



Postoperative magnetic resonance imaging (MRI) after microdiscectomy for lumbar disc herniation frequently shows spinal canal compression by the remaining annulus, which gradually decreases over time. Transforaminal endoscopic lumbar discectomy (TELD) can remove the herniation with minimal trauma to surrounding soft tissue. We aim to identify this remodeling of annulus fibrosus and the change of disc signal after TELD.


We reviewed patients who underwent TELD. Clinical data obtained were Oswestry disability index (ODI) and visual analog scale (VAS) for back and leg pain. Residual mass signal and disc protrusion size were measured in postoperative MRI.


Thirty-one patients were reviewed. The mean age was 38.3 ± 14.4 years (range 18 to 76 years). ODI was 18.2% at the first follow-up and 12.7% at the last follow-up (p = 0.009). VAS for back and leg pain were 2.0 and 1.0 without significant change during follow-up. Disc protrusion size was reduced by 67.7% at the 1-year follow-up (p < 0.001). The residual mass signals at postoperative day 1 were high in 12 cases, intermediate in 18 cases, and low in1 case. The signal intensity was correlated with the percentage of disc protrusion reduction (p = 0.048). The percentage of disc protrusion reduction correlated with the last follow-up ODI (p = 0.018).


One year after TELD, annulus remodeling was observed with an average of 67.7% of size reduction. The high signal intensity of residual mass at day 1 correlated with disc protrusion reduction at follow-up MRI. The percentage of disc protrusion reduction associated with the ODI at the final follow-up.


Transforaminal endoscopic lumbar discectomy Annuloplasty Magnetic resonance imaging Annulus fibrosus remodeling Intervertebral disc signal 



No funding was received for this study.

Compliance with ethical standards

Conflict of interest

J-SK consults for RIWOspine, GmbH and Elliquence, LLC.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Akaworn Mahatthanatrakul
    • 1
  • Vit Kotheeranurak
    • 2
  • Guang-Xun Lin
    • 3
  • Jung-Woo Hur
    • 3
  • Ho Jung Chung
    • 3
  • Jin-Sung Kim
    • 3
    Email author
  1. 1.Department of OrthopaedicsNaresuan University HospitalPhitsanulokThailand
  2. 2.Department of OrthopaedicsQueen Savang Vadhana Memorial HospitalChonburiThailand
  3. 3.Spine Center, Department of Neurosurgery, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulSouth Korea

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