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Introduction: Degenerative changes of the cervical spine often cause disability and flight duty limitations among Finnish Air Force (FINAF) fighter pilots. We aimed to study the effect of +Gz exposure on degenerative changes in the cervical spine by comparing cervical MRIs of FINAF fighter pilots and controls., Methods: At baseline, the volunteer study population consisted of 56 20-year-old FINAF male fighter pilots (exposure group) and 56 21-year-old Army and Navy cadets (control group). Both groups underwent MRI of the cervical spine at the baseline and after 5 years. Degenerative changes evaluated using MRI included intervertebral disc (IVD) degeneration (Pfirrmann classification), disc herniations, uncovertebral arthrosis, Schmorl's nodes, Modic changes, spinal canal stenosis, kyphosis and scoliosis., Results: The degree of IVD degeneration in the whole cervical spine increased significantly in both populations with no between-group differences. The prevalence of disc herniations also tended to increase in both populations with no difference in the incidence over the follow-up. However, pilots proved to have more disc herniations at the baseline and at the follow-up. There were virtually no between-group differences in other assessed degenerative changes., Discussion: We found that IVD degeneration and the prevalence of disc herniations increased at a similar rate for fighter pilots and non-flying military students when all cervical levels were summed up. The lack of difference may be explained by the relatively low cumulative +Gz exposure during the first 5 years of a pilots' career., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Childhood brain tumor (BT) survivors have an increased risk of treatment-related late effects, which can reduce health-related quality of life and increase morbidity. This study aimed to investigate lumbar disc degeneration in magnetic resonance imaging (MRI) in adult survivors of radiotherapy-treated childhood BT compared to age and sex-matched population controls., Methods: In this cross-sectional comparative study, 127 survivors were identified from hospital registries. After a mean follow-up of 20.7 years (range 5-33.1), 67 survivors (mean age 28.4, range 16.2-43.5) were investigated with MRI and compared to 75 sex-matched population-based controls. Evaluated MRI phenotypes included Pfirrmann grading, , intervertebral disc protrusions, extrusions, and high-intensity-zone-lesions (HIZ). Groups were also compared for known risk factors of lumbar intervertebral disc (IVD) degeneration., Results: Childhood BT survivors had higher Pfirrmann grades than controls at all lumbar levels (all p < 0.001). Lumbar disc protrusions at L4-5 (p = 0.02) and extrusions at L3-4 (p = 0.04), L4-5 (p = 0.004), and L5-S1 (p = 0.01) were significantly more common in the BT group compared to the control. The survivor cohort also had significantly more HIZ-lesons than the controls (n=13 and n=1, p=0.003). Age at diagnosis was associated with lower degree of IVD degeneration (p < 0.01). Blood pressure correlated with IVD degeneration (P < 0.05)., Conclusions: Signs of early disc degeneration related to tumor treatment can be seen in the IVDs of survivors. Disc degeneration was more severe in children treated in adolescence., (© 2023. The Author(s).)

Background: Lumbar disc degeneration (LDD) is associated with low back pain (LBP). Although both insomnia and mental distress appear to influence the pain experience, their role in the association between LDD and LBP is uncertain. Our objective was to investigate the role of co-occurring insomnia and mental distress in the association between LDD and LBP-related disability., Methods: A total of 1080 individuals who had experienced LBP during the previous year underwent 1.5-T lumbar magnetic resonance imaging, responded to questionnaires, and participated in a clinical examination at the age of 47. Full data was available for 843 individuals. The presence of LBP and LBP-related disability (numerical rating scale, range 0-10) were assessed using a questionnaire. LDD was assessed by a Pfirrmann-based sum score (range 0-15, higher values indicating higher LDD). The role of insomnia (according to the five-item Athens Insomnia Scale) and mental distress (according to the Hopkins Symptom Check List-25) in the association between the LDD sum score and LBP-related disability was analyzed using linear regression with adjustments for sex, smoking, body mass index, education, leisure-time physical activity, occupational physical exposure, Modic changes, and disc herniations., Results: A positive association between LDD and LBP-related disability was observed among those with absence of both mental distress and insomnia (adjusted B = 0.132, 95% CI = 0.028-0.236, p = 0.013), and among those with either isolated mental distress (B = 0.345 CI = 0.039-0.650, p = 0.028) or isolated insomnia (B = 0.207, CI = 0.040-0.373, p = 0.015). However, among individuals with co-occurring insomnia and mental distress, the association was not significant (B = -0.093, CI = -0.346-0.161, p = 0.470)., Conclusions: LDD does not associate with LBP-related disability when insomnia and mental distress co-occur. This finding may be useful when planning treatment and rehabilitation that aim to reduce disability among individuals with LDD and LBP. Future prospective research is warranted., (© 2023. The Author(s).)

Low back pain is a very common symptom and the leading cause of disability throughout the world. Several degenerative imaging findings seen on magnetic resonance imaging are associated with low back pain but none of them is specific for the presence of low back pain as abnormal findings are prevalent among asymptomatic subjects as well. The purpose of this population-based study was to investigate if more specific magnetic resonance imaging predictors of low back pain could be found via texture analysis and machine learning. We used this methodology to classify T 2 -weighted magnetic resonance images from the Northern Finland Birth Cohort 1966 data to symptomatic and asymptomatic groups. Lumbar spine magnetic resonance imaging was performed using a fast spin-echo sequence at 1.5 T. Texture analysis pipeline consisting of textural feature extraction, principal component analysis, and logistic regression classifier was applied to the data to classify them into symptomatic (clinically relevant pain with frequency ≥30 days and intensity ≥6/10) and asymptomatic (frequency ≤7 days, intensity ≤3/10, and no previous pain episodes in the follow-up period) groups. Best classification results were observed applying texture analysis to the two lowest intervertebral discs (L4-L5 and L5-S1), with accuracy of 83%, specificity of 83%, sensitivity of 82%, negative predictive value of 94%, precision of 56%, and receiver operating characteristic area-under-curve of 0.91. To conclude, textural features from T 2 -weighted magnetic resonance images can be applied in low back pain classification., (© 2020 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals LLC on behalf of Orthopaedic Research Society.)

Purpose: Modic changes (MC) are associated with low back pain (LBP). Inflammation is considered as a key factor that triggers symptoms in especially type I MC, but so far of the potential inflammatory candidates only TNFα has been linked to MC. The objective of the study was to analyze a set of inflammatory mediators in human surgical disk samples and quantify their association with MC in the adjacent vertebral bodies., Methods: The study sample consisted of 51 intervertebral disk tissue specimens; 20 'No MC' disks, 19 'Type I MC' disks, and 12 'Type II MC' disks. mRNA expression of 46 cytokines was quantified from isolated RNA. Tissue samples were stained using hematoxylin and eosin, toluidine blue, Herovici, CD68 and CD163., Results: No significant differences were found in the amount of macrophages or presence of chondrocyte conglomerates between the MC groups. Of the multiple genes tested, statistically significant associations were observed for M-CSF1 (p = 0.028), RANKL (p = 0.035), RUNX1 (p = 0.032), and RUNX2 (p = 0.047) that were increased in 'Type II MC,' while OSCAR (p = 0.042) was increased in 'Type I MC' group compared to 'No MC.', Conclusions: Since these cytokines are related to differentiation and proliferation of osteoclasts, our data suggest that the stimulation of vertebral osteoclasts by factors secreted by disk tissue is involved in the pathophysiology of MC.

Study Design: A cross-sectional magnetic resonance imaging (MRI) study., Objective: We investigated the association among Modic changes, Schmorl's nodes, spondylolytic defects, high-intensity zone lesions, radial tears, herniations, and low back symptom severity., Summary of Background Data: Disc degeneration is associated with low back pain in early adulthood, but the associations between other MRI findings and low back pain are not well known., Methods: Questionnaire data and MRI scans (1.5-T) were available for 554 subjects derived from a birth cohort at 21 years of age. Data on low back pain and back-related functional limitations at 18, 19, and 21 years of age were used for clustering of subjects, using latent class analysis. We used logistic regression with adjustment for the degree of disc degeneration to evaluate the associations between specific imaging findings and low back symptom severity., Results: The prevalence of herniations was 20%, Schmorl's nodes 17%, radial tears 9.9%, high-intensity zone lesions 3.2%, spondylolytic defects 5.8%, and Modic changes 0.7%. Latent class analysis produced 5 clusters: "Always Painful" (n = 65) meant painful at all time points and "Recent Onset Pain" (n = 56) meant increasing symptom severity, whereas subjects in the "Moderately Painful" (n = 73), "Minor Pain" (n = 193), and "No Pain" (n = 167) clusters had fewer symptoms. Compared with the "No Pain" cluster, Schmorl's nodes were more likely to occur in the "Always Painful" cluster (P = 0.017) and herniations in the 3 most painful clusters (P < 0.001). Herniations were associated with low back symptom severity (odds ratio, 2.5; 95% confidence interval, 1.4-4.4). Schmorl's nodes and radial tears were associated with symptoms in crude analyses only, whereas high-intensity zone lesions and spondylolytic defects occurred in similar frequencies in all clusters., Conclusion: Herniations were most likely in the subjects with recent onset or persistent (3-yr period) low back symptoms, although they were also detected in subjects with no symptoms. The clinical relevance of herniations on MRI remains to be evaluated in the context of symptoms.

Study Design: A cross-sectional imaging study of young adults., Objective: To investigate the prevalence of disc degeneration (DD) and displacement, anular tears, and Modic changes in lumbar magnetic resonance imaging (MRI) among young adults., Summary of Background Data: Although low back pain in young adulthood is common, the prevalence of spinal MRI findings at this age remains virtually unknown., Methods: The study population was a subcohort of the Northern Finland Birth Cohort 1986. Subjects living within 100 km of Oulu (n = 874) were invited to participate in lumbar MRI at 20 to 22 years of age (mean: 21.2 years). Degree of DD, type of Modic changes, and presence of disc bulges, herniations, high intensity zone (HIZ) lesions, and radial tears at all lumbar levels were assessed., Results: Three hundred twenty-five women and 233 men (n = 558) attended the MR imaging. DD was significantly more frequent in men (54% vs. 42%, P = 0.005), as was multiple DD (21% vs. 14%, P = 0.036). The prevalences of disc bulges and radial tears were 25% and 9.1%, respectively, without gender differences. HIZ lesions were more common among women than men (8.6% vs. 4.3%, P = 0.046), whereas herniations were significantly more common among men (5.6% vs. 2.5%, P = 0.047). Only 2 disc extrusions were observed, one in each gender. All degenerative disc findings were more common at the L5-S1 level except HIZ lesions, which were most likely at L4-L5. The prevalence of the Modic changes was 1.4%, without gender difference, type I being more common than type II. Typically, Modic changes were located adjacent to a DD Grade 4 disc and at the 2 lowest levels., Conclusion: Almost half of young Finnish adult aged 21 years had at least one degenerated disc, and a quarter had a bulging disc. Modic changes and disc herniations were, however, relatively rare.

The value of apparent diffusion coefficient (ADC) measurements in intervertebral disc has been studied because ADC provides an estimate of free diffusion of unbound water and could be used as a quantitative tool to estimate degenerative changes. However, the challenging nature of diffusion imaging of spine and limited numbers of subjects in earlier studies has produced contradictory findings. We aimed to determine the relation between ADC and visual degenerative changes in lumbar intervertebral discs in a sufficiently large homogeneous study group. Lumbar spines of 228 volunteer middle-aged men were MR imaged at 1.5 T including anatomic and diffusion-weighted imaging. ADC values, T2 signal intensity and height, and width of the three lowest lumbar intervertebral discs were measured and disc degeneration visually graded. The calculated average ADC of 530 measured discs was 2.01 x 10(-3) mm(2)/s+/-0.29 (+/-S.D.). The reduction in ADC between visually normal and moderately degenerated discs was 4%. Severely degenerated discs showed 5% larger ADC values than normal discs, presumably due to free water in cracks and fissures of those discs. T2 signal intensity of the disc was significantly correlated with the ADC values, whereas other measured parameters did not show correlation. There was no evident difference in ADC between the studied anatomic lumbar levels. Because there is considerable overlap between ADC values of normal and degenerated discs, we conclude that ADC measurements of intervertebral discs, at least with current technology, have limited clinical value.

Objective: A decreased supply of nutrition to the intervertebral disc can lead to disc degeneration. Nutrient supply can be simulated in vivo by measuring gadolinium enhancement of the disc. We aimed to study the changes associated with disc degeneration that may have effect on the nutrition of the disc, i.e. lumbar artery narrowing, Modic changes, endplate defects, and apparent diffusion coefficient (ADC) in nucleus pulposus., Patients and Methods: Twenty male volunteers underwent a lumbar spine examination at 1.5 T for anatomical imaging, diffusion weighted imaging, magnetic resonance angiography, and for T1 relaxation time quantification of contrast enhancement of intervertebral disc., Results: Enhancement of the disc increased with degeneration. Disc space narrowing associated strongly with the enhancement (Pearson's correlation coefficient 0.46, P < 0.001). The enhancement rate in discs adjacent to Modic type 2 changes was 24%, adjacent to type 1/2 changes 58%, and 13% in the absence of Modic changes. Discs adjacent to endplate defects enhanced 32% compared to 10% of normal endplates. Lumbar artery narrowing or ADC in the disc were not associated with the enhancement., Conclusion: Increased enhancement of a degenerated disc is associated mostly with disc space narrowing and with the presence of degenerative endplate changes and endplate defects.

Objective: This paper aims to evaluate the presence of endplate sclerosis in different types of Modic changes and to assess the capability of MRI in detecting endplate sclerosis within these changes., Materials and Methods: The lumbar spines (L3-S1) of 70 patients were retrospectively reviewed to determine Modic changes and disc degeneration from MRI and endplate sclerosis from CT. T1- and T2-weighted signal intensity and Hounsfield unit (HU) measurements of type I and II Modic changes were recorded and the association of both Modic types I and II with endplate sclerosis was analyzed with a Mann-Whitney test., Results: Altogether 82 Modic changes in 36 subjects were recorded: 13% were type I, 12% mixed type I/II, 65% type II, 9% mixed type II/III, and 1% type III. Thirty-eight percent of the endplates with Modic changes had sclerosis in CT. Of specific Modic types, mixed I/II and II/III associated significantly with endplate sclerosis. Endplate sclerosis was not detected in MRI in a quantitative analysis., Conclusion: Endplate sclerosis exists in all types of Modic changes, especially in mixed Modic types, and not only in type III changes, as previously assumed. Endplate sclerosis was not detected in MRI, which may depend on the amount of mineralization of the bone marrow.

Background: Modic changes are bone marrow lesions visible in magnetic resonance imaging (MRI), and they are assumed to be associated with symptomatic intervertebral disc disease, especially changes located at L5-S1. Only limited information exists about the determinants of Modic changes. The objective of this study was to evaluate the determinants of vertebral endplate (Modic) changes, and whether they are similar for Modic changes and severe disc degeneration focusing on L5-S1 level., Methods: 228 middle-aged male workers (159 train engineers and 69 sedentary factory workers) from northern Finland underwent sagittal T1- and T2-weighted MRI. Modic changes and disc degeneration were analyzed from the scans. The participants responded to a questionnaire including items of occupational history and lifestyle factors. Logistic regression analysis was used to evaluate the associations between selected determinants (age, lifetime exercise, weight-related factors, fat percentage, smoking, alcohol use, lifetime whole-body vibration) and Modic type I and II changes, and severe disc degeneration (= grade V on Pfirrmann's classification)., Results: The prevalences of the Modic changes and severe disc degeneration were similar in the occupational groups. Age was significantly associated with all degenerative changes. In the age-adjusted analyses, only weight-related determinants (BMI, waist circumference) were associated with type II changes. Exposure to whole-body vibration, besides age, was the only significant determinant for severe disc degeneration. In the multivariate model, BMI was associated with type II changes at L5-S1 (OR 2.75 per one SD = 3 unit increment in BMI), and vibration exposure with severe disc degeneration at L5-S1 (OR 1.08 per one SD = 11-year increment in vibration exposure)., Conclusion: Besides age, weight-related factors seem important in the pathogenesis of Modic changes, whereas whole-body vibration was the only significant determinant of severe disc degeneration.

Study Design: A randomized controlled trial., Objectives: To evaluate the long-term efficacy of infliximab, a monoclonal antibody against tumor necrosis factor alpha (TNF-alpha), in patients with acute/subacute sciatica secondary to herniated disc., Summary of Background Data: The results of experimental studies and our open-label trial support the use of infliximab in sciatica. Here we report the 1-year results of a randomized controlled trial (FIRST II, Finnish Infliximab Related STudy) evaluating the efficacy and safety of a single infusion of infliximab for sciatic pain., Methods: Inclusion criteria were unilateral sciatic pain with a disc herniation concordant with the symptoms and signs of radicular pain. Patients had to be candidates for discectomy. Criteria for discectomy included (in addition to a symptomatic disc herniation on MRI) neural entrapment (straight leg raising [SLR] < or =60 degrees ) with either a short-term (2-4 weeks) severe or long-term (4-12 weeks) moderate leg pain. Forty patients were allocated to a single intravenous infusion of either infliximab 5 mg/kg or placebo. Differences in the clinical examination parameters (straight leg raise [SLR], muscle strength, sensory defects, tendon reflexes), patient-reported symptoms (leg and back pain using a visual analog scale [VAS], Oswestry disability, quality-of-life [RAND-36]), sick leaves, number of discectomies, and adverse effects between the two treatment groups over the 1-year follow-up were compared using Mann-Whitney U test or Student's t test, repeated-measures analysis, or Cox proportional hazards model. Logistic regression was used to assess the predictors of good response., Results: Sixty-seven percent of patients in the infliximab group reported no pain at 52 weeks compared with 63% in the control group (P = 0.72). Similar efficacy was observed between treatment groups for other outcomes. Eight patients in each group required surgery. Three nonserious adverse reactions were encountered in the infliximab group. The response (irrespective of the treatment) was significantly better with shorter symptom duration and less SLR restriction at baseline. Patients in the infliximab group appeared to especially benefit in cases of a L4-L5 (or L3-L4) herniation and if a Modic change was colocalized at the symptomatic level., Conclusions: Although the long-term results of this randomized trial do not support the use of infliximab compared with placebo for lumbar radicular pain in patients with disc herniation-induced sciatica, further study in a subgroup of patients with L4-L5 or L3-L4 herniations, especially in the presence of Modic changes, appears to be warranted.

Study Design: Randomized, controlled study., Objective: To evaluate the effect of infliximab on herniated nucleus pulposus (HNP) resorption., Summary of Background Data: Although the effects of tumor necrosis factor alpha (TNF-alpha) on HNP resorption are not fully understood, TNF-alpha appears to be an essential mediator in HNP resorption., Methods: As part of a substudy of the FIRST II study, magnetic resonance images (MRIs) were obtained from 21 patients who were candidates for discectomy at weeks 0, 2, 12, and 26 after receiving a single infusion of either 5 mg/kg infliximab (11 patients) or placebo (10 patients). The volume (mm3) of HNP, thickness (mm) and extent (%) of rim enhancement, and presence of nerve root edema were assessed., Results: HNP volume decreased significantly from baseline to 6 months in both treatment groups (P < 0.01), with no difference noted between the infliximab and placebo groups. By week 2, rim enhancement thickness increased significantly in the infliximab group compared with the placebo group (P = 0.003). Two patients in each group required back surgery before the 6-month assessment., Conclusions: Infliximab did not appear to interfere with disc herniation resorption over a 6-month period.

Study Design: A longitudinal follow-up of Modic changes on magnetic resonance imaging (MRI)., Objectives: To assess the prevalence and natural course Modic changes over a 3-year follow-up period., Summary of Background Data: Modic changes are bone marrow and endplate lesions visible on MRI. To the authors' knowledge, no follow-up studies on their natural course have been published., Methods: The study population consisted of 60 unoperated sciatica patients 23 to 76 years of age. Baseline and 3-year lumbar MR images from L1-L2 through L5-S1 were analyzed independently by 2 radiologists and a consensus reading was performed., Results: At baseline, the prevalence of Modic changes was 23%. Seven discs had mixed Type I/II, and 63 Type II change. Changes typically occurred at L4-L5 and L5-S1, and associated positively with age (P = 0.009). Ten of 70 discs (14%) with Modic changes at baseline displayed another type at 3 years. Furthermore, the nonconverted changes increased significantly in size. The incidence of new Modic changes during the follow-up was 6% (13 of 230)., Conclusions: Modic changes are common MRI findings in patients with degenerative lumbar disc disease. We found evidence that Modic Type II changes may be less stable than previously assumed.

Study Design: A follow-up of disc herniation (herniated nucleus pulposus [HNP]) resorption on magnetic resonance imaging (MRI)., Objective: To assess the determinants of resorption of HNP., Summary of Background Data: Neovascularization in the outermost areas of HNP, presenting as an enhancing rim in gadolinium diethylenetriamine pentaacetic acid MR images, is thought to be a major determinant of spontaneous resorption of HNP., Methods: Patients with HNP-induced sciatica at baseline were rescanned at 2 months (N = 74) and after 12 months (N = 53). The volume of HNP (mm), thickness (mm) and extent (%) of enhancement, and the degree of HNP migration (Komori classification) were analyzed. Repeated measures analysis of covariance was used in statistical analysis., Results: Significant resorption of HNP occurred from baseline to 2 months, although the resorption rate was more pronounced over the whole 1-year follow-up. Higher baseline scores of rim enhancement thickness, higher degree of HNP displacement in the Komori classification, and age category 41-50 years were associated with a higher resorption rate. Thickness of rim enhancement was a stronger determinant of spontaneous resorption than extent of rim enhancement. Clinical symptom alleviation occurs concordantly with a faster resorption rate., Conclusions: MRI is a useful prognostic tool for identifying patients with HNP-induced sciatica with a benign natural course.

Study Design: A randomized controlled trial., Objectives: To evaluate the efficacy of infliximab, a monoclonal antibody against tumor necrosis factor (TNF)-alpha in a randomized controlled setting., Summary of Background Data: Recently, we obtained encouraging results in an open-label study of infliximab in patients with disc herniation-induced sciatica. Furthermore, the results of experimental studies support the use of infliximab in sciatica. Therefore, we initiated a randomized, controlled trial (FIRST II, Finnish Infliximab Related STudy) to confirm the efficacy of a single infusion of infliximab for sciatic pain., Methods: Inclusion criteria were unilateral moderate to severe sciatic pain with an MRI-confirmed disc herniation concordant with the symptoms and signs of radicular pain. Patients had to be candidates for discectomy, as evaluated by an independent orthopedic surgeon. Forty patients were allocated to a single intravenous infusion of either infliximab 5 mg/kg or placebo. Assessments at baseline and various time points included clinical examination with measurement of straight leg raising restriction; questionnaires related to subjective symptoms (leg and back pain by 100-mm visual analog scale, Oswestry disability); sick leaves; number of discectomies; and adverse effects possibly related to treatment. The primary endpoint was a reduction in leg pain from baseline to 12 weeks, which was analyzed using a Mann-Whitney U test and repeated-measures analysis., Results: A significant reduction in leg pain was observed in both groups, with no significant difference between treatment regimens. Similar efficacy was observed between treatment groups for secondary endpoints. Seven patients in each group required surgery. No adverse effects related to treatment were encountered., Conclusions: The results of this randomized trial do not support the use of infliximab for lumbar radicular pain in patients with disc herniation-induced sciatica.

Study Design: An open-label trial., Objectives: To test the long-term efficacy of infliximab, a monoclonal antibody against tumor necrosis factor-alpha (TNF-alpha), in disc herniation-induced sciatica., Summary of Background Data: Our recent trial indicated that a single infusion of 3 mg/weight-kg of infliximab produced a rapid curative effect in disc herniation-induced sciatica. Here, we describe the 1-year effect of a 3 mg/kg of infliximab in these 10 patients and our experience with a lower dose of 1 mg/kg of infliximab for the same indication in 2 additional patients., Methods: Patients with severe sciatica were treated with a single infusion of infliximab, 3 mg/weight-kg in 10 patients and 1 mg/kg in 2 patients, intravenously over 2 hours. The outcomes (leg and back pain on a 100-mm visual scale, Oswestry disability, clinical signs) were assessed at 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year after the infusion. The outcomes with 3 mg/kg of infliximab were compared to 62 patients who received periradicular saline for sciatica in a previous trial. The resorption rate of disc herniations from baseline to 1 year was compared between infliximab and control groups., Results: The response to 1 mg/kg of infliximab for leg pain was good only in 1 of the 2 patients treated, whereas the response to 3 mg/kg of infliximab for leg pain was sustained in most patients over the 1-year follow-up. The 1-year response significantly favored 3 mg/kg of infliximab over periradicular saline in leg pain (P = 0.005) and disability (P = 0.003). Neurologic abnormalities normalized more comprehensively in the infliximab group (P = 0.001). Reduction in disc herniation volume did not differ between the infliximab-treated patients and controls., Conclusions: The results showed that the beneficial effect of a single infusion of 3 mg/kg of infliximab for herniation-induced sciatica is sustained in most patients over a 1-year follow-up period. Furthermore, infliximab does not seem to interfere with the spontaneous resorption of disc herniations.