Summary
MRI is routinely used in the evaluation and management of patients with failed back surgery syndrome (FBSS). However, its value is unclear in the early detection of signs that can negatively affect the later course of surgical cases. The purpose of the present study is to describe the MR images of early postoperative MRI at 3 days in 30 unselected patients who underwent lumbar microdiscectomy, and to correlate the findings with follow up MRI at 8 weeks and with final outcome. The findings are correlated with literature data. Early postoperative MRI findings were consisting of pseudohernia in 24 patients (80%), annular rent in 23 patients (80%), and other non-specific postoperative findings. On the late MRI the pseudohernia persisted in 12 patients (50%), the annular rent in 4 patients (15%) and asymptomatic pseudo-spondylodiscitis was apparent in 3 patients (10%) as was a case of true spondylodiscitis. Therefore, early postoperative findings have limited value in the management of patients after surgery for lumbar disc herniation, since the images were not correlated with the immediate clinical course after surgery nor with the late radiological and clinical outcome. The evident imaging changes in the early postoperative period after lumbar disc surgery limit the accuracy of the interpretation of MRI examinations.
Similar content being viewed by others
References
Boden SD, Davis DO, Dina TS, Parker CP,et al (1992) Contrast-enhanced MR imaging performed after successful lumbar disc surgery: prospective study. Radiology 182: 59–64
Boden SD, Davis DO, Dina TS, Summer JL, Wiesel SW (1992) Postoperative discitis: distinguishing early MR imaging findings from normal postoperative disc space changes. Radiology 184: 765–771
Braun IF, Hoffman JC, Davis PC, Landman JA, Tindall GT (1985) Contrast enhancement in CT differentiation between recurrent disc herniation and postoperative scar: prospective study. AJR 145: 785–790
Bundschuh CV, Modic MT, Ross JS, Masaryk TJ, Bohlman H (1988) Epidural fibrosis and recurrent disc herniation in the lumbar spine: MR imaging assessment. AJR 150: 923–932
Burton CV, Kirkaldy-Willis WH, Yong-Hing F, Heithall KB (1981) Causes of failure of surgery on the lumbar spine. Clin Orthop 157: 191–199
Cavanagh S, Stevens J, Johnson JR (1993) High-resolution MRI in the investigation of recurrent pain after lumbar discectomy. J Bone Joint Surg 75B: 524–528
Cervellini P, Curri D, Volpin L, Bernardi L, Pinna V, Benedetti A (1988) Computed tomography of epidural fibrosis after discectomy: a comparison between symptomatic and asymptomatic patients. Neurosurgery 23: 710–713
Davis CH (1982) Extradural spinal cord and nerve root compression from benign lesions in the lumbar area. In: Youmans JR (ed) Neurosurgical surgery, 2nd Ed. Saunders, Philadelphia, pp 2535–2561
Deutsch AL, Howard M, Dawson EG, Goldstein TB, Mink JH, Zeegen EH, Delamarter RB (1993) Lumbar spine following successful surgical discectomy. Magnetic resonance imaging features and implications. Spine 18: 1054–1060
Fandiño J, Botana C, Viladrich A, Gomez-Bueno J (1993) Reoperation after lumbar disc surgery: results in 130 cases. Acta Neurochir (Wien) 123: 102–104
Firoozina H, Kircheff II, Rafii M, Golimbu G (1987) Lumbar spine after surgery: examination with intravenous contrast enhanced CT. Radiology 163: 221–226
Heilbronner R, Fankhauser H, Schnyder P, De Tribolet N (1991) Computed tomography of the postoperative intervertebral disc and lumbar spinal canal: serial long-term investigation in 19 patients after successful operation for lumbar disc herniation. Neurosurgery 29(1): 1–7
Hochhauser L, Kieffer SA, Cacayorin ED, Petro GR, Teller WF (1988) Recurrent postdiscectomy low back pain: MR-surgical correlation. AJR 151: 755–760
Hueftle MG, Modic MT, Ross JS, Masaryk TJ,et al (1988) Lumbar spine: postoperative MR imaging with Gd-DTPA. Radiology 169: 817–824
Kotilainen E, Alanen A, Erkintalo M, Helenius H, Valtonen S (1994) Postoperative hematomas after successful lumbar microdiscectomy or percutaneous nucleotomy: a magnetic resonance imaging study. Surg Neurol 41: 98–105
Kotilainen E, Alanen A, Erkintalo M, Valtonen S, Kormano M (1994) Magnetic resonance imaging changes and clinical outcome after microdiscectomy or nucleotomy for ruptured disc. Surg Neurol 41: 432–440
Modic MT, Masaryk TJ, Ross JS, Carter JR (1988) Imaging of degenerative disc disease. Radiology 168: 177–186
Montaldi S, Fankhauser H, Schnyder P, De Tribolet N (1988) Computed tomography of the post-operative intervertebral disc and lumbar spinal canal: investigation of twenty-five patients after successful operation for lumbar disc herniation. Neurosurgery 22(6): 1014–1022
Ross JS, Masaryk TJ, Modic MT, Bohlman H,et al (1987) Lumbar spine: postoperative assessment with surface-coil MR imaging. Radiology 164: 851–860
Ross JS, Masaryk TJ, Schrader M, Gentili A, Bohlman H, Modic MT (1990) MR imaging of the postoperative lumbar spine: assessment with gadopentate dimeglumine. AJNR 11: 771–776
Ruscalleda J (1992) Postoperative spine. Rivista di Neuroradiologia 5: 93–100
Spallone A, Martino V, Floris R (1993) The role of early postoperative CT-scan following surgery for herniated lumbar disc. Acta Neurochir (Wien) 123: 52–56
Tullberg T, Grane P, Rydberg J, Isacson J (1994) Comparison of contrast-enhanced computed tomography and gadolinium-enhanced magnetic resonance imaging one year after lumbar discectomy. Spine 19: 183–188
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Floris, R., Spallone, A., Aref, T.Y. et al. Early postoperative MRI findings following surgery for herniated lumbar disc. Acta neurochir 139, 169–175 (1997). https://doi.org/10.1007/BF01844746
Issue Date:
DOI: https://doi.org/10.1007/BF01844746