Abstract
Magnetic resonance imaging (MRI) has become a principal modality in the evaluation of the postoperative lumbar spine. Gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA) can often facilitate differentiation of scar from recurrent disc herniation according to established criteria. Scar has been believed to enhance predictably. We reviewed the contrast-enhanced MR scans of 44 patients who were examined for recurrent back pain following disc surgery and attempted to assess the enhancement characteristics of scar as a function of the time interval between initial surgery and the imaging study. In 44 patients, scar was believed to be present at 32 of 49 disc levels. The degree of enhancement was related to the postoperative interval; those studies performed no later than 9 months after surgery tended to exhibit the greatest degree of enhancement. Surgical confirmation of these MRI findings was available in 12 patients.
In patients examined long after surgery, scar enhancement may be less intense than in those examined shortly after surgery, or even nonexistent. This temporal factor should be considered when using contrast material to differentiate scar from recurrent disc herniation in postoperative examinations of the lumbar spine.
Similar content being viewed by others
References
Breger RK, Williams AL, Daniels DL, Czervionke LF, Mark LP, Haughton VM, Papke RA, Coffer M (1989) Contrast enhancement in spinal MR imaging. AJR 153:387
Bundschuh CV, Modic MT, Ross JS, Masaryk TJ, Bohlman H (1988) Epidural fibrosis and recurrent disk herniation in the lumbar spine: MR imaging assessment. AJNR 9:169
Elster AD, DiPersio DA (1990) Cranial postoperative site: assessment with contrast-enhanced MR imaging. Radiology 174:93
Finnegan WJ, Fenlin JM, Marvel JP, Nardini RJ, Rothman RH (1979) Results of surgical intervention in the symptomatic multiply-operated back patient. J Bone Joint Surg [Am] 61:1077
Hochhauser I., Kieffer SA, Cacayorin ED, Petro GR, Teller WF (1988) Recurrent postdiskectomy low back pain: MR-surgical correlation. AJNR 9:769
Hueftle MG, Modic MT, Ross JS, Masaryk TJ, Carter JR, Wilber RG, et al. (1988) Lumbar spine: postoperative MR imaging with Gd-DTPA. Radiology 167:817
Law JD, Lehman RW, Kirsch WM (1978) Reoperation after lumbar intervertebral disc surgery. J Neurosurg 48:259
Ross JS, Masaryk TJ, Modic MT, Bohlman H, Delamater R, Wilber G (1987) Lumbar spine: postoperative assessment with surface coil MR imaging. Radiology 164:851
Ross JS, Modic MT, Masaryk TJ, Hueftle MG (1988) The postoperative lumbar spine. Semin Roentgenol 13:125
Ross JS, Delamater R, Hueftle MG, Masaryk TJ, Aikawa M, Carter J, VanDyke C, Modic MT (1989) Gadolinium-DTPAenhanced MR imaging of the postoperative lumbar spine: time course and mechanism of enhancement. AJR 152:825
Ross JS, Blaser S, Masaryk TJ, Emory SE, Bolesta M, Carter J, et al. (1989) Gd-DTPA enhancement of posterior epidural scar: an experimental model. AJNR 10:1083
Ross JS, Modic MT, Masaryk TJ, Schrader M, Gentill A (1989) Gd-DTPA in the postoperative lumbar spine: update. Abstract, RSNA, annual meeting, Chicago, 1989
Sotiropoulos S, Chafetz NI, Lang P, Winkler M, Morris JM, Weinstein PR, Genant HK (1989) Differentiation between postoperative scar and recurrent disk herniation: prospective comparison of MR, CT, and contrast-enhanced CT. AJNR 10:639
Sze G (1988) Gadolinium-DTPA in spinal disease. Radiol Clin North Am 26:1009
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Glickstein, M.F., Sussman, S.K. Time-dependent scar enhancement in magnetic resonance imaging of the postoperative lumbar spine. Skeletal Radiol. 20, 333–337 (1991). https://doi.org/10.1007/BF01267658
Issue Date:
DOI: https://doi.org/10.1007/BF01267658