Contrast-enhanced MR imaging performed after successful lumbar disk surgery: prospective study

A prospective study was undertaken to establish the normal spectrum and timing of gadolinium-enhanced magnetic resonance (MR) imaging findings in 15 patients who had resolution of symptoms after successful lumbar disk surgery. Enhancement of the facet joints (in 88% of disk levels) and paraspinal muscles (100%) decreased gradually after surgery. Enhancement of the decompressed nerve root tracked proximally toward the conus medullaris in 62% at 3 weeks and was absent in all by 6 months postoperatively. Areas of intermediate signal intensity with peripheral enhancement and mass effect were seen on T1-weighted images at the site of the original disk herniation in 38% at 3 weeks and 12% at 3 months, despite complete relief of leg pain. These results reveal that even in successfully treated (asymptomatic) patients, residual mass effect on the neural elements may frequently simulate a recurrent or residual disk fragment. There is an orderly progression of imaging changes during the first 6 months after lumbar surgery that limits the interpretation of MR examinations during that period.