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Evaluation of Patients' Posture and Gait Profile After Lumbar Fusion Surgery by Video Rasterstereography and Treadmill Gait Analysis
Published on: March 23, 2019
The clinical value of early postoperative MRI after lumbar spine surgery
Matthew Crocker1, Timothy L Jones, Philip Rich
1Academic Neurosurgery Unit, St George's University of London, London, UK. mjncrocker@gmail.com
Introduction:
MRI scanning has historically been considered difficult to interpret in the early period following lumbar spine surgery, and hence of limited value. We investigate the hypothesis that MRI scanning within 6 weeks of lumbar spine surgery cannot accurately diagnose neural compression in symptomatic patients, and define the utility of postoperative MRI in this context.
Methods:
A series of 32 consecutive patients had early postoperative MRI following lumbar discectomy or laminectomy for continued, worsening or new symptoms of neural compression. The neuroradiologists' reports were evaluated for the reported presence of neural compression and confidence level (low, medium, high). These MRI findings were then compared to the patients' subsequent course and findings of any surgery performed.
Results:
Twenty of 29 scans (69%) were confidently predictive of the correct treatment pathway (reoperation with positive finding or conservative treatment with a good outcome) whereas 3/3 (100%) patients who had conservative management despite the MRI confidently suggesting compression had poor outcome. The MRI is highly likely to influence management: 11/14 (79%) patients with scans suggesting neural compression had revision surgery and 18/18 (100%) patients with no neural compression on MRI were managed conservatively.
Conclusions:
Our data suggest that early MRI scanning after lumbar laminectomy or discectomy accurately detects neural compression at the surgery site in patients with continued or worsening symptoms.
Insights
Early MRI scans after lumbar spine surgery can accurately detect neural compression in symptomatic patients, guiding treatment decisions effectively. This aids in determining the need for reoperation or conservative management for better patient outcomes.
Area of Science:
- Neurosurgery
- Radiology
- Spinal Imaging
Background:
- Lumbar spine surgery outcomes can be challenging to interpret with early MRI scans.
- Historically, limited value has been attributed to early postoperative MRI for diagnosing neural compression.
Purpose of the Study:
- To test the hypothesis that MRI within 6 weeks of lumbar spine surgery cannot accurately diagnose neural compression.
- To define the utility of postoperative MRI in symptomatic patients following lumbar spine surgery.
Main Methods:
- 32 patients underwent early postoperative MRI after lumbar discectomy or laminectomy for neural compression symptoms.
- Radiologists' reports on neural compression and confidence levels were evaluated.
- MRI findings were compared with subsequent patient outcomes and surgical findings.
Main Results:
- 69% of scans accurately predicted the treatment pathway (reoperation or conservative management).
- Patients treated conservatively despite MRI suggesting compression had poor outcomes.
- MRI influenced management in 79% of cases suggesting compression (revision surgery) and 100% of cases without compression (conservative management).
Conclusions:
- Early MRI scans after lumbar laminectomy or discectomy accurately detect neural compression.
- Postoperative MRI is valuable for guiding treatment in patients with persistent or worsening symptoms.
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Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...