MAGNETIC RESONANCE IMAGING IN FAILED BACK SURGERY SYNDROME

Area of Science:

• Neurosurgery
• Radiology
• Spinal Medicine

Background:

• Failed back surgery syndrome (FBSS) is a frequent and disabling complication following lumbosacral spine surgery, affecting 5-10% of patients.
• Common causes include wrong level surgery, inadequate techniques, instability, recurrent disc herniation, and lumbosacral fibrosis.

Purpose of the Study:

• To highlight the importance of understanding FBSS origins and prevention.
• To emphasize the role of advanced imaging in differentiating pathologies for targeted therapy.
• To improve the correlation between clinical diagnosis, imaging findings, and patient treatment.

Main Methods:

• Review of causes and outcomes of FBSS.
• Evaluation of diagnostic imaging modalities for post-operative lumbosacral spine assessment.
• Focus on the utility of Gadolinium-enhanced Magnetic Resonance (MR) imaging.

Main Results:

• Repeated surgery for recurrent disc herniation yields results comparable to initial interventions.
• Repeated surgery for fibrosis shows lower success rates (30-35%), with 15-20% experiencing symptom worsening.
• Gadolinium-enhanced MR is identified as the most sensitive and specific imaging tool for evaluating post-operative FBSS.

Conclusions:

• Accurate differentiation of FBSS pathologies through imaging is essential for selecting appropriate therapies.
• Enhanced understanding of FBSS etiology and improved imaging interpretation can optimize patient management.
• Gadolinium-enhanced MR imaging is critical for neuro-radiological evaluation in FBSS patients.