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[Computerized tomography in surgically treated lumbar disk hernia. Multicenter study].

A Cecchini1, P Garbagna, A Martelli

  • 1Servizio di Radiodiagnostica, IRCCS, Policlinico S. Matteo, Pavia.

La Radiologia Medica
|June 1, 1988
PubMed
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Postoperative lumbar herniated disk (HD) CT scans reveal epidural fibrosis in 81% of patients, often associated with recurrent hernias. Contrast-enhanced CT aids in differentiating fibrosis from recurrent herniation.

Area of Science:

  • Radiology
  • Neurosurgery
  • Orthopedic Surgery

Background:

  • Postoperative complications after lumbar herniated disk (HD) surgery can include recurrent or new disk herniations and epidural fibrosis.
  • Accurate differentiation between these conditions is crucial for appropriate patient management and treatment planning.

Purpose of the Study:

  • To evaluate the utility of computed tomography (CT) in diagnosing postoperative lumbar herniated disk complications.
  • To assess the prevalence of epidural fibrosis and recurrent herniation after lumbar HD surgery.
  • To identify CT criteria for distinguishing epidural fibrosis from recurrent herniation.

Main Methods:

  • A multicenter, analytic-statistical CT study was conducted on 128 patients with postoperative lumbar herniated disk.

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  • CT scans were performed at varying intervals post-surgery, with and without intravenous contrast medium (bolus and perfusion techniques).
  • Findings were analyzed for recurrent/new herniations, epidural fibrosis, bony canal stenosis, vacuum disk, calcifications, dural sac changes, pseudomeningocele, and diskitis.

    • Main Results:

    • Epidural fibrous scars were demonstrated in 81% of patients, frequently associated with recurrent/new hernias (50% of fibrosis cases).
    • Contrast-enhanced CT identified fibrosis in 72% of contrast-injected patients, with specific enhancement patterns.
    • Recurrent hernias were found in 38% of cases, and new hernias in 8%. Other findings included bony canal stenosis (22%), vacuum disk (26%), and dural sac compression (19.5%).

    Conclusions:

    • Epidural fibrosis is a near-inevitable consequence of lumbar herniated disk surgery, detectable with high sensitivity by CT.
    • Post-contrast enhancement patterns on CT can help differentiate fibrosis from recurrent herniation, though co-occurrence is possible.
    • While CT is valuable, correlating findings with clinical presentation is essential, as fibrosis can be asymptomatic, influencing therapeutic decisions.