Contrast-enhanced computed tomography scanning of the postoperative spine

A prospective study of contrast-enhanced computed tomography (CT) scanning was undertaken for 17 levels previously operated upon in the lumbosacral spine in 14 patients. All levels with prior operations were scanned before and after the administration of intravenous contrast medium. A standardized technique for contrast enhancement using high doses of intravenous contrast medium was employed and a specialized technique for measuring enhancement with corrections for scan artifacts was used. Results indicated that measurable contrast enhancement occurred in 16 of 17 postoperative scars up to 12 years after surgery. Enhanced scans provided more accurate delineation of the size and margins of postoperative scarring than precontrast scans. No instances of enhancement of normal disk or recurrent herniated disk were observed. In six instances recurrent herniated disks were predicted on the basis of contrast-enhanced CT scans and subsequently confirmed at reoperation. Contrast-enhanced CT scans meticulously performed appear to permit differentiation between scarring and disk herniation in patients with recurring symptoms after operations for lumbosacral disk disease.