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Magnetic resonance image changes and clinical outcome after microdiscectomy or nucleotomy for ruptured disc
E Kotilainen1, A Alanen, M Erkintalo
1Department of Neurosurgery, University of Turku, Finland.
Abstract:
Preoperative and postoperative magnetic resonance imaging (MRI) of the lumbar spine was performed on 41 patients treated either microsurgically or with percutaneous nucleotomy for lumbar disc herniation. On the first postoperative day, MRI revealed an edematous mass effect at the level of surgery in 25 (61%) patients. The mass effect caused compression of the anterior dural sac mimicking preoperative disc herniation. After the follow-up of 6 months, the mass effect had disappeared in all patients, and the MRI finding in the operated disc space was that of a prolapse in six (15%) patients and that of a protrusion in 16 (39%) patients. Postoperative scarring was detected in 23 (56%) patients. The amount of the epidural scar tissue was significantly (p = 0.0002) associated with the extent of the early postoperative hemorrhagic changes detected in these patients with MRI. No association was observed between these MRI findings (mass effect, disc herniation, epidural scarring) and the clinical outcome of the patients.
Insights
Postoperative MRI for lumbar disc herniation reveals temporary edematous mass effect and scarring in many patients. These findings, including epidural scarring, did not correlate with clinical outcomes after six months.
Area of Science:
- Neurosurgery
- Radiology
- Spinal Surgery
Background:
- Lumbar disc herniation is a common condition requiring surgical intervention.
- Postoperative imaging is crucial for evaluating treatment outcomes and complications.
- Magnetic resonance imaging (MRI) provides detailed visualization of spinal structures.
Purpose of the Study:
- To evaluate early and late postoperative MRI findings after surgical treatment for lumbar disc herniation.
- To assess the incidence of edematous mass effect, disc re-herniation, and epidural scarring.
- To determine the correlation between MRI findings and clinical outcomes.
Main Methods:
- Prospective study involving 41 patients undergoing microsurgery or percutaneous nucleotomy for lumbar disc herniation.
- Preoperative and postoperative lumbar spine MRI scans were performed.
- Patients were followed for 6 months, with clinical outcome assessment.
Main Results:
- Early postoperative MRI showed edematous mass effect compressing the dural sac in 61% of patients.
- After 6 months, mass effect resolved; disc prolapse (15%) or protrusion (39%) was noted.
- Postoperative epidural scarring occurred in 56% of patients and correlated with early hemorrhagic changes (p=0.0002).
Conclusions:
- Early postoperative MRI findings like edematous mass effect are common but transient after lumbar disc surgery.
- Epidural scarring is frequent and associated with early hemorrhage, but not predictive of clinical outcome.
- These MRI findings, including mass effect and scarring, did not correlate with the clinical outcome in patients treated for lumbar disc herniation.