Gadolinium enhancement of vertebral endplates following lumbar disc surgery

Gadolinium enhancement may be normal in the vertebral endplates adjacent to previously operated intervertebral discs. To determine the frequency of this finding and to differentiate this normal healing process from early lesions due to focal infection, we studied 135 patients who had undergone surgery for herniated lumbar disc, and compared them with 249 unoperated patients with radicular symptoms and 15 with known spondylodiscitis. Hypointense foci which enhanced with gadolinium were identified in the endplates of 25 (18.5%) of the operated patients, 9 of whom required a second operation for recurrent disc herniation, at which time the absence of infection was confirmed. Gadolinium enhancement within the endplates adjacent to the operated disc occurs during normal healing after surgery. Care should be taken before invoking a diagnosis of focal infection or secondary spondylodiscitis.