Radiographic changes after lumbar discectomy. Sequential enhanced computed tomography in relation to clinical...

Area of Science:

• Neurosurgery
• Radiology
• Orthopedic Surgery

Background:

• Single-level disc herniations are a common cause of back and leg pain.
• Surgical intervention, including microsurgery and standard surgery, aims to alleviate symptoms by resecting herniated disc material.
• Radiographic changes post-surgery require evaluation to understand their clinical significance.

Purpose of the Study:

• To prospectively evaluate radiographic changes after disc resection surgery.
• To correlate these postoperative radiographic findings with clinical symptoms, specifically back and leg pain.
• To compare microsurgery with standard surgery regarding scar tissue formation.

Main Methods:

• Prospective randomized study of 50 patients with single-level disc herniations.
• Patients underwent either microsurgery or standard surgery.
• Contrast-enhanced computed tomography (CT) scans were performed postoperatively at 1 week, 1-2 months, and 1 year.

Main Results:

• At 1 year, radiographic findings included posterior disc protrusion (16 patients), scar tissue (47 patients), and nerve root displacement (13 patients).
• Microsurgery did not result in less scar tissue compared to standard surgery.
• No definite correlation was found between any postoperative radiographic changes and persistent back or leg pain.

Conclusions:

• Postoperative radiographic findings such as disc protrusion, scar tissue, and nerve root displacement are common after disc resection.
• The presence and extent of these radiographic changes do not reliably predict residual clinical symptoms like back or leg pain.
• Current surgical techniques, including microsurgery, do not show a clear advantage in preventing scar tissue formation that correlates with pain relief.