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Early postoperative MRI findings following surgery for herniated lumbar disc
R Floris1, A Spallone, T Y Aref
1Department of Radiology, University of Rome Tor Vergata, Hospital S. Eugenio, Italy.
Abstract:
MRI is routinely used in the evaluation and management of patients with failed back surgery syndrome (FBSS). However, its value is unclear in the early detection of signs that can negatively affect that later course of surgical cases. The purpose of the present study is to describe the MR images of early postoperative MRI at 3 days in 30 unselected patients who underwent lumbar microdiscectomy, and to correlate the findings with follow up MRI at 8 weeks and with final outcome. The findings are correlated with literature data. Early postoperative MRI findings were consisting of pseudohernia in 24 patients (80%), annular rent in 23 patients (80%), and other non-specific postoperative findings. On the late MRI the pseudohernia persisted in 12 patients (50%), the annular rent in 4 patients (15%) and asymptomatic pseudo-spondylodiscitis was apparent in 3 patients (10%) as was a case of true spondylodiscitis. Therefore, early postoperative findings have limited value in the management of patients after surgery for lumbar disc herniation, since the images were not correlated with the immediate clinical course after surgery nor with the late radiological and clinical outcome. The evident imaging changes in the early postoperative period after lumbar disc surgery limit the accuracy of the interpretation of MRI examinations.
Insights
Early MRI scans after lumbar microdiscectomy show common findings like pseudohernia and annular rents. However, these early postoperative imaging results have limited value in predicting patient outcomes for failed back surgery syndrome (FBSS).
Area of Science:
- Neurosurgery
- Radiology
- Spinal Surgery
Background:
- Magnetic Resonance Imaging (MRI) is standard for evaluating failed back surgery syndrome (FBSS).
- The utility of early postoperative MRI in predicting outcomes remains unclear.
- Lumbar microdiscectomy is a common surgical procedure for disc herniation.
Purpose of the Study:
- To describe early (3-day) postoperative MRI findings after lumbar microdiscectomy.
- To correlate these early findings with 8-week follow-up MRIs and final patient outcomes.
- To assess the value of early postoperative MRI in managing patients with failed back surgery syndrome.
Main Methods:
- Prospective study of 30 unselected patients undergoing lumbar microdiscectomy.
- Early (3-day) and late (8-week) MRI scans were performed.
- Findings were correlated with clinical outcomes and literature data.
Main Results:
- Early MRI revealed pseudohernia in 80% and annular rents in 80% of patients.
- Late MRI showed persistent pseudohernia in 50% and rents in 15%.
- Asymptomatic pseudo-spondylodiscitis was seen in 10%, with one case of true spondylodiscitis.
Conclusions:
- Early postoperative MRI findings after lumbar microdiscectomy have limited predictive value for patient outcomes.
- Significant imaging changes in the early period can reduce the accuracy of MRI interpretation.
- Early imaging results should be interpreted cautiously in the context of clinical presentation and late outcomes.