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No association between peridural scar and outcome after lumbar microdiscectomy
O P Nygaard1, R Kloster, R Dullerud
1Department of Neurosurgery, University Hospital of Tromsø, Norway.
Abstract:
The association between postoperative scar formation on MRI and outcome was investigated in 54 out of one hundred patients operated on with microdiscectomy in a prospective cohort study with a one year follow up. The patients were classified as failures or successes at the 12 months follow up according to a clinical overall score. All the 14 failures were investigated with MRI, and 40 patients classified as successes were picked at random for MRI. Patients with signs of recurrent disc herniation on MRI were excluded. The MRI scans were rated according to the presence or absence of scar formation within the spinal canal and the degree of scar enhancement by two independent neuroradiologists ignorant of treatment outcome. No evidence of scar formation was found in 4 patients, a small amount in 11, intermediate in 38 and extensive scar tissue in 1 patient. Slightly enhancing scar tissue was found in 18 patients, intermediate in 27 patients and strong enhancement in 5 patients. No association between the amount or enhancement of peridural scar formation and clinical outcome was found. Both the total clinical score and the difference between pre- and post-operative clinical score were used in the calculations. Testing the different subsets in the clinical overall score, as well as the patient satisfaction VAS score, did not reveal any association.
Insights
Postoperative scar formation after microdiscectomy, assessed by MRI, showed no association with patient outcomes. This finding suggests scar tissue on MRI scans does not predict success or failure in spinal surgery patients.
Area of Science:
- Neurosurgery
- Radiology
- Orthopedics
Background:
- Microdiscectomy is a common spinal surgery.
- Postoperative scar formation can occur within the spinal canal.
- The clinical significance of this scar tissue on outcomes is not fully understood.
Purpose of the Study:
- To investigate the association between postoperative scar formation on MRI and clinical outcomes following microdiscectomy.
- To determine if the amount or enhancement of peridural scar tissue correlates with patient success or failure after surgery.
Main Methods:
- Prospective cohort study of 54 patients undergoing microdiscectomy with a one-year follow-up.
- MRI scans were used to assess scar formation and enhancement in the spinal canal.
- Patients were classified as success or failure based on a clinical overall score; recurrent disc herniation was excluded.
Main Results:
- Scar formation was present in varying degrees (none to extensive) in 50 out of 54 patients.
- Scar enhancement was also variable (slight, intermediate, strong) across the patient group.
- No statistically significant association was found between the amount or enhancement of peridural scar tissue and clinical outcome, including patient satisfaction.
Conclusions:
- Postoperative peridural scar formation, as visualized and quantified by MRI, does not appear to be a significant predictor of clinical outcome after microdiscectomy.
- Further research may be needed to identify other factors influencing surgical success in these patients.