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Early postoperative MRI findings following surgery for herniated lumbar disc. Part II: A gadolinium-enhanced study
R Floris1, A Spallone, T Y Aref
1Department of Radiology, University of Rome Tor Vergata, Hospital S. Eugenio, Italy.
Abstract:
The aim of our study was to evaluate the contrast-enhanced MR imaging (MRI) findings, in the early postoperative period, in unselected patients undergoing lumbar microdiscectomy (15/16 had total resolution of their symptoms). Contrast-enhanced imaging studies were performed, in all 16 patients of our series, before surgery, and at the third postoperative day and, two months after surgery. Postoperative paraspinal muscles enhancement was present in all patients. In the postoperative period, nerve root enhancement was present in 5/16 patients at the early survey and persisted in one after two months. A pseudohernia depicted as epidural intermediate signal intensity tissue, was seen in 13 patients at the third day MRI, and only in eight after two months. This pseudohernia enhanced peripherally in 8/13 patients and enhanced homogeneously in the remaining five at the first postsurgical examination; in the late MRI the peripheral enhancement was appreciable in only two patients while a homogeneous enhancement was observed in six. Clinical symptoms resolved completely in 14/16 patients on clinical evaluation at the third postoperative day, while the remaining two patients showed residual symptoms and signs of radicular compression. At the early MRI these two patients showed intradural nerve root enhancement. Two months later, one patient did not show the previously described nerve root enhancement and improved clinically, while the other had a positive Straight Leg Raising Sign with persistent intradural nerve root enhancement. In conclusion, no correlation between clinical course and contrast-enhancement of pseudohernia and extradural nerve root was appreciable, although intradural nerve root enhancement seems to represent a clinically relevant finding.
Insights
Contrast-enhanced MRI after lumbar microdiscectomy reveals findings like muscle enhancement and pseudohernias. Intradural nerve root enhancement, though rare, may correlate with persistent radicular compression symptoms.
Area of Science:
- Neurosurgery
- Radiology
- Medical Imaging
Background:
- Lumbar microdiscectomy is a common surgical procedure.
- Postoperative imaging is crucial for evaluating surgical outcomes.
- Contrast-enhanced MRI provides detailed anatomical and pathological information.
Purpose of the Study:
- To evaluate contrast-enhanced MRI findings in the early postoperative period following lumbar microdiscectomy.
- To correlate imaging findings with clinical outcomes.
- To assess the evolution of postoperative changes over two months.
Main Methods:
- Contrast-enhanced MRI was performed before surgery, on postoperative day 3, and at two months in 16 patients.
- Imaging findings included paraspinal muscle enhancement, nerve root enhancement, and pseudohernia.
- Clinical evaluation assessed symptom resolution and radicular compression signs.
Main Results:
- All patients showed postoperative paraspinal muscle enhancement.
- Nerve root enhancement was seen in 5/16 patients early postoperatively, persisting in one.
- Pseudohernias were common, with varying enhancement patterns that changed over time. Intradural nerve root enhancement correlated with residual symptoms.
Conclusions:
- Postoperative paraspinal muscle enhancement and pseudohernias are common after lumbar microdiscectomy.
- Contrast enhancement of pseudohernias and extradural nerve roots did not correlate with clinical outcomes.
- Intradural nerve root enhancement appears to be a clinically relevant finding indicating potential persistent nerve root compression.