Defining the use of gadolinium enhanced MRI in the assessment of the postoperative lumbar spine

Wilkinson, LE; Elson, E.; Saifuddin, Asif; Ransford, A. O.

doi:10.1016/s0009-9260(97)80330-3

Cited by 21 publications

(6 citation statements)

References 14 publications

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“…Kayama et al [4] suggested that radiating pain may be due to the passage of inflammatory nuclear material through full thickness annular tears with a direct action on the adjacent nerve root. The presence of inflammatory tissue in the epidural space adjacent to annular tears has been documented [17]. Ohnmeiss et al [12] were unable to assess the relationship between leak from the disc and extremity pain, since their study utilised CT discography.…”

Section: Discussionmentioning

confidence: 99%

An analysis of radiating pain at lumbar discography

Saifuddin

Emanuel

White

et al. 1998

European Spine Journal

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IntroductionLow back pain with radiation into the lower limb is a common clinical complaint. Imaging studies frequently show absence of nerve root compression [9] and it has been suggested that the origin of such referred pain lies within the intervertebral disc itself. Crock introduced the concept of 'internal disc disruption', suggesting that chemical alterations within the nucleus pulposus of a degenerative disc could result in both back pain and lower limb pain [2,3]. The aim of the present study was to identify pathological features of the intervertebral disc, as demonstrated by discography, that were associated with concordant pain radiation. Materials and methodsThe study consisted of a retrospective review of lumbar discography reports of 99 consecutive patients. All patients were referred for discography by a single spinal surgeon over a period of 30 months for the investigation of chronic low back pain, with or without radiating pain, as a precursor to spinal fusion. The study group comprised 52 males and 47 females with a mean age of 43.3 years (range 22-69 years). MRI prior to discography excluded the presence of nerve root compression. All discograms were performed by a single radiologist using a posterolateral injection technique. Non-ionic contrast medium was injected through a single 18-G needle until there was either a firm end-point to the injection, or until pain was provoked, or to a maximum of 5-6 ml. For each disc injected, the following features were recorded: (1) nuclear morphology, (2) presence and site of annular tears and (3) patient response (no pain, concordant back pain, concordant radiating pain into the buttock, hip, groin or lower limb, or non-conAbstract This study aimed to identify the morphological abnormalities of the intervertebral disc, as demonstrated by lumbar discography, that are associated with pain radiation to the hip, groin, buttock or lower limb. We carried out a retrospective review of 99 consecutive lumbar discogram reports. The association of disc degeneration, annular tears (partial or full thickness) and the level of disc injected was determined with respect to the presence and pattern of radiating pain. A total of 260 discs were injected, of which 179 were considered abnormal. Posterior annular tears were demonstrated in 84 discs, anterior annular tears in 15 discs and 45 discs had both anterior and posterior tears. A significant association was identified between isolated posterior tears and the production of concordant radiating pain (P = 0.0041). No difference was identified between partial thickness posterior tears and full thickness posterior tears associated with leak of contrast medium, with regard to radiating pain. Similarly, there was no significant association between disc level injected and the pattern of pain radiation. The results indicate that pain experienced in the buttock, hip, groin or lower limb can arise from the posterior annulus of the intervertebral disc without direct involvement of the nerve root.

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Section: Discussionmentioning

confidence: 99%

An analysis of radiating pain at lumbar discography

Saifuddin

Emanuel

White

et al. 1998

European Spine Journal

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“…In common with other studies [6][7][8] only minor side effects resulted in our study. It has great value in the diagnosis of nerve root pathology and is more sensitive than gadolinium enhanced MRI 21 for visualizing scar tissue.…”

Section: Discussionmentioning

confidence: 99%

Comparison of caudal steroid epidural with targeted steroid placement during spinal endoscopy for chronic sciatica: a prospective, randomized, double-blind trial

Dashfield

Taylor

Cleaver

et al. 2005

British Journal of Anaesthesia

107

136

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“…MRI and epidurography are generally used to diagnose adhesions in the epidural space. When adhesions are present in the epidural space, MRI shows enhanced contrast effects in the connective tissue in the epidural space and disappearance of epidural fat [ 3 , 4 ]. Although MRI is noninvasive and can be used for extensive observation of adhesions, its diagnostic precision is low.…”

Section: Case Presentationmentioning

confidence: 99%

Adhesions in the epidural space caused by frequent epidural blocks

et al. 2017

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We report a case of adhesions in the epidural space caused by more than 200 times epidural blocks that were observed with epiduroscopy. A 41-year-old man had repeatedly undergone lumbar epidural blocks to treat pain in his leg, resulting in decreased efficacy of the epidural block. We described endoscopic findings that these adhesions were mostly consisted of adhesions formed from the soft connective tissue.

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Defining the use of gadolinium enhanced MRI in the assessment of the postoperative lumbar spine

Cited by 21 publications

References 14 publications

An analysis of radiating pain at lumbar discography

An analysis of radiating pain at lumbar discography

Comparison of caudal steroid epidural with targeted steroid placement during spinal endoscopy for chronic sciatica: a prospective, randomized, double-blind trial

Adhesions in the epidural space caused by frequent epidural blocks

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