Epidural fibrosis and recurrent disk herniation in the lumbar spine: MR imaging assessment

Bundschuh, C.V.; Modic, M T; Ross, J. S.; Masaryk, T J; Bohlman, Henry H.

doi:10.2214/ajr.150.4.923

Cited by 73 publications

(29 citation statements)

References 1 publication

(1 reference statement)

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“…Other reports have suggested a relationship between the location of the scar and its signal intensity on unenhanced MR examinations of the postoperative spine [2,8]. Anterior and lateral fibrosis tends to show greater signal intensity on Tz-weighted sequences than does scar occurring posteriorly or in the posterior soft tissues.…”

Section: Discussionmentioning

confidence: 88%

“…With MRI specificity and accuracy are greater than with unenhanced CT scanning [14] although results were approximately equal in one report [13], Several authors have documented the usefulness of unenhanced MRI in evaluating the postoperative spine [2,5,8,13]. Morphologic features that suggest scar as opposed to recurrent disc herniation include the presence of aberrant soft tissue in the spinal canal without mass effect upon the thecal sac, absence of continuity of mass with the parent disc, presence of abnormal soft tissue above or below the disc level, retraction of the thecal sac at the level of the mass, and irregular configuration [2,5]. The signal features of scar in unenhanced MRI of the spine are somewhat more variable.…”

Section: Discussionmentioning

confidence: 99%

“…Magnetic resonance imaging (MRI) has facilitated the evaluation of patients with the failed back surgery syndrome [1,2,5,6,8,9,13]. Differentiation between recurrent disc herniation and postoperative scarring is of crucial importance in these patients, because only those individuals with recurrent disc herniation can be expected [4,7].…”

Section: Time-dependent Enhancement -Magnetic Resonance Imagingmentioning

confidence: 99%

“…Distinguishing features of recurrent disc herniation as opposed to postoperative scarring can be identified on both unenhanced [2,5,8, 23] and enhanced [1,6,10,12,14] MR images. Morphologic criteria such as an anterior location, lack of mass effect, lack of continuity with the parent disc, and the presence of hyperintense or heterogeneously intense material tend to indicate scarring on unenhanced MR scans.…”

Section: Time-dependent Enhancement -Magnetic Resonance Imagingmentioning

confidence: 99%

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Time-dependent scar enhancement in magnetic resonance imaging of the postoperative lumbar spine

Glickstein

Sussman

1991

Skeletal Radiol.

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Magnetic resonance imaging (MRI) has become a principal modality in the evaluation of the post-operative lumbar spine. Gadolinium-diethylenetriamine-pentaacetic acid (Gd-DTPA) can often facilitate differentiation of scar from recurrent disc herniation according to established criteria. Scar has been believed to enhance predictably. We reviewed the contrast-enhanced MR scans of 44 patients who were examined for recurrent back pain following disc surgery and attempted to assess the enhancement characteristics of scar as a function of the time interval between initial surgery and the imaging study. In 44 patients, scar was believed to be present at 32 of 49 disc levels. The degree of enhancement was related to the postoperative interval; those studies performed no later than 9 months after surgery tended to exhibit the greatest degree of enhancement. Surgical confirmation of these MRI findings was available in 12 patients. In patients examined long after surgery, scar enhancement may be less intense than in those examined shortly after surgery, or even nonexistent. This temporal factor should be considered when using contrast material to differentiate scar from recurrent disc herniation in post-operative examinations of the lumbar spine.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Time-dependent Enhancement -Magnetic Resonance Imagingmentioning

confidence: 99%

Section: Time-dependent Enhancement -Magnetic Resonance Imagingmentioning

confidence: 99%

See 2 more Smart Citations

Time-dependent scar enhancement in magnetic resonance imaging of the postoperative lumbar spine

Glickstein

Sussman

1991

Skeletal Radiol.

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“…Although some contrast patients with scarring do not show enhancement, the use of intravenous injections has been found to be valuable in situations where this diagnosis i s equivocal. The appearances of scar on magnetic resonance are hypo-or isointense on TI weighted spin echo, and hyperintense on T2 relative to the annulus (Bundschuh et al 1988). Epidural scar formation also enhances on T1 weighted images after the injection of gadolinium DTPA (Heuftle et al 1988) while disc material remains unchanged, appearing either hypo or isointense, with annulus on T1 and T2 sequences.…”

mentioning

confidence: 99%