MRI after successful lumbar discectomy

Goethem, Johan Van; Kelft, Erik Van de; Biltjes, I.; Hasselt, Boudewijn A.A.M. van; Hauwe, Luc van den; Parizel, Paul M.; Schepper, A. M. A. De

doi:10.1007/bf02278130

Cited by 67 publications

(32 citation statements)

References 20 publications

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“…But possibly the infection takes place later, after the nucleus material has been removed. After disc herniation surgery, MRI shows contrast enhancement along the surgical tract in all patients 6 weeks and 6 months after surgery [31]. This enhancement is portraying hyper vascularisation, and it is possible that the bacteria might enter the disc at this later point.…”

Section: Discussionmentioning

confidence: 90%

Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae?

et al. 2013

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Purpose To investigate the prevalence of infected herniated nucleus material in lumbar disc herniations and to determine if patients with an anaerobic infected disc are more likely to develop Modic change (MC) (bone oedema) in the adjacent vertebrae after the disc herniation. MCs (bone oedema) in vertebrae are observed in 6 % of the general population and in 35-40 % of people with low back pain. These changes are strongly associated with low back pain. There are probably a mechanical cause and an infective cause that causes MC. Several studies on nuclear tissue from herniated discs have demonstrated the presence of low virulent anaerobic microorganisms, predominantly Propionibacterium acnes, in 7-53 % of patients. At the time of a herniation these low virulent anaerobic bacteria may enter the disc and give rise to an insidious infection. Local inflammation in the adjacent bone may be a secondary effect due to cytokine and propionic acid production. Methods Patients undergoing primary surgery at a single spinal level for lumbar disc herniation with an MRI-confirmed lumbar disc herniation, where the annular fibres were penetrated by visible nuclear tissue, had the nucleus material removed. Stringent antiseptic sterile protocols were followed. Results Sixty-one patients were included, mean age 46.4 years (SD 9.7), 27 % female. All patients were immunocompetent. No patient had received a previous epidural steroid injection or undergone previous back surgery. In total, microbiological cultures were positive in 28 (46 %) patients. Anaerobic cultures were positive in 26 (43 %) patients, and of these 4 (7 %) had dual microbial infections, containing both one aerobic and one anaerobic culture. No tissue specimens had more than two types of bacteria identified. Two (3 %) cultures only had aerobic bacteria isolated. In the discs with a nucleus with anaerobic bacteria, 80 % developed new MC in the vertebrae adjacent to the previous disc herniation. In contrast, none of those with aerobic bacteria and only 44 % of patients with negative cultures developed new MC. The association between an anaerobic culture and new MCs is highly statistically significant (P = 0.0038), with an odds ratio of 5.60 (95 % CI 1.51-21.95). Conclusion These findings support the theory that the occurrence of MCs Type 1 in the vertebrae adjacent to a previously herniated disc may be due to oedema surrounding an infected disc. The discs infected with anaerobic bacteria were more likely (P \ 0.0038) to develop MCs in the adjacent vertebrae than those in which no bacteria were found or those in which aerobic bacteria were found.

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Section: Discussionmentioning

confidence: 90%

Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae?

et al. 2013

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“…Nevertheless, caution may be advisible in the interpretation of gadolineum enhancement in early postoperative MRI, because of the normal sequence of changes [39]. The degree and enhancement of the scar formation is dependent on time since the operation, and decreases within the first 6 months [12,40]. Grane et al [13] found that patients examined less than 1 year after surgery had more epidural scarring than those investigated after the first 12 months.…”

Section: Discussionmentioning

confidence: 99%

“…Grane et al [13] found that patients examined less than 1 year after surgery had more epidural scarring than those investigated after the first 12 months. We avoided analyzing MRI investigations within the first 6 months after surgery because of the risk of misinterpretations [40]. Between 6-and 12-months examinations few patients demonstrate changes in the amount of peridural scar, so an interval of 6 months between surgery and MRI seems to be sufficient for the assessment of postoperative peridural scarring [20].…”

Section: Discussionmentioning

confidence: 99%

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Recurrent pain after lumbar discectomy: the diagnostic value of peridural scar on MRI

Vogelsang

Finkenstaedt

Vogelsang

et al. 1999

European Spine Journal

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“…Early detected epidural tissue on MRI can be due to postoperative haematoma and may develop to epidural scar tissue [4]. Because of the normal changes before 6 months after surgery there is risk of misinterpretations [31][32][33].…”

Section: Discussionmentioning

confidence: 99%

Peridural scar and its relation to clinical outcome: a randomised study on surgically treated lumbar disc herniation patients

et al. 2008

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A prospective randomised 2-year follow-up study on patients undergoing lumbar disc herniation surgery. The objective was to investigate the relationship between peridural scarring and clinical outcome, the scar development 6 and 24 months postoperatively by using MRI, and if ADCON-L (a bioresorbable carbohydrate polymer gel) has an effect on scar size and/or improve patients' outcome after lumbar disc herniation surgery. The association between peridural scarring and recurrent pain after lumbar disc herniation surgery is debated. Numerous materials have been used in attempts to prevent or reduce postoperative peridural scarring; however, there are conflicting data regarding the clinical effects. The study included 119 patients whose mean age was 39 years (18-66); 51 (47%) were women. Sixty patients (56%) were perioperatively randomised to receive ADCON-L, and 48 (44%) served as controls. All patients underwent MRI at 6 and 24 months postoperatively, and an independent radiologist graded the size, location and development of the scar, by using a previously described scoring system. Preand 2-year postoperatively patients graded their leg pain on a visual analogue scale (VAS). At the 2-year follow-up patients rated their satisfaction with treatment (subjective outcome) and were evaluated by an independent neurologist (objective outcome), using MacNab score. There was no relationship between size or localisation of the scar and any of the clinical outcomes (VAS, subjective and objective outcome). The scar size decreased between 6 and 24 months in 49%, was unchanged in 42% and increased in 9% of the patients. Patients treated with ADCON-L did not demonstrate any adverse effects, nor did they demonstrate less scarring or better clinical outcome than control patients. No significant association between the presence of extensive peridural scar or localisation of scar formation and clinical outcome could be detected in the present study. Further, no positive or negative effects of ADCON-L used in disc herniation surgery could be seen.

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MRI after successful lumbar discectomy

Cited by 67 publications

References 20 publications

Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae?

Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae?

Recurrent pain after lumbar discectomy: the diagnostic value of peridural scar on MRI

Peridural scar and its relation to clinical outcome: a randomised study on surgically treated lumbar disc herniation patients

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