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No relationship between epidural fibrosis and sciatica in the lumbar postdiscectomy syndrome. A study with contrast-enhanced magnetic resonance imaging in symptomatic and asymptomatic patients

Annertz, Mårten LU ; Jönsson, Bo LU ; Strömqvist, Björn LU and Holtås, Stig LU (1995) In Spine 20(4). p.449-453
Abstract
STUDY DESIGN. Symptomatic patients were retrospectively analyzed and compared with a control group from an ongoing prospective and consecutive study. OBJECTIVES. To determine the presence and extent of epidural fibrosis in patients with and without recurrent sciatic pain after previous lumbar discectomy, contrast-enhanced magnetic resonance images were evaluated and correlated with surgical findings in the symptomatic patients. Recurrent hernia and bony stenosis were ruled out as the probable causative agent, as well as any morphologic explanation other than fibrosis. SUMMARY OF BACKGROUND DATA. Repeat surgical results for patients with the lumbar postdiscectomy syndrome with epidural fibrosis alone are often unfavorable. The pathogenic... (More)
STUDY DESIGN. Symptomatic patients were retrospectively analyzed and compared with a control group from an ongoing prospective and consecutive study. OBJECTIVES. To determine the presence and extent of epidural fibrosis in patients with and without recurrent sciatic pain after previous lumbar discectomy, contrast-enhanced magnetic resonance images were evaluated and correlated with surgical findings in the symptomatic patients. Recurrent hernia and bony stenosis were ruled out as the probable causative agent, as well as any morphologic explanation other than fibrosis. SUMMARY OF BACKGROUND DATA. Repeat surgical results for patients with the lumbar postdiscectomy syndrome with epidural fibrosis alone are often unfavorable. The pathogenic role of epidural fibrosis, however, has not been established. METHODS. The magnetic resonance images of eight patients with recurrent or persistent sciatic pain after lumbar discectomy were compared with those of eight asymptomatic patients constituting a control group. All were examined with magnetic resonance imaging on a 0.3 T unit before and after intravenous injection of gadolinium-DTPA, and clinically, 6 months to 4 years after surgery. The symptomatic patients subsequently underwent reoperation. RESULTS. Fourteen patients had focal or diffuse epidural fibrosis around the nerve root and/or the thecal sac at the operated level, whereas the postoperative findings for two patients were "normal," one in the operated and one in the control group. No difference between the groups regarding mass effect or affection of the nerve roots or thecal sac was noted. At reoperation of the eight symptomatic patients, fibrosis was the only pathologic finding in all cases except one, in which surgery confirmed the normal finding on magnetic resonance imaging. Six of the eight operated patients had recurrent or persistent symptoms within a year of the reoperation. CONCLUSION. No differences regarding the presence and extent of epidural fibrosis between the symptomatic and asymptomatic patients could be demonstrated with contrast-enhanced magnetic resonance imaging. The role of epidural fibrosis as the causative agent in the lumbar postdiscectomy syndrome is questioned. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Spine
volume
20
issue
4
pages
449 - 453
publisher
Lippincott Williams & Wilkins
external identifiers
  • pmid:7747228
  • scopus:0028933365
ISSN
0362-2436
language
English
LU publication?
yes
id
38ae31ef-5cd4-4c66-a1cc-6a622b8ee747 (old id 1109297)
date added to LUP
2008-07-28 09:36:18
date last changed
2017-11-05 04:25:38
@article{38ae31ef-5cd4-4c66-a1cc-6a622b8ee747,
  abstract     = {STUDY DESIGN. Symptomatic patients were retrospectively analyzed and compared with a control group from an ongoing prospective and consecutive study. OBJECTIVES. To determine the presence and extent of epidural fibrosis in patients with and without recurrent sciatic pain after previous lumbar discectomy, contrast-enhanced magnetic resonance images were evaluated and correlated with surgical findings in the symptomatic patients. Recurrent hernia and bony stenosis were ruled out as the probable causative agent, as well as any morphologic explanation other than fibrosis. SUMMARY OF BACKGROUND DATA. Repeat surgical results for patients with the lumbar postdiscectomy syndrome with epidural fibrosis alone are often unfavorable. The pathogenic role of epidural fibrosis, however, has not been established. METHODS. The magnetic resonance images of eight patients with recurrent or persistent sciatic pain after lumbar discectomy were compared with those of eight asymptomatic patients constituting a control group. All were examined with magnetic resonance imaging on a 0.3 T unit before and after intravenous injection of gadolinium-DTPA, and clinically, 6 months to 4 years after surgery. The symptomatic patients subsequently underwent reoperation. RESULTS. Fourteen patients had focal or diffuse epidural fibrosis around the nerve root and/or the thecal sac at the operated level, whereas the postoperative findings for two patients were "normal," one in the operated and one in the control group. No difference between the groups regarding mass effect or affection of the nerve roots or thecal sac was noted. At reoperation of the eight symptomatic patients, fibrosis was the only pathologic finding in all cases except one, in which surgery confirmed the normal finding on magnetic resonance imaging. Six of the eight operated patients had recurrent or persistent symptoms within a year of the reoperation. CONCLUSION. No differences regarding the presence and extent of epidural fibrosis between the symptomatic and asymptomatic patients could be demonstrated with contrast-enhanced magnetic resonance imaging. The role of epidural fibrosis as the causative agent in the lumbar postdiscectomy syndrome is questioned.},
  author       = {Annertz, Mårten and Jönsson, Bo and Strömqvist, Björn and Holtås, Stig},
  issn         = {0362-2436},
  language     = {eng},
  number       = {4},
  pages        = {449--453},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Spine},
  title        = {No relationship between epidural fibrosis and sciatica in the lumbar postdiscectomy syndrome. A study with contrast-enhanced magnetic resonance imaging in symptomatic and asymptomatic patients},
  volume       = {20},
  year         = {1995},
}