Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Transiting Nerve Rootlet Abnormalities on MRI after Lumbar Laminectomy: Associations with Persistent Postoperative Pain

  • Chankue Park (Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital) ;
  • In Sook Lee (Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Kyoung Hyup Nam (Department of Neurosurgery, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • You Seon Song (Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Tae Hong Lee (Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • In Ho Han (Department of Neurosurgery, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Dong Hwan Kim (Department of Neurosurgery, Pusan National University Hospital, Pusan National University School of Medicine)
  • Received : 2020.03.03
  • Accepted : 2020.05.26
  • Published : 2021.02.01
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Abstract

Objective: To determine whether changes in the transiting nerve rootlet or its surroundings, as seen on MRI performed after lumbar hemilaminectomy, are associated with persistent postoperative pain (PPP), commonly known as the failed back surgery syndrome. Materials and Methods: Seventy-three patients (mean age, 61 years; 43 males and 30 females) who underwent single-level partial hemilaminectomy of the lumbar spine without postoperative complications or other level spinal abnormalities between January 2010 and December 2018 were enrolled. Two musculoskeletal radiologists evaluated transiting nerve rootlet abnormalities (thickening, signal alteration, distinction, and displacement), epidural fibrosis, and intrathecal arachnoiditis on MRI obtained one year after the operations. A spine surgeon blinded to the radiologic findings evaluated each patient for PPP. Univariable and multivariable analyses were used to evaluate the association between the MRI findings and PPP. Results: The presence of transiting nerve rootlet thickening, signal alteration, and ill-distinction was significantly different between the patients with PPP and those without, for both readers (p ≤ 0.020). Conversely, the presence of transiting nerve rootlet displacement, epidural fibrosis, and intrathecal arachnoiditis was not significantly different between the two groups (p ≥ 0.128). Among the above radiologic findings, transiting nerve rootlet thickening and signal alteration were the most significant findings in the multivariable analyses (p ≤ 0.009). Conclusion: On MRI, PPP was associated with transiting nerve rootlet abnormalities, including thickening, signal alterations, and ill-distinction, but was not associated with epidural fibrosis or intrathecal arachnoiditis. The most relevant findings were the nerve rootlet thickening and signal alteration.

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References

  1. Chan C, Peng P. Failed back surgery syndrome. Pain Med 2011;12:577-606
  2. Shamim MS, Parekh MA, Bari ME, Enam SA, Khursheed F. Microdiscectomy for lumbosacral disc herniation and frequency of failed disc surgery. World Neurosurg 2010;74:611-616
  3. Rajaee SS, Bae HW, Kanim LE, Delamarter RB. Spinal fusion in the United States: analysis of trends from 1998 to 2008. Spine (Phila Pa 1976) 2012;37:67-76
  4. Martin BI, Mirza SK, Spina N, Spiker WR, Lawrence B, Brodke DS. Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015. Spine (Phila Pa 1976) 2019;44:369-376
  5. Sebaaly A, Lahoud MJ, Rizkallah M, Kreichati G, Kharrat K. Etiology, evaluation, and treatment of failed back surgery syndrome. Asian Spine J 2018;12:574-585
  6. Lee YS, Choi ES, Song CJ. Symptomatic nerve root changes on contrast-enhanced MR imaging after surgery for lumbar disk herniation. AJNR Amn J Neuroradiol 2009;30:1062-1067
  7. Patel ND, Broderick DF, Burns J, Deshmukh TK, Fries IB, Harvey HB, et al. ACR appropriateness criteria low back pain. J Am Col Radiol 2016;13:1069-1078
  8. Coskun E, Suzer T, Topuz O, Zencir M, Pakdemirli E, Tahta K. Relationships between epidural fibrosis, pain, disability, and psychological factors after lumbar disc surgery. Eur Spine J 2000;9:218-223
  9. Maroon J, Abla A, Bost J. Association between peridural scar and persistent low back pain after lumbar discectomy. Neurol Res 1999;21:S43-S46
  10. Ross JS, Robertson JT, Frederickson RC, Petrie JL, Obuchowski N, Modic MT, et al. Association between peridural scar and recurrent radicular pain after lumbar discectomy: magnetic resonance evaluation. Neurosurgery 1996;38:855-863
  11. Annertz M, Jonsson B, Stromqvist B, Holtas S. 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. Spine (Phila Pa 1976) 1995;20:449-453
  12. Marques JP, Simonis FF, Webb AG. Low-field MRI: an MR physics perspective. J Magn Reson Imaging 2019;49:1528-1542
  13. Mohi Eldin MM, Abdel Razek NM. Epidural fibrosis after lumbar disc surgery: prevention and outcome evaluation. Asian Spine J 2015;9:370-385
  14. Weber C, Kvistad KA, Moholdt VA, Nygaard OP, Solheim O. Repeated 3.0 tesla magnetic resonance imaging after clinically successful lumbar disc surgery. Spine (Phila Pa 1976) 2016;41:239-245
  15. Grane P, Tullberg T, Rydberg J, Lindgren L. Postoperative lumbar MR imaging with contrast enhancement: comparison between symptomatic and asymptomatic patients. Acta Radiol 1996;37:366-372
  16. Delamarter RB, Ross JS, Masaryk TJ, Modic MT, Bohlman HH. Diagnosis of lumbar arachnoiditis by magnetic resonance imaging. Spine (Phila Pa 1976) 1990;15:304-310
  17. Ross JS, Masaryk TJ, Modic MT, Delamater R, Bohlman H, Wilbur G, et al. MR imaging of lumbar arachnoiditis. AJR Am J Roentgenol 1987;149:1025-1032
  18. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159-174
  19. Herrera Herrera I, Moreno de la Presa R, Gonzalez Gutierrez R, Barcena Ruiz E, Garcia Benassi JM. Evaluation of the postoperative lumbar spine. Radiologia 2013;55:12-23
  20. Robertson JT. Role of peridural fibrosis in the failed back: a review. Eur Spine J 1996;5:S2-S6
  21. Anderson TL, Morris JM, Wald JT, Kotsenas AL. Imaging appearance of advanced chronic adhesive arachnoiditis: a retrospective review. AJR Am J Roentgenol 2017;209:648-655
  22. Van Goethem J, Parizel P, Jinkins J. Review article: MRI of the postoperative lumbar spine. Neuroradiology 2002;44:723-739
  23. Dessouky R, Khaleel M, Khalifa DN, Tantawy HI, Chhabra A. Magnetic resonance neurography of the lumbosacral plexus in failed back surgery syndrome. Spine (Phila Pa 1976) 2018;43:839-847