ASSOCIATION BETWEEN PERIDURAL SCAR AND RECURRENT RADICULAR PAIN AFTERLUMBAR DISKECTOMY - MAGNETIC-RESONANCE EVALUATION

THE PURPOSE OF this study was to investigate the presence of any corre lation between recurrent radicular pain during the first six months fo llowing first surgery for herniated lumbar intervertebral disc and the amount of lumbar peridural fibrosis as defined by MR imaging. 197 pat ients who underwent first-time single-level unilateral discectomy for lumbar disc herniation were evaluated in a randomized, double-blind, c ontrolled multicenter clinical trial. Clinical assessments, performed by physicians blinded to patient treatment status, were conducted preo peratively and at one and six months postoperatively. The enhanced MR images of the operative site utilized in the analysis were obtained at six months postoperatively. Radicular pain was recorded by the patien t using a validated visual analog pain scale in which 0 = no pain and 10 = excruciating pain. The data obtained at the 6 month time point we re analyzed for an association between amount of peridural scar as mea sured by MR imaging and clinical failure as defined by the recurrence of radicular pain. The results showed that the probability of recurren t pain increases when scar score increases. Patients having extensive peridural scar were 3.2 times more likely to experience recurrent radi cular pain than those patients with less extensive peridural scarring. In conclusion, this prospective, controlled, randomized, blinded, mul ticenter study has demonstrated that there is a significant associatio n between the presence of extensive peridural scar and the occurrence of recurrent radicular pain.