GADOLINIUM ENHANCEMENT OF VERTEBRAL END-PLATES FOLLOWING LUMBAR DISC SURGERY

Gadolinium enhancement may be normal in the vertebral endplates adjace nt to previously operated inter-vertebral discs. To determine the freq uency of this finding and to differentiate this normal healing process from early lesions due to focal infection, we studied 135 patients wh o had undergone surgery for herniated lumbar disc, and compared them w ith 249 unoperated patients with radicular symptoms and 15 with known spondylodiscitis. Hypo-intense foci which enhanced with gadolinium wer e identified in the endplates of 25 (18.5%) of the operated patients, 9 of whom required a second operation for recurrent disc herniation, a t which time the absence of infection was confirmed. Gadolinium enhanc ement within the end-plates adjacent to the operated disc occurs durin g normal healing after surgery. Care should be taken before invoking a diagnosis of focal infection or secondary spondylodiscitis.