DEFINING THE USE OF GADOLINIUM-ENHANCED MRI IN THE ASSESSMENT OF THE POSTOPERATIVE LUMBAR SPINE

A retrospective study of case notes and magnetic resonance imaging (MR I) examinations was performed to assess the value of gadolinium enhanc ed MRI in the investigation of persistent back pain following lumbar s pine surgery in patients who have not had a discectomy for disc hernia tion, Gadolinium enhancement is commonly used during MRI of patients w ith persistent back pain following surgery and epidural scar is freque ntly identified in patients who have had a previous discectomy. Howeve r the value of gadolinium enhancement in patients without previous dis cectomy had not been addressed, One hundred sets of case notes were ex amined and 24 patients with an accurate history of previous lumbar spi ne surgery without discectomy mere identified, The nature of surgery a nd the MRI findings were correlated in these patients, Epidural enhanc ement was identified at seven sites in six patients (engorged epidural venous plexus, three; enhancement adjacent to degenerate discs, two; enhancement adjacent to facets, two), In no case was epidural scarring involving nerve roots identified, We conclude that routine gadolinium enhancement is unnecessary in patients without a history of discectom y for disc herniation.