Lumbar spine following successful surgical discectomy : magnetic resonance imaging features and implications

In an attempt to determine the expected long-term appearance of the lumbar spine in patients who have undergone successful lumbar discectomy, follow-up magnetic resonance (MR) examinations were performed on 23 patients (26 levels). All patients in the study had undergone at surgery at least one year prior to the study. All patients met rigorous criteria for a successful outcome. In nine cases, the postoperative study indicated a virtually total resolution of the previously identified disc herniations. In 13 cases, the study noted moderate, persistent posterior contour defects in the disc that contributed to persistent mass effect on the thecal sac or corresponding nerve root. In the remaining four cases, the postoperative study indicated virtually no change in the apparent contour of the posterior disc margin. Gadolinium contrast examinations demonstrated enhancement of the persistent contour abnormalities in 18 of 19 disc levels, suggesting the common presence of fibrosis, which was at times "mass-like," in these successful patients. These findings suggest that localized discal contour abnormalities morphologically simulating recurrent disc herniations and variably contributing to mass effect, may be commonly encountered in long-term follow-up imaging studies of successful discectomy patients.