Failed Back Surgery Syndrome: Magnetic Resonance Imaging Assessment

Abstract

Background data: Failed back surgery syndrome (FBSS) refers to pain and functional incapacitation of varying degrees following spinal surgery for low back pain. FBSS represent almost 10-40% of patients. MRI is the best diagnostic modality for detection of its causes, after full clinical assessment. Study Design: this is a prospective clinical case study Purpose: The aim of this study is to describe the various MRI findings seen in the postoperative spine of patient with failed back surgery syndrome. Patients and methods: this study carried out forty patients complaining of recurrent back-pain and/ or sciatica after back surgery. All patients were referred from orthopedic department to radiology department of Zagazig University hospitals for MRI examination, after full clinical assessment. Patients were evaluated clinically and examined by magnetic resonance imaging. This study was conducted through July 2012 to March 2014. Patients were 28 males & 12 females with a mean age of 41.6 (20-78 years) age. All patients were managed according to their clinical picture and MRI findings. Results: Eighteen patients (45%) showed recurrent disc prolapse; 10 (25%) patients postoperative epidural fibrosis; 6 (15%) both recurrent disc prolapse and epidural scarring; two (5%) patients arachnoiditis, two (5%) patient discitis, one (2.5%) patient postoperative pseudomeningocele formation & one (2.5%) patient postoperative epidural hematoma collection. Gadolinium-diethylenetriaminepenta- acetic acid (Gd-DTPA)-enhanced MRI was particularly helpful in differentiating recurrent disc prolapse and epidural fibrosis. Conclusion: MRI correctly predict recurrent disc prolapse, epidural fibrosis,arachnoiditis, spinal stenosis and other causes of failed back surgery syndrome, illustrating the value of this modality in the evaluation of FBSS. (2014ESJ068)

Keywords

• epidural fibrosis
• recurrent disc prolapse
• arachnoiditis
• MRI
• spinal stenosis