June 1, 2014

Enhanced Intervertebral Disc in Post-discectomy Patients

Sagittal, fat-suppressed T1W MR images of the spine without (above) and with (below) IV contrast show two band enhancement of L4/5 disc (arrows), which parallel to the endplates of an asymptomatic post remote-discectomy patient. 
 Facts: Imaging of Postoperative Lumbar Discectomy

  • Intervertebral disc enhancement, annular enhancement and vertebral body enhancement are generally suggestive signs of disc space infection in post-discectomy patients
  • However, some patients without clinical signs/symptoms of infection may have abnormal enhancement of disc/endplate and annulus. 
  • In a study of 94 patients without clinical infection, post-operative MRI (3-6 months after surgery) shows anular enhancement in almost all cases and 20% of patients have disc enhancement that are not present on preoperative MRI
  • Suggestive pattern of "incidental" enhancement: linear enhancement within the disc (two thin bands paralleling the end plates). Authors postulate that this could be due to accelerated degenerative disc change, unrelated to infection
Ross JS, Zepp R, Modic MT. The postoperative lumbar spine: enhanced MR evaluation of the intervertebral disk. AJNR Am J Neuroradiol 1996;17:323-331.

1 comment:

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