Differentiation between postoperative scar and recurrent disk herniation: prospective comparison

Twenty-five symptomatic postlumbar surgery patients had findings on lumbar spinal noncontrast CT that were equivocal for distinguishing recurrent disk herniation from postoperative epidural fibrosis (scar). Contrast-enhanced CT and lumbar MR imaging were performed to differentiate these two conditions. Of the 14 levels, surgically explored, the diagnosis of scar or recurrent disk herniation was correct with contrast-enhanced CT at 10 levels and with MR imaging at 11 levels. At the levels operated on less than 2 years prior to MR imaging, scar more frequently demonstrated intermediate than low signal intensity. Scar older than 2 years most often showed low signal intensity. These preliminary findings suggest that MR may be useful in differentiating post-operative fibrosis from recurrent disk herniation in a significant proportion of patients whose unenhanced CT scans are equivocal. The diagnostic evaluation of patients presenting with failed back surgery syn-drome is a challenge to both radiologists and surgeons. Although the cause of this syndrome is complex and often multifactorial, recurrent disk herniation and post