Article
Routine postoperative imaging early after lumbar decompression surgery – A prospective evaluation
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Authors
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Gerrit Alexander Schubert
- Neurochirurgische Klinik, RWTH Universität Aachen, Deutschland; Neurochirurgische Klinik, Universitätsmedizin Mannheim, Universität Heidelberg, Deutschland; Neurochirurgische Klinik, Medizinische Universität Innsbruck, Innsbruck, Österreich
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Michael Diepers
- Neuroradiologische Klinik, Kantonsspital Aarau, Aarau, Schweiz
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Aldemar Andres Hegewald
- Neurochirurgische Klinik, Universitätsmedizin Mannheim, Universität Heidelberg, Deutschland; Neurochirurgische Klinik, Medizinische Universität Innsbruck, Innsbruck, Österreich
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Marcel Seiz
- Neurochirurgische Klinik, Universitätsmedizin Mannheim, Universität Heidelberg, Deutschland; Neurochirurgische Klinik, Medizinische Universität Innsbruck, Innsbruck, Österreich
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Peter Schmiedek
- Neurochirurgische Klinik, Universitätsmedizin Mannheim, Universität Heidelberg, Deutschland
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Claudius Thomé
- Neurochirurgische Klinik, Medizinische Universität Innsbruck, Innsbruck, Österreich
| Published: | May 21, 2013 |
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Outline
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Objective: With increasing availability of MRI scanning, postoperative imaging after lumbar surgery may be performed more readily even with non-specific symptoms without neurological deficit. Extensive postoperative changes on MRI scans are frequently observed, but the clinical significance and the impact on the surgical decision making process are unclear. This study was designed to determine the value of routine postoperative MR imaging early after decompressive lumbar surgery.
Method: We prospectively enrolled patients undergoing interlaminar fenestration surgery for lumbar spinal stenosis. All patients completed standardized questionnaires, were assessed neurologically on admission, and underwent MRI scanning within 72h (radiological outcome A: moderate to severe stenosis; outcome B: no or mild stenosis). At the same time, a repeat clinical exam was performed, and surgical technique and intraoperative complications were recorded.
Results: We recruited 28 consecutive patients undergoing elective bilateral interlaminar fenestration of 50 lumbar segments. Significant improvement of preoperative symptoms was seen even early after surgery, no patient had to undergo revision surgery. However, in 2/3 of all patients, at least one segment was judged to be moderately to severely compressed according to radiological criteria. Radiological outcome did not correlate with postoperative leg or back pain. Patient satisfaction index was comparable in both groups. Intraoperative placement of hemostatic material was not associated with an increase in radiological evidence of compression. If a drain was placed intraoperatively, the cross sectional diameter of the spinal canal was significantly wider. This did not, however, translate into a difference in overall VAS or wound discomfort. Patients tended to report more back and leg pain with drains and were less satisfied with the result of the operation.
Conclusions: Early routine MR imaging after lumbar decompression surgery frequently shows radiologically relevant stenosis, which does not influence outcome. Drain placement is associated with less radiological narrowing, but also with lower patient satisfaction. Early postoperative imaging without clinical correlate may yield only non-specific and non-discriminatory information.
