Routine Postoperative Imaging Early After Lumbar Decompression Surgery – A Prospective Evaluation.
Spine (Phila Pa 1976). 2013 Jun 17;
Authors: Schubert G, Diepers M, Hegewald A, Seiz M, Thomé C
Study Design. prospective cohort studyObjective. to determine the value of routine postoperative MR imaging early after lumbar decompression in patients with non-specific symptoms.Summary of background data. Imaging after lumbar surgery may be performed more readily even with non-specific symptoms and without neurological deficit.Methods. Patients undergoing elective lumbar decompression surgery completed standardized questionnaires, were assessed neurologically on admission, and underwent MRI scanning within 72h after surgery. Residual stenosis was graded as absent or mild (outcome A) or moderate to severe (outcome B). Surgical technique and intraoperative complications and postoperative neurological status were recorded.Results. We recruited 28 consecutive patients who reported significant improvement of preoperative symptoms. In 2/3 of all patients, postoperative imaging showed at least one segment with moderate or severe residual stenosis (B). Radiological outcome did not correlate with postoperative pain. Patient satisfaction index was comparable in group A and B. The cross section of the spinal canal was significantly wider with a drain in situ. 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 postoperative MR imaging in patients with non-specific symptoms frequently shows radiologically relevant stenosis, which is neither associated with outcome nor patient satisfaction. Drain placement is associated with less radiological narrowing, but with lower patient satisfaction. Imaging without clinical correlate may yield non-discriminatory information likely to unsettle and puzzle both patient and health care provider.
PMID: 23778369 [PubMed – as supplied by publisher]