Artikel
Early recurrence after operations for lumbar disc and spinal canal stenosis, follow-up and assessment of postoperative diagnostic image
Das Frührezidiv nach Operationen an lumbalen Bandscheiben und Spinalkanalstenose, Verlaufsbeobachtung und Beurteilung bildgebender Diagnostik
Suche in Medline nach
Autoren
Veröffentlicht: | 23. April 2004 |
---|
Gliederung
Text
Objective
To evaluate the postoperatively performed diagnostics imaging with the clinical finding in accordance with the intra-operative findings.
Methods
Between 1997-2002, 3300 lumbar spine operations were performed in our department. 91 Patients had to be re-operated within 14 days after the first operation. The decision for the second operation was made according to the clinical findings and postoperative diagnostic imaging. The CT scan was the most common investigation (88%), followed by MRI of the lumbar spine (36%), Myelogram with myelo-CT was necessary in (22%) of the patients.
Results
In 53% patients residual free sequestered disc parts were found, of which in 11% an extra-foraminal sequester was found. However, in 17% of the cases no convincing finding was seen. In 6% postoperative epidural haematoma was diagnosed. The CT scan was accurate in only in 48-65% of the cases. The MRI has an accuracy of 86-100%, with or without CT. in follow-up, 71% of the patients were pain free. There was no correlation between the intra-operative finding and the success of the second operation.
Conclusions
The decision to re-operate in the direct postoperative phase depends mainly on clinical finding and secondly diagnostic imaging. An early revision is simple to perform with no scar tissue and can improve the prognosis of the disease in relation to freedom from pain. CT scan is fast, economical and accurate in about 1/3 of the cases. However, the MRI is more accurate in nearly all cases.