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Transiting Nerve Rootlet Abnormalities on MRI after Lumbar Laminectomy: Associations with Persistent Postoperative Pain

Korean Journal of Radiology 2021년 22권 2호 p.225 ~ 232
박찬규, 이인숙, 남경협, 송유선, 이태홍, 한인호, 김동환,
소속 상세정보
박찬규 ( Park Chan-Kue ) - Pusan National University Yangsan Hospital Department of Radiology
이인숙 ( Lee In-Sook ) - Pusan National University School of Medicine Pusan National University Hospital Department of Radiology
남경협 ( Nam Kyoung-Hyup ) - Pusan National University School of Medicine Pusan National University Hospital Department of Neurosurgery
송유선 ( Song You-Seon ) - Pusan National University School of Medicine Pusan National University Hospital Department of Radiology
이태홍 ( Lee Tae-Hong ) - Pusan National University School of Medicine Pusan National University Hospital Department of Radiology
한인호 ( Han In-Ho ) - Pusan National University School of Medicine Pusan National University Hospital Department of Neurosurgery
김동환 ( Kim Dong-Hwan ) - Pusan National University School of Medicine Pusan National University Hospital Department of Neurosurgery

Abstract


Objective: To determine whether changes in the transiting nerve rootlet or its surroundings, as seen on MRI performed after lumbar hemilaminectomy, are associated with persistent postoperative pain (PPP), commonly known as the failed back surgery syndrome.

Materials and Methods: Seventy-three patients (mean age, 61 years; 43 males and 30 females) who underwent single-level partial hemilaminectomy of the lumbar spine without postoperative complications or other level spinal abnormalities between January 2010 and December 2018 were enrolled. Two musculoskeletal radiologists evaluated transiting nerve rootlet abnormalities (thickening, signal alteration, distinction, and displacement), epidural fibrosis, and intrathecal arachnoiditis on MRI obtained one year after the operations. A spine surgeon blinded to the radiologic findings evaluated each patient for PPP. Univariable and multivariable analyses were used to evaluate the association between the MRI findings and PPP.

Results: The presence of transiting nerve rootlet thickening, signal alteration, and ill-distinction was significantly different between the patients with PPP and those without, for both readers (p ≤ 0.020). Conversely, the presence of transiting nerve rootlet displacement, epidural fibrosis, and intrathecal arachnoiditis was not significantly different between the two groups (p ≥ 0.128). Among the above radiologic findings, transiting nerve rootlet thickening and signal alteration were the most significant findings in the multivariable analyses (p ≤ 0.009).

Conclusion: On MRI, PPP was associated with transiting nerve rootlet abnormalities, including thickening, signal alterations, and ill-distinction, but was not associated with epidural fibrosis or intrathecal arachnoiditis. The most relevant findings were the nerve rootlet thickening and signal alteration.

키워드

Persistent postoperative pain; Failed back surgery; Laminectomy; Spinal nerve roots; Epidural fibrosis

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