Failed Back Syndrome: Evaluation with MRI

Abstract

Introduction: One of a major late post operative complication of discectomy is persistent pain and radiculopathy also termed as failed back syndrome. The study aims to evaluate the MRI findings of failed back syndrome.

Methods: A retrospective hospital record based study among 53 patients was carried out at multimodality- imaging center associated with a tertiary care neurological center in Kathmandu, Nepal. MRI of patients performed for persistent pain after discectomy were selected for duration of 3 years and reviewed. All MRIs were performed with and without contrast enhancement. Three radiologists reported the MRIs with mutual consensus in disputed issues. All data were entered in SPSS spreadsheet and analysis was done using SPSS version 19.

Results: The mean age of the patients was 45.9± 16.1 years. Out of the total 53 cases, the operative site was at cervical spine in 35.8% cases, in lumbar spine in 64.2% cases and none in dorsal spine. Predominant epidural fibrosis without any other cause attributed to radiculopathy in 93.5% patients. Recurrent Disc herniation was noted in 6.5% patients whereas spondylodiscitis was seem in only one (1.9%) patient at C6-C7 level. The most common level operated in lumbar spine was L5-S1 (28.3%) followed by L4-L5 (24.5%) and in cervical spine was C4-C5 and C5-C6 contributing 17% each.

Conclusion: The study concluded that the common causes of failed back syndrome were epidural fibrosis, recurrent disc herniation and rarely spondylodiscitis.