Recurrent pain after lumbar discectomy: the diagnostic value of peridural scar on MRI

The association between peridural scarring and recurrent pain after lumbar discectomy is much debated. A recently published study found that patients with extensive peridural fibrosis were 3.2 times more likely to experience recurrent radicular pain than those with less extensive scarring. This finding may lead to an overestimation of peridural fibrosis in clinical practice. In a retrospective study we analyzed the records of 53 patients who underwent a lumbar MRI because of recurrent pain after first unilateral microdiscectomy. Patients were classified as those with radicular or non-radicular pain according to history and clinical findings. The diagnosis was confirmed by spinal anesthetic block. The extension of scarring was compared between the two groups of patients. The amount of epidural fibrosis was examined on contrast-enhanced MRI in axial slices subdivided into four quadrants. The amount of fibrosis was divided into four stages in each affected quadrant. We found no differences regarding the amount of peridural fibrosis between patients with radicular pain and patients with non-radicular pain. We conclude that the extent of peridural scarring as defined by MRI is of minor value in the differential diagnosis of recurrent back and leg pain after lumbar microdiscectomy.