Friday, November 13, 2009

FAILED BACK SURGERY SYNDROME



Our patient is a post operative status for lumbar disc disease and has pain in the left leg. Plain study was done and revealed likely L4/5 disc protrusion and L5/S1 central/right paracentral bulge, which could not explain the left sided persistent pain. Post gadolinium study was advised by our radiologists. On post gadolinium scans in addition to the residual/recurrent disc pathology, focal enhancing soft tissue was noted in the left lateral recess at L5/S1 level with impingement of the left sided traversing root (S1) and exiting nerve root (L5) at this level. This likely suggests scar tissue. As residual disc doesn’t enhance and epidural scar tissue enhances. Although, recurrent disc prolapse and epidural scar are not mutually exclusive diagnosis, they may be seen together as in our case but they need to be identified independently as the former may improve after re-exploration.

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