DIAGNOSTIC DILEMMAS IN POST-SURGICAL SCIATICA: A RADIOLOGICAL PERSPECTIVE

Introduction: Sciatica affects 12–43% of individuals, imposing an economic burden exceeding $50 billion annually in the United States. Lumbar discectomy, performed in ~10% of cases, offers symptom relief but yields variable outcomes and a 10–40% risk of persistent or recurrent pain, often classified as "failed back surgery syndrome" (FBSS). Postoperative imaging is crucial for assessing complications, with MRI, especially gadolinium-enhanced, being the gold standard for differentiating normal healing from pathology. This Objectives: study evaluates nerve root changes, disc space alterations, and epidural fibrosis in recurrent sciatica cases post-surgery, while also reviewing typical MRI appearances of healing and complications. This retrospective study analyzed medical records and imaging of 139 pati Methods And Patients: ents who underwent first-time lumbar disc surgery at King Hussein Medical Center (2021–2023). Inclusion criteria included persistent radicular pain (VAS 4–10) lasting >6 weeks postoperatively despite conservative management. MRI evaluations assessed recurrent disc herniation (RDH), epidural fibrosis (PEF), nerve root enhancement (NRE), and nerve root thickening (NRT). Imaging included pre- and post-contrast sequences on 3T scanners. Clinical and radiological findings were correlated to assess associations with symptoms. Statistical analysis included t-tests and interobserver agreement (ICC). Findings highlight the role of MRI in identifying postoperative complications and their clinical implications. The study Results: analyzed 139 patients (78 males, 61 females; median age: 48.62 ± 7.1 years) undergoing lumbar disc surgery across 196 levels. No significant differences were observed between sexes in age, BMI, VAS scores, follow-up duration, or smoking history. The mean symptom duration was 4.6 ± 2.82 months, with a 9.32 ± 3.12-month follow-up period. Postoperative MRI demonstrated excellent interobserver reliability (ICC ≥0.81). VAS scores for leg pain improved significantly from preoperative levels (males: 7.21 ± 2.31 to 0.95 ± 1.09; females: 6.48 ± 2.78 to 1.36 ± 1.25). Complications included disc recurrence (16.3%), epidural fibrosis (38.8%), pathological nerve root enhancement (20.8%), and nerve root thickening (58.4%), with no significant sex-based differences. The results underscore MRI's role in monitoring postoperative outcomes and complications. Postoperative nerve root alterations, including thickening, enhancement, and epidural Conclusion: fibrosis, combined with recurrent sciatica or disc herniation, may indicate the need for further surgical intervention, particularly in cases of failed back surgery syndrome (FBSS). Despite limitations in sample size and long-term follow-up, this study highlights the critical role of contrast-enhanced MRI as the gold standard for assessing postoperative lumbar spine changes, enabling accurate evaluation of normal healing and complications.