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Subchondral Marrow Changes After Laser Diskectomy in the Lumbar Spine

MR Imaging Findings and Clinical Correlation

Oliver A. Cvitanic1, Jeffrey Schimandle2, G. David Casper3 and Phillip F. J. Tirman4

1 Southwest Oklahoma MRI, 9901 S. Pennsylvania, Oklahoma City, OK 73159
2 Oklahoma Sports Science and Orthopedics, 2149 S.W. 59th St., Ste. 201, Oklahoma City, OK 73119.
3 Oklahoma Orthopedic Institue, 1016 S.W. 44th St., Ste. 500, Oklahoma City, OK 73109.
4 San Francisco Magnetic Resonance Center, 3333 California St., Ste. 105, San Francisco, CA 94118.



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  		Fig. 1A. —Configurations of subchondral bone marrow changes shown on drawings of midline postoperative sagittal MR images of lumbar spine. Flame-shaped subchondral marrow change on one side of treated disk. Configuration is moderately to highly suggestive of laser injury.

 


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  		Fig. 1B. —Configurations of subchondral bone marrow changes shown on drawings of midline postoperative sagittal MR images of lumbar spine. Elliptic subchondral marrow change on both sides of treated disk. Configuration is highly suggestive of laser injury.

 


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  		Fig. 1C. —Configurations of subchondral bone marrow changes shown on drawings of midline postoperative sagittal MR images of lumbar spine. Bandlike subchondral marrow change on both sides of the treated disk. Configuration is not suggestive of laser injury.

 


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  		Fig. 2A. —45-year-old man with flame-shaped subchondral marrow abnormalities who underwent laser diskectomy. Sagittal T1-weighted postoperative MR image (TR/TE, 700/10) reveals early circumferential bulging and healthy subchondral bone marrow at L3-L4 and L4-L5.

 


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  		Fig. 2B. —45-year-old man with flame-shaped subchondral marrow abnormalities who underwent laser diskectomy. Sagittal T1-weighted MR image (800/10) obtained 2 months after laser diskectomy reveals flame-shaped abnormalities (arrows) of subchondral marrow involving L4 and L5.

 


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  		Fig. 2C. —45-year-old man with flame-shaped subchondral marrow abnormalities who underwent laser diskectomy. Sagittal T1-weighted MR image (600/10) obtained 67 months after laser diskectomy reveals nearly complete resolution of subchondral marrow abnormalities (arrows).

 


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  		Fig. 3A. —42-year-old man with flame-shaped subchondral marrow abnormality. Sagittal T1-weighted MR image (TR/TE, 800/10) obtained 6 weeks after laser diskectomy reveals flame-shaped lesion in anterior aspect of L4.

 


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  		Fig. 3B. —42-year-old man with flame-shaped subchondral marrow abnormality. Sagittal T1-weighted MR image (600/10) obtained 72 months after laser diskectomy reveals shrinkage of subchondral marrow abnormality (arrow).

 


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  		Fig. 4A. —38-year-old woman with elliptical subchondral marrow abnormalities 5 weeks after laser diskectomy. Sagittal T1-weighted MR image (TR/TE, 800/10) reveals isointense abnormalities in subchondral bone marrow on both sides of L4-L5 disk (arrows).

 


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  		Fig. 4B. —38-year-old woman with elliptical subchondral marrow abnormalities 5 weeks after laser diskectomy. Sagittal T2-weighted MR image (4000/80) reveals intraosseous edema (arrows) but no intradiskal edema, facilitating differentiation between abnormal subchondral bone marrow and disk.

 


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  		Fig. 5A. —52-year-old man with elliptic subchondral marrow abnormalities after laser diskectomy. Sagittal T1-weighted MR image (TR/TE, 800/10) obtained 5 weeks after laser diskectomy reveals symmetric elliptic areas of hypointensity in subchondral bone at L3-L4 and L5-S1.

 


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  		Fig. 5B. —52-year-old man with elliptic subchondral marrow abnormalities after laser diskectomy. Sagittal T1-weighted MR image (800/10) after IV gadolinium administration reveals enhancement of hypointense subchondral marrow abnormalities (arrows) at both levels.

 


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  		Fig. 5C. —52-year-old man with elliptic subchondral marrow abnormalities after laser diskectomy. Sagittal T1-weighted MR image (600/10) obtained 68 months after laser diskectomy reveals healed myeloid-depleted subchondral bone marrow.

 

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